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Response to electroconvulsive therapy in elderly patients with late‐onset bipolar disorder: The impact of cerebral small vessel disease
No full textObjectivesCerebral Small Vessel Disease (CSVD) is a chronic, progressive vascular disorder that confers increased vulnerability to psychiatric syndromes, including late-life mood disorders. In this study, we investigated the impact of CSVD on electroconvulsive therapy (ECT) outcomes in patients with late-onset bipolar disorder (BD).MethodsA sample of 54 non-demented elderly patients (>= 60 years) with late-onset BD and treatment-resistant major depression, mixed state, or catatonia who underwent bilateral ECT were included in this naturalistic observational study. A diagnosis of CSVD was established based on brain neuroimaging performed before ECT. All patients were evaluated before and after ECT using the Brief Psychiatric Rating Scale (BPRS), the Hamilton Rating Scale for Depression (HAM-D), and the Clinical Global Impression scale (CGI).ResultsOf the total sample, 19 patients were diagnosed with CSVD (35.2%). No significant differences were observed at baseline between patients with and without CSVD. Overall, a response was obtained in 66%-68.5% of patients, with remission in 56.2%. No significant differences in ECT outcomes were found between those with and without CSVD, and both groups exhibited substantial improvements in symptom severity following ECT.ConclusionsThe outcome of ECT in late-onset BD was not influenced by the presence of CSVD. This finding aligns with previous research on unipolar depression. Accordingly, ECT should be considered for elderly patients with late-onset BD, regardless of the presence of CSVD.CSVD was found in 19 out of 54 (35.2%) elderly with late-onset BD referred to ECT. Response to ECT was achieved in about two-thirds of patients with late-onset BD. ECT was equally effective in patients with and without CSVD
Response to electroconvulsive therapy in elderly patients with late-onset bipolar disorder: the impact of cerebral small vessel disease.
No full textBackground: Over 25% of all bipolar disorder (BD) patients are elderly, with late-onset bipolar disorder (LOBD) often linked to neuroprogression and neurodegeneration. Cerebral small vessel disease (CSVD), a common and progressive vascular disorder in the elderly, contributes significantly to various neurological and psychiatric conditions. Major affective episodes in this demographic are associated with high morbidity and mortality, necessitating urgent interventions. Electroconvulsive therapy (ECT) is a highly effective first-line treatment for severe clinical conditions, such as treatment-resistant depression, mixed states, and mania, with response rates between 70% and over 90%.
Aim of the study: The effectiveness of ECT was evaluated in non-demented elderly patients (≥ 60 years) with LOBD and treatment-resistant major depression, mixed state, or catatonia. Specifically, the response rates and symptoms improvement after ECT were assessed to determine whether CSVD might influence ECT outcomes.
Materials and Methods: This naturalistic and observational study was conducted in a cohort of 54 treatment-resistant patients who underwent bilateral ECT between January 2006 and August 2023. All patients were evaluated prior to and after the ECT course using the Brief Psychiatric Rating Scale (BPRS), the Young Mania Rating Scale (YMRS), the Hamilton Rating Scale for Depression (HAM-D), and the Clinical Global Impression scale (CGI). A diagnosis of CSVD was established based on brain neuroimaging performed before ECT.
Results: No significant differences were observed between patients with and without CSVD at baseline. 37 patients (68.6%) responded to ECT according to CGI-I, with similar response rates in patients without (n = 25, 71,7%) and with CSVD (n = 12, 63,2%). No significant differences in ECT outcomes nor in longitudinal changes of rating scale scores were found between groups.
Conclusion: To the best of our knowledge, our study is the first to investigate the impact of CSVD, as identified through CT or MRI brain scans, on a cohort of non-demented, treatment-resistant elderly patients with LOBD. Response to ECT in bipolar depression, mixed states, and catatonia was not influenced by the presence of CSVD. This finding aligns with previous research on unipolar elderly depressed patients. ECT should be considered for elderly patients with BD, regardless of the presence of CSVD
Neutrophil/Lymphocyte, Platelet/Lymphocyte, and Monocyte/Lymphocyte Ratios in Mood Disorders
No full textMajor depressive disorder (MDD) and bipolar disorders (BDs), the most severe types of mood disorders (MDs), are considered as among the most disabling illnesses worldwide. Several studies suggested that inflammatory neuroinflammation might be involved in the pathophysiology of MDs while reporting increasing data on the relationships between these processes and classical neurotransmitters, hypothalamus-pituitary-adrenal axis (HPA), and neurotrophic factors. The assessment of neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), and monocyte/lymphocyte ratio (MLR) in peripheral blood represents a simple method to evaluate the inflammatory status. The aim of the present paper was to review the literature on the possible relationships between NLR, PLR, and MLR in MDs and to comment on their possible wider use in clinical research. Thirty-five studies were included in the present review. The majority of them had higher values of these parameters, particularly NLR values in patients with MDs when compared to healthy subjects. The increase would appear more robust in patients with BD during a manic episode, thus indicating that it could be considered as both state and trait markers. In addition, increased NLR and PLR levels seem to represent prognostic elements for the early discovery of post-stroke depression. The findings of the present review would indicate the need to carry out further studies in this field. In particular, NLR, PLR, and MLR seem to be promising tools to detect economically and easily the activation of the inflammatory system and to perhaps evaluate the etiology and course of MDs. Again, they could suggest some information to better understand the relationship between inflammatory and cardiovascular disease and MDs, and thus, to provide clinical implications in terms of management and treatment
Going Beyond Counting First Authors in Author Co-citation Analysis
Get PDFThