Health education and psychosocial interventions prevent emotional distress, and the latter has be... more Health education and psychosocial interventions prevent emotional distress, and the latter has been shown to have an impact on survival. In turn, digital health education interventions may help promote equity by reaching a higher number of cancer patients, both because they avoid journeys to the hospital, by and having a better efficiency. A total of 234 women recently diagnosed with breast cancer in a comprehensive cancer center used the digital ecosystem ICOnnecta’t from March 2019 to March 2021. ICOnnecta’t consists of four care levels, provided to patients according to their level of distress. The second level of this intervention consists of an educational campus, which was analyzed to track users’ interests and their information-seeking behavior. Overall, 99 out of 234 women (42.3%) used the educational campus. There were no significant differences in sociodemographic and clinical variables between the campus users and non-users. Among users, the median number of resources uti...
Introduction: Kidney transplant donors lose 50% of their renal mass after nephrectomy. The remain... more Introduction: Kidney transplant donors lose 50% of their renal mass after nephrectomy. The remaining kidney compensates for this loss and it is estimated that 70% of the baseline renal function prior to donation is recovered. Factors associated with post-donation renal compensation are not well understood. Methods: Retrospective study of 66 consecutive kidney donors (mean age 48.8 years, 74.2% women). We analyzed the potential factors associated with the compensatory mechanisms of the remaining kidney by comparing donors according to their renal compensation rate (RCR) (Group A, infra-compensation [<70%]; Group B, normal compensation [>70%]). Results: We compared Group A (n = 38) and group B (n = 28). Predictors for RCR > 70% were higher baseline creatinine (A vs. B: 0.73 ± 0.14 vs. 0.82 ± 0.11; p = 0.03) and a lower baseline glomerular filtration rate (GFR), estimated both by MDRD-4 (A vs. B: 97.7 ± 18.8 vs. 78.6 ± 9.6 ml/min; p < 0.001) and CKD-EPI (A vs. B: 101.7 ± 15 vs. 88.3 ± 11.7 ml/min; p ≤ 0.001). Age, gender, smoking, hypertension and GFR measured by Tc-DTPA did not show any correlation with the RCR. The multivariate analysis confirmed baseline estimated glomerular filtration rate (eGFR) to be a predictor of compensation: the higher the baseline eGFR, the lower the likelihood of >70% compensation (MDRD-4, OR = 0.94 [95% CI 0.8-0.9], p = 0.01). The compensation rate decreased by 0.4% (p < 0.001) and 0.3% (p = 0.006) for every ml/min increase in baseline eGFR estimated by MDRD-4 and CKD-EPI, respectively. Conclusions: One year after living donor nephrectomy, the remaining kidney partially compensates baseline renal function. In our experience, baseline eGFR is inversely proportional to the one-year renal compensation rate.
BackgroundIn mental health, comorbidities are the norm rather than the exception. However, curren... more BackgroundIn mental health, comorbidities are the norm rather than the exception. However, current meta-analytic methods for summarizing the neural correlates of mental disorders do not consider comorbidities, reducing them to a source of noise and bias rather than benefitting from their valuable information.ObjectivesWe describe and validate a novel neuroimaging meta-analytic approach that focuses on comorbidities. In addition, we present the protocol for a meta-analysis of all major mental disorders and their comorbidities.MethodsThe novel approach consists of a modification of Seed-based d Mapping—with Permutation of Subject Images (SDM-PSI) in which the linear models have no intercept. As in previous SDM meta-analyses, the dependent variable is the brain anatomical difference between patients and controls in a voxel. However, there is no primary disorder, and the independent variables are the percentages of patients with each disorder and each pair of potentially comorbid disord...
Introduccio El trastorn depressiu major (TDM), caracteritzat per sentiments de tristesa i/o apati... more Introduccio El trastorn depressiu major (TDM), caracteritzat per sentiments de tristesa i/o apatia, malestar fisic i deficits cognitius, presenta un 50% de recaigudes i un 20% de cronificacio. Les teories etiologiques mes integradores postulen que les alteracions de materia gris i els deficits cognitius facilitarien la recurrencia/cronifiacio del episodi. No obstant, les arees afectades son inconsistents entre els estudis, complicant la millora dels tractaments. A mes, les estrategies terapeutiques per als pacients resistents als tractaments (DRT) son escasos, afetcant generalment la cognicio, i dificultant una complerta recuperacio. Aixi, es requereixen noves vies d'estudi centrades en la prevencio de la recurrencia/cronificacio dels pacients a traves de la deteccio de variables predictores individuals que optimitzin les opcions terapeutiques. Objectius E1: Investigar l'afectacio de materia gris cerebral en diferents estadis de la malaltia depressiva i determinar l'efec...
BACKGROUND Offspring of patients diagnosed with Bipolar Disorder and Schizophrenia (Off-BDSZ) hav... more BACKGROUND Offspring of patients diagnosed with Bipolar Disorder and Schizophrenia (Off-BDSZ) have a high genetic risk of developing a mental illness. The aim of this project is to develop and investigate the efficacy of an intervention aimed at this population, based on the concept of cognitive reserve. METHODS This is a multicenter randomized trial with an experimental test-retest design study with control group. Two groups will be included: a community comparison group (CC) and a Off-BDSZ group. A total of 108 Off-BDSZ and 65 CC aged between 6-25 years will be recruited. Off-BDSZ participants will be randomized to receive either Cognitive Reserve EnhAncement ThErapy (CREATE) (n=54), or a supportive approach (n=54). The CC group will be assessed at baseline. The duration of the intervention will be 3 months, with 12 weekly group sessions. The primary outcome will be the improvement in CR measured according to change in the Cognitive Reserve Assessment Scale in Health (CRASH) and Cognitive Reserve scale for Adolescents (CORE-A). All participants will be blindly evaluated using clinical, cognitive and neuroimaging measures at baseline, at three months (after the psychological intervention), and at twelve-month follow-up after treatment completion. DISCUSSION The results will provide insight into whether the CREATE-Offspring version may enhance cognitive reserve (CR) in child, adolescent and young adult Off-BDSZ as well as advance knowledge about changes in clinical manifestations, neuropsychological performance and brain structure and function associated with improving CR. This novel and cost-effective intervention represents an advance in the framework of preventive interventions in mental health. TRIAL REGISTRATION Clinicaltrials.gov, NCT03722082. Registered on 26 October 2018.
This is a PDF file of an article that has undergone enhancements after acceptance, such as the ad... more This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
BACKGROUND Impairment of social cognition is documented in bipolar disorder (BD) and schizophreni... more BACKGROUND Impairment of social cognition is documented in bipolar disorder (BD) and schizophrenia/schizoaffective disorder (SCH). In healthy individuals, women perform better than men in some of its sub-domains. However, in BD and SCH the results are mixed. Our aim was to compare emotion recognition, affective Theory of Mind (ToM) and first- and second-order cognitive ToM in BD, SCH and healthy subjects, and to investigate sex-related differences. METHODS 120 patients (BD = 60, SCH = 60) and 40 healthy subjects were recruited. Emotion recognition was assessed by the Pictures of Facial Affect (POFA) test, affective ToM by the Reading the Mind in the Eyes Test (RMET) and cognitive ToM by several false-belief stories. Group and sex differences were analyzed using parametric (POFA, RMET) and non-parametric (false-belief stories) tests. The impact of age, intelligence quotient (IQ) and clinical variables on patient performance was examined using a series of linear/logistic regressions. RESULTS Both groups of patients performed worse than healthy subjects on POFA, RMET and second-order false-belief (p < 0.001), but no differences were found between them. Instead, their deficits were related to older age and/or lower IQ (p < 0.01). Subthreshold depression was associated with a 6-fold increased risk of first-order false-belief failure (p < 0.001). Sex differences were only found in healthy subjects, with women outperforming men on POFA and RMET (p ≤ 0.012), but not on first/second-order false-belief. LIMITATIONS The cross-sectional design does not allow for causal inferences. CONCLUSION BD and SCH patients had deficits in emotion recognition, affective ToM, and second-order cognitive ToM, but their performance was comparable to each other, highlighting that the differences between them may be subtler than previously thought. First-order cognitive ToM remained intact, but subthreshold depression altered their normal functioning. Our results suggest that the advantage of healthy women in the emotional and affective aspects of social cognition would not be maintained in BD and SCH.
European Archives of Psychiatry and Clinical Neuroscience, 2021
Some evidence suggests that patients with bipolar disorder (BD) have better Theory of Mind (ToM) ... more Some evidence suggests that patients with bipolar disorder (BD) have better Theory of Mind (ToM) skills than patients with schizophrenia/schizoaffective disorder (SCH). However, this difference is not consistently reported across studies, so rather than being global, it may be restricted to specific aspects of ToM. Our primary objective was to compare higher order ToM performance between BD and SCH patients using the Hinting Task (HT). Ninety-four remitted patients were recruited (BD = 47, SCH = 47). Intelligence quotient (IQ), attention, memory, executive functions, and processing speed were also assessed. Patients with BD performed better on the HT than patients with SCH, even when the analysis was adjusted for IQ and neurocognition ( p < 0.001, $$\eta_{p}^{2}$$ η p 2 = 0.144). Regression analysis in the total sample showed that a diagnosis of SCH and lower IQ were associated with lower HT scores ( R 2 = 0.316, p < 0.001). In the BD group, verbal memory and processing speed were the main predictors of HT performance ( R 2 = 0.344, p < 0.001). In the SCH group, no variable was significant in explaining HT performance. In the context of previous studies that found no significant differences in the most basic aspects of ToM (e.g., understand other people's thoughts/beliefs), our results suggest that differences between the two disorders might be limited to the more challenging aspects (e.g., understand the intended meaning of indirect requests). No causal inferences can be made in this cross-sectional study. However, regression analyses show that whereas in BD patients, ToM functioning would be partially modulated by neurocognitive performance, in SCH patients, it could be largely independent of the well-known neurocognitive impairment.
Background. This study aimed to identify clinical and cognitive factors associated with increased... more Background. This study aimed to identify clinical and cognitive factors associated with increased risk for difficult-to-treat depression (DTD) or treatment-resistant depression (TRD). Methods. A total of 229 adult outpatients with major depression were recruited from the mental health unit at a public hospital. Participants were subdivided into resistant and nonresistant groups according to their Maudsley Staging Model score. Sociodemographic, clinical, and cognitive (objective and subjective measures) variables were compared between groups, and a logistic regression model was used to identify the factors most associated with TRD risk. Results. TRD group patients present higher verbal memory impairment than the nonresistant group irrespective of pharmacological treatment or depressive symptom severity. Logistic regression analysis showed that low verbal memory scores (odds ratio [OR]: 2.02; 95% confidence interval [CI]: 1.38–2.95) together with high depressive symptom severity (OR: ...
BackgroundHeterogeneity in cognitive functioning among major depressive disorder (MDD) patients c... more BackgroundHeterogeneity in cognitive functioning among major depressive disorder (MDD) patients could have been the reason for the small-to-moderate differences reported so far when it is compared to other psychiatric conditions or to healthy controls. Additionally, most of these studies did not take into account clinical and sociodemographic characteristics that could have played a relevant role in cognitive variability. This study aims to identify empirical clusters based on cognitive, clinical and sociodemographic variables in a sample of acute MDD patients.MethodsIn a sample of 174 patients with an acute depressive episode, a two-step clustering analysis was applied considering potentially relevant cognitive, clinical and sociodemographic variables as indicators for grouping.ResultsTreatment resistance was the most important factor for clustering, closely followed by cognitive performance. Three empirical subgroups were obtained: cluster 1 was characterized by a sample of non-re...
times higher odds of very high cardiovascular risk. Interestingly, the highest adjusted odds rati... more times higher odds of very high cardiovascular risk. Interestingly, the highest adjusted odds ratio 4.00 (95% CI 2.62-6.10, p < 0.001) had individuals living in Riga (capital of Latvia) compared to those living in rural area. Conclusions: We have found a statistically significant association between depression (PHQ-9 ≥ 10) and very high risk of cardiovascular mortality. It would be advisable to screen all individuals with SCORE ≥10% for depression to delay the development and improve the prognosis of CVD.
Background: Childhood maltreatment increases the risk of suicide attempts in the general populati... more Background: Childhood maltreatment increases the risk of suicide attempts in the general population, possibly having similar effects among patients with major depressive disorder (MDD). The few studies that have addressed this association have been restricted to specific populations (e.g. treatment-resistant depression, personality disorders) and have rarely taken sex into account. Objective: To examine the impact of childhood maltreatment on suicide attempts among MDD patients above and beyond other risk factors and potential confounders, while considering potential sex-specific effects. Methods: The study assessed 165 patients with a principal diagnosis of MDD. Neurological alterations, psychiatric comorbidities, and drug abuse were reasons for exclusion. Logistic regressions using the whole sample, and divided by sex, were run to test the association between childhood maltreatment and history of suicide attempts, controlling for symptom severity, comorbidities, and treatment-resistant depression. Results: There was a significant and clinically relevant association between childhood maltreatment and history of suicide attempts in the total sample. Patients with childhood maltreatment were 3.01 times more likely to present a history of suicide attempts than patients without childhood maltreatment. A family history of psychiatric disorders also contributed to the variance of attempted suicide, but its interaction with childhood maltreatment was not statistically significant. When testing the model separately, the effect of childhood maltreatment on suicide attempts remained for females, whereas for males, age of MDD onset and Childhood Trauma Questionnaire minimization-denial scale were predictive variables. Conclusions: Childhood maltreatment is a clear predictor of suicidal behaviour among MDD patients, and this effect remains significant after controlling for potential confounders. Also, the sex of patients emerges as a relevant factor that may model the mechanisms underlying the prediction of suicide attempts. Since suicide is the main cause of premature death among MDD patients, interventions targeting childhood maltreatment should be included in preventive and clinical strategies.
Background: Given the limitation of pharmacological treatments to treat cognitive symptoms in pat... more Background: Given the limitation of pharmacological treatments to treat cognitive symptoms in patients with Major Depressive Disorder (MDD), cognitive remediation programs has been proposed as a possible procognitive intervention but findings are not conclusive. This study investigates the efficacy of an INtegral Cognitive REMediation (INCREM) that includes a combination of a Functional Remediation (FR) strategy plus a Computerized Cognitive Training (CCT) in order to improve not only cognitive performance but also the psychosocial functioning and the quality of life. Methods: A single blind randomized controlled clinical trial in 81 patients with a diagnosis of MDD in clinical remission or in partial remission. Participants will be randomized to one of three conditions: INCREM (FR + CCT), Psychoeducation plus online games and Treatment As Usual (TAU). Intervention will consist in 12 group sessions, of approximately 110 min once a week. The primary outcome measure will be % of change in psychosocial functioning after treatment measured by the Functional Assessment Short Test (FAST); additionally, number of sick leaves and daily activities will also be recorded as pragmatic outcomes. Discussion: To our knowledge, this is the first randomized controlled clinical trial using a combination of two different approaches (FR + CCT) to treat the present cognitive deficits and to promote their improvements into a better psychosocial functioning. Trial registration: Clinical Trials NCT03624621. Date registered 10th of August 2018 and last updated 24th August 2018.
The training of healthcare staff (obstetricians, psychiatrists and nursing) in prevention and imp... more The training of healthcare staff (obstetricians, psychiatrists and nursing) in prevention and improvement of obesity and preeclampsia during pregnancy and psychoeducation about labour and the risks-benefits of C-section, in women diagnosed of BD, would probably decrease the rates of psycho-pathological worsening linked to fear of childbirth and the ongoing C-section and C-section on maternal request's rates, requiring the last one only in special cases where the vaginal labour is a clear contraindication (comorbidity with PTSD or risk of PTSD).
BD have demonstrated a relationship between deficits in executive function and increased suicidal... more BD have demonstrated a relationship between deficits in executive function and increased suicidality. This relationship has not yet been investigated in bipolar youth. The present study examined the association between a history of suicide attempts and executive functioning in youth with BD. Methods: Twenty depressed bipolar participants, ages 13 to 21, completed a diagnostic interview, mood, and executive function measures. All participants were given the WCST, Trail Making Test, Color-Word Interference Test to create an executive function composite score, and the Columbia Suicide Severity Rating Scale to assess lifetime symptoms of suicidal ideation and behavior. Results: All participants had a history of suicidal ideation and 15 participants had a history of attempts. Logistic regression was performed on suicidal behavior with executive functioning, age, and depression scores as predictors, X2 (3, 20) 5 12.88, p 5 .005. Executive function predicted the occurrence of suicide attempts in bipolar youth, X2 (1, 20) 5 3.90, p , .05. Specifically, better executive performance was associated with a history of suicide attempts. Conclusions: Bipolar adolescents with a history of suicide attempts demonstrated better performance on tests of executive function. These findings were surprising and differ from previous reports in suicidal adults. The relationship between executive function and suicide-risk in bipolar youth may be impacted by brain development during adolescence. Additional studies are needed to examine the interaction between neurodevelopmental changes in executive functioning and suicide-risk in bipolar youth.
Despite its high recurrence rate, major depression disorder (MDD) still lacks neurobiological mar... more Despite its high recurrence rate, major depression disorder (MDD) still lacks neurobiological markers to optimize treatment selection. The aim of this study was to examine the prognostic potential of clinical and structural magnetic resonance imaging (sMRI) in the long-term MDD clinical outcomes (COs). Forty-nine MDD patients were grouped into one of four different CO categories according to their trajectory: recovery, partial remission, remission recurrence, and chronic depression. Regression models including baseline demographic, clinical, and sMRI data were used for predicting patients' COs and symptom severity 5 years later. The model including only clinical data explained 32.4% of the variance in COs and 55% in HDRS, whereas the model combining clinical and sMRI data increased up to 52/68%, respectively. A bigger volume of right anterior cingulate gyrus was the variable that best predicted COs. The findings suggest that the addition of sMRI brain data to clinical informatio...
Positron emission tomography (PET) studies have shown that the antidepressant effect of chronic d... more Positron emission tomography (PET) studies have shown that the antidepressant effect of chronic deep brain stimulation (DBS) of the subcallosal cingulate gyrus (SCG) may be consequence of modifications of brain metabolism at key structures involved in depression. Like clinical benefits, these metabolic changes may reverse when the stimulation is discontinued, even preceding clinical worsening. However no data on immediate effects of DBS discontinuation are available. The aim of this study was to determine immediate cerebral metabolism changes during a short switch-off of electrical stimulation in implanted patients with treatment-resistant depression (TRD) who had achieved clinical improvement after a period of chronic DBS. Seven patients with TRD who had been previously implanted for DBS in SCG were included. After a period of clinical stabilization two consecutive FDG-PET were acquired, the first with active stimulation and the second after 48 h of inactive stimulation. A HAMD-17 to assess depressive symptoms was performed before both scans. Analyses were performed with SnPM8. Inactive stimulation was characterized by metabolism decreases in dorsal anterior cingulate (Broadmann Area, BA24), premotor region (BA6) and putamen with respect to active stimulation. No clinical changes according to HAMD-17 were detected. The main limitation of this study is the small sample size. Our results point to immediate effects of DBS discontinuation on metabolism of brain depressive network which precede clinical changes, helping to disentangle the rationale behind DBS efficacy in TRD.
Health education and psychosocial interventions prevent emotional distress, and the latter has be... more Health education and psychosocial interventions prevent emotional distress, and the latter has been shown to have an impact on survival. In turn, digital health education interventions may help promote equity by reaching a higher number of cancer patients, both because they avoid journeys to the hospital, by and having a better efficiency. A total of 234 women recently diagnosed with breast cancer in a comprehensive cancer center used the digital ecosystem ICOnnecta’t from March 2019 to March 2021. ICOnnecta’t consists of four care levels, provided to patients according to their level of distress. The second level of this intervention consists of an educational campus, which was analyzed to track users’ interests and their information-seeking behavior. Overall, 99 out of 234 women (42.3%) used the educational campus. There were no significant differences in sociodemographic and clinical variables between the campus users and non-users. Among users, the median number of resources uti...
Introduction: Kidney transplant donors lose 50% of their renal mass after nephrectomy. The remain... more Introduction: Kidney transplant donors lose 50% of their renal mass after nephrectomy. The remaining kidney compensates for this loss and it is estimated that 70% of the baseline renal function prior to donation is recovered. Factors associated with post-donation renal compensation are not well understood. Methods: Retrospective study of 66 consecutive kidney donors (mean age 48.8 years, 74.2% women). We analyzed the potential factors associated with the compensatory mechanisms of the remaining kidney by comparing donors according to their renal compensation rate (RCR) (Group A, infra-compensation [<70%]; Group B, normal compensation [>70%]). Results: We compared Group A (n = 38) and group B (n = 28). Predictors for RCR > 70% were higher baseline creatinine (A vs. B: 0.73 ± 0.14 vs. 0.82 ± 0.11; p = 0.03) and a lower baseline glomerular filtration rate (GFR), estimated both by MDRD-4 (A vs. B: 97.7 ± 18.8 vs. 78.6 ± 9.6 ml/min; p < 0.001) and CKD-EPI (A vs. B: 101.7 ± 15 vs. 88.3 ± 11.7 ml/min; p ≤ 0.001). Age, gender, smoking, hypertension and GFR measured by Tc-DTPA did not show any correlation with the RCR. The multivariate analysis confirmed baseline estimated glomerular filtration rate (eGFR) to be a predictor of compensation: the higher the baseline eGFR, the lower the likelihood of >70% compensation (MDRD-4, OR = 0.94 [95% CI 0.8-0.9], p = 0.01). The compensation rate decreased by 0.4% (p < 0.001) and 0.3% (p = 0.006) for every ml/min increase in baseline eGFR estimated by MDRD-4 and CKD-EPI, respectively. Conclusions: One year after living donor nephrectomy, the remaining kidney partially compensates baseline renal function. In our experience, baseline eGFR is inversely proportional to the one-year renal compensation rate.
BackgroundIn mental health, comorbidities are the norm rather than the exception. However, curren... more BackgroundIn mental health, comorbidities are the norm rather than the exception. However, current meta-analytic methods for summarizing the neural correlates of mental disorders do not consider comorbidities, reducing them to a source of noise and bias rather than benefitting from their valuable information.ObjectivesWe describe and validate a novel neuroimaging meta-analytic approach that focuses on comorbidities. In addition, we present the protocol for a meta-analysis of all major mental disorders and their comorbidities.MethodsThe novel approach consists of a modification of Seed-based d Mapping—with Permutation of Subject Images (SDM-PSI) in which the linear models have no intercept. As in previous SDM meta-analyses, the dependent variable is the brain anatomical difference between patients and controls in a voxel. However, there is no primary disorder, and the independent variables are the percentages of patients with each disorder and each pair of potentially comorbid disord...
Introduccio El trastorn depressiu major (TDM), caracteritzat per sentiments de tristesa i/o apati... more Introduccio El trastorn depressiu major (TDM), caracteritzat per sentiments de tristesa i/o apatia, malestar fisic i deficits cognitius, presenta un 50% de recaigudes i un 20% de cronificacio. Les teories etiologiques mes integradores postulen que les alteracions de materia gris i els deficits cognitius facilitarien la recurrencia/cronifiacio del episodi. No obstant, les arees afectades son inconsistents entre els estudis, complicant la millora dels tractaments. A mes, les estrategies terapeutiques per als pacients resistents als tractaments (DRT) son escasos, afetcant generalment la cognicio, i dificultant una complerta recuperacio. Aixi, es requereixen noves vies d'estudi centrades en la prevencio de la recurrencia/cronificacio dels pacients a traves de la deteccio de variables predictores individuals que optimitzin les opcions terapeutiques. Objectius E1: Investigar l'afectacio de materia gris cerebral en diferents estadis de la malaltia depressiva i determinar l'efec...
BACKGROUND Offspring of patients diagnosed with Bipolar Disorder and Schizophrenia (Off-BDSZ) hav... more BACKGROUND Offspring of patients diagnosed with Bipolar Disorder and Schizophrenia (Off-BDSZ) have a high genetic risk of developing a mental illness. The aim of this project is to develop and investigate the efficacy of an intervention aimed at this population, based on the concept of cognitive reserve. METHODS This is a multicenter randomized trial with an experimental test-retest design study with control group. Two groups will be included: a community comparison group (CC) and a Off-BDSZ group. A total of 108 Off-BDSZ and 65 CC aged between 6-25 years will be recruited. Off-BDSZ participants will be randomized to receive either Cognitive Reserve EnhAncement ThErapy (CREATE) (n=54), or a supportive approach (n=54). The CC group will be assessed at baseline. The duration of the intervention will be 3 months, with 12 weekly group sessions. The primary outcome will be the improvement in CR measured according to change in the Cognitive Reserve Assessment Scale in Health (CRASH) and Cognitive Reserve scale for Adolescents (CORE-A). All participants will be blindly evaluated using clinical, cognitive and neuroimaging measures at baseline, at three months (after the psychological intervention), and at twelve-month follow-up after treatment completion. DISCUSSION The results will provide insight into whether the CREATE-Offspring version may enhance cognitive reserve (CR) in child, adolescent and young adult Off-BDSZ as well as advance knowledge about changes in clinical manifestations, neuropsychological performance and brain structure and function associated with improving CR. This novel and cost-effective intervention represents an advance in the framework of preventive interventions in mental health. TRIAL REGISTRATION Clinicaltrials.gov, NCT03722082. Registered on 26 October 2018.
This is a PDF file of an article that has undergone enhancements after acceptance, such as the ad... more This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
BACKGROUND Impairment of social cognition is documented in bipolar disorder (BD) and schizophreni... more BACKGROUND Impairment of social cognition is documented in bipolar disorder (BD) and schizophrenia/schizoaffective disorder (SCH). In healthy individuals, women perform better than men in some of its sub-domains. However, in BD and SCH the results are mixed. Our aim was to compare emotion recognition, affective Theory of Mind (ToM) and first- and second-order cognitive ToM in BD, SCH and healthy subjects, and to investigate sex-related differences. METHODS 120 patients (BD = 60, SCH = 60) and 40 healthy subjects were recruited. Emotion recognition was assessed by the Pictures of Facial Affect (POFA) test, affective ToM by the Reading the Mind in the Eyes Test (RMET) and cognitive ToM by several false-belief stories. Group and sex differences were analyzed using parametric (POFA, RMET) and non-parametric (false-belief stories) tests. The impact of age, intelligence quotient (IQ) and clinical variables on patient performance was examined using a series of linear/logistic regressions. RESULTS Both groups of patients performed worse than healthy subjects on POFA, RMET and second-order false-belief (p < 0.001), but no differences were found between them. Instead, their deficits were related to older age and/or lower IQ (p < 0.01). Subthreshold depression was associated with a 6-fold increased risk of first-order false-belief failure (p < 0.001). Sex differences were only found in healthy subjects, with women outperforming men on POFA and RMET (p ≤ 0.012), but not on first/second-order false-belief. LIMITATIONS The cross-sectional design does not allow for causal inferences. CONCLUSION BD and SCH patients had deficits in emotion recognition, affective ToM, and second-order cognitive ToM, but their performance was comparable to each other, highlighting that the differences between them may be subtler than previously thought. First-order cognitive ToM remained intact, but subthreshold depression altered their normal functioning. Our results suggest that the advantage of healthy women in the emotional and affective aspects of social cognition would not be maintained in BD and SCH.
European Archives of Psychiatry and Clinical Neuroscience, 2021
Some evidence suggests that patients with bipolar disorder (BD) have better Theory of Mind (ToM) ... more Some evidence suggests that patients with bipolar disorder (BD) have better Theory of Mind (ToM) skills than patients with schizophrenia/schizoaffective disorder (SCH). However, this difference is not consistently reported across studies, so rather than being global, it may be restricted to specific aspects of ToM. Our primary objective was to compare higher order ToM performance between BD and SCH patients using the Hinting Task (HT). Ninety-four remitted patients were recruited (BD = 47, SCH = 47). Intelligence quotient (IQ), attention, memory, executive functions, and processing speed were also assessed. Patients with BD performed better on the HT than patients with SCH, even when the analysis was adjusted for IQ and neurocognition ( p < 0.001, $$\eta_{p}^{2}$$ η p 2 = 0.144). Regression analysis in the total sample showed that a diagnosis of SCH and lower IQ were associated with lower HT scores ( R 2 = 0.316, p < 0.001). In the BD group, verbal memory and processing speed were the main predictors of HT performance ( R 2 = 0.344, p < 0.001). In the SCH group, no variable was significant in explaining HT performance. In the context of previous studies that found no significant differences in the most basic aspects of ToM (e.g., understand other people's thoughts/beliefs), our results suggest that differences between the two disorders might be limited to the more challenging aspects (e.g., understand the intended meaning of indirect requests). No causal inferences can be made in this cross-sectional study. However, regression analyses show that whereas in BD patients, ToM functioning would be partially modulated by neurocognitive performance, in SCH patients, it could be largely independent of the well-known neurocognitive impairment.
Background. This study aimed to identify clinical and cognitive factors associated with increased... more Background. This study aimed to identify clinical and cognitive factors associated with increased risk for difficult-to-treat depression (DTD) or treatment-resistant depression (TRD). Methods. A total of 229 adult outpatients with major depression were recruited from the mental health unit at a public hospital. Participants were subdivided into resistant and nonresistant groups according to their Maudsley Staging Model score. Sociodemographic, clinical, and cognitive (objective and subjective measures) variables were compared between groups, and a logistic regression model was used to identify the factors most associated with TRD risk. Results. TRD group patients present higher verbal memory impairment than the nonresistant group irrespective of pharmacological treatment or depressive symptom severity. Logistic regression analysis showed that low verbal memory scores (odds ratio [OR]: 2.02; 95% confidence interval [CI]: 1.38–2.95) together with high depressive symptom severity (OR: ...
BackgroundHeterogeneity in cognitive functioning among major depressive disorder (MDD) patients c... more BackgroundHeterogeneity in cognitive functioning among major depressive disorder (MDD) patients could have been the reason for the small-to-moderate differences reported so far when it is compared to other psychiatric conditions or to healthy controls. Additionally, most of these studies did not take into account clinical and sociodemographic characteristics that could have played a relevant role in cognitive variability. This study aims to identify empirical clusters based on cognitive, clinical and sociodemographic variables in a sample of acute MDD patients.MethodsIn a sample of 174 patients with an acute depressive episode, a two-step clustering analysis was applied considering potentially relevant cognitive, clinical and sociodemographic variables as indicators for grouping.ResultsTreatment resistance was the most important factor for clustering, closely followed by cognitive performance. Three empirical subgroups were obtained: cluster 1 was characterized by a sample of non-re...
times higher odds of very high cardiovascular risk. Interestingly, the highest adjusted odds rati... more times higher odds of very high cardiovascular risk. Interestingly, the highest adjusted odds ratio 4.00 (95% CI 2.62-6.10, p < 0.001) had individuals living in Riga (capital of Latvia) compared to those living in rural area. Conclusions: We have found a statistically significant association between depression (PHQ-9 ≥ 10) and very high risk of cardiovascular mortality. It would be advisable to screen all individuals with SCORE ≥10% for depression to delay the development and improve the prognosis of CVD.
Background: Childhood maltreatment increases the risk of suicide attempts in the general populati... more Background: Childhood maltreatment increases the risk of suicide attempts in the general population, possibly having similar effects among patients with major depressive disorder (MDD). The few studies that have addressed this association have been restricted to specific populations (e.g. treatment-resistant depression, personality disorders) and have rarely taken sex into account. Objective: To examine the impact of childhood maltreatment on suicide attempts among MDD patients above and beyond other risk factors and potential confounders, while considering potential sex-specific effects. Methods: The study assessed 165 patients with a principal diagnosis of MDD. Neurological alterations, psychiatric comorbidities, and drug abuse were reasons for exclusion. Logistic regressions using the whole sample, and divided by sex, were run to test the association between childhood maltreatment and history of suicide attempts, controlling for symptom severity, comorbidities, and treatment-resistant depression. Results: There was a significant and clinically relevant association between childhood maltreatment and history of suicide attempts in the total sample. Patients with childhood maltreatment were 3.01 times more likely to present a history of suicide attempts than patients without childhood maltreatment. A family history of psychiatric disorders also contributed to the variance of attempted suicide, but its interaction with childhood maltreatment was not statistically significant. When testing the model separately, the effect of childhood maltreatment on suicide attempts remained for females, whereas for males, age of MDD onset and Childhood Trauma Questionnaire minimization-denial scale were predictive variables. Conclusions: Childhood maltreatment is a clear predictor of suicidal behaviour among MDD patients, and this effect remains significant after controlling for potential confounders. Also, the sex of patients emerges as a relevant factor that may model the mechanisms underlying the prediction of suicide attempts. Since suicide is the main cause of premature death among MDD patients, interventions targeting childhood maltreatment should be included in preventive and clinical strategies.
Background: Given the limitation of pharmacological treatments to treat cognitive symptoms in pat... more Background: Given the limitation of pharmacological treatments to treat cognitive symptoms in patients with Major Depressive Disorder (MDD), cognitive remediation programs has been proposed as a possible procognitive intervention but findings are not conclusive. This study investigates the efficacy of an INtegral Cognitive REMediation (INCREM) that includes a combination of a Functional Remediation (FR) strategy plus a Computerized Cognitive Training (CCT) in order to improve not only cognitive performance but also the psychosocial functioning and the quality of life. Methods: A single blind randomized controlled clinical trial in 81 patients with a diagnosis of MDD in clinical remission or in partial remission. Participants will be randomized to one of three conditions: INCREM (FR + CCT), Psychoeducation plus online games and Treatment As Usual (TAU). Intervention will consist in 12 group sessions, of approximately 110 min once a week. The primary outcome measure will be % of change in psychosocial functioning after treatment measured by the Functional Assessment Short Test (FAST); additionally, number of sick leaves and daily activities will also be recorded as pragmatic outcomes. Discussion: To our knowledge, this is the first randomized controlled clinical trial using a combination of two different approaches (FR + CCT) to treat the present cognitive deficits and to promote their improvements into a better psychosocial functioning. Trial registration: Clinical Trials NCT03624621. Date registered 10th of August 2018 and last updated 24th August 2018.
The training of healthcare staff (obstetricians, psychiatrists and nursing) in prevention and imp... more The training of healthcare staff (obstetricians, psychiatrists and nursing) in prevention and improvement of obesity and preeclampsia during pregnancy and psychoeducation about labour and the risks-benefits of C-section, in women diagnosed of BD, would probably decrease the rates of psycho-pathological worsening linked to fear of childbirth and the ongoing C-section and C-section on maternal request's rates, requiring the last one only in special cases where the vaginal labour is a clear contraindication (comorbidity with PTSD or risk of PTSD).
BD have demonstrated a relationship between deficits in executive function and increased suicidal... more BD have demonstrated a relationship between deficits in executive function and increased suicidality. This relationship has not yet been investigated in bipolar youth. The present study examined the association between a history of suicide attempts and executive functioning in youth with BD. Methods: Twenty depressed bipolar participants, ages 13 to 21, completed a diagnostic interview, mood, and executive function measures. All participants were given the WCST, Trail Making Test, Color-Word Interference Test to create an executive function composite score, and the Columbia Suicide Severity Rating Scale to assess lifetime symptoms of suicidal ideation and behavior. Results: All participants had a history of suicidal ideation and 15 participants had a history of attempts. Logistic regression was performed on suicidal behavior with executive functioning, age, and depression scores as predictors, X2 (3, 20) 5 12.88, p 5 .005. Executive function predicted the occurrence of suicide attempts in bipolar youth, X2 (1, 20) 5 3.90, p , .05. Specifically, better executive performance was associated with a history of suicide attempts. Conclusions: Bipolar adolescents with a history of suicide attempts demonstrated better performance on tests of executive function. These findings were surprising and differ from previous reports in suicidal adults. The relationship between executive function and suicide-risk in bipolar youth may be impacted by brain development during adolescence. Additional studies are needed to examine the interaction between neurodevelopmental changes in executive functioning and suicide-risk in bipolar youth.
Despite its high recurrence rate, major depression disorder (MDD) still lacks neurobiological mar... more Despite its high recurrence rate, major depression disorder (MDD) still lacks neurobiological markers to optimize treatment selection. The aim of this study was to examine the prognostic potential of clinical and structural magnetic resonance imaging (sMRI) in the long-term MDD clinical outcomes (COs). Forty-nine MDD patients were grouped into one of four different CO categories according to their trajectory: recovery, partial remission, remission recurrence, and chronic depression. Regression models including baseline demographic, clinical, and sMRI data were used for predicting patients' COs and symptom severity 5 years later. The model including only clinical data explained 32.4% of the variance in COs and 55% in HDRS, whereas the model combining clinical and sMRI data increased up to 52/68%, respectively. A bigger volume of right anterior cingulate gyrus was the variable that best predicted COs. The findings suggest that the addition of sMRI brain data to clinical informatio...
Positron emission tomography (PET) studies have shown that the antidepressant effect of chronic d... more Positron emission tomography (PET) studies have shown that the antidepressant effect of chronic deep brain stimulation (DBS) of the subcallosal cingulate gyrus (SCG) may be consequence of modifications of brain metabolism at key structures involved in depression. Like clinical benefits, these metabolic changes may reverse when the stimulation is discontinued, even preceding clinical worsening. However no data on immediate effects of DBS discontinuation are available. The aim of this study was to determine immediate cerebral metabolism changes during a short switch-off of electrical stimulation in implanted patients with treatment-resistant depression (TRD) who had achieved clinical improvement after a period of chronic DBS. Seven patients with TRD who had been previously implanted for DBS in SCG were included. After a period of clinical stabilization two consecutive FDG-PET were acquired, the first with active stimulation and the second after 48 h of inactive stimulation. A HAMD-17 to assess depressive symptoms was performed before both scans. Analyses were performed with SnPM8. Inactive stimulation was characterized by metabolism decreases in dorsal anterior cingulate (Broadmann Area, BA24), premotor region (BA6) and putamen with respect to active stimulation. No clinical changes according to HAMD-17 were detected. The main limitation of this study is the small sample size. Our results point to immediate effects of DBS discontinuation on metabolism of brain depressive network which precede clinical changes, helping to disentangle the rationale behind DBS efficacy in TRD.
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Papers by Maria Serra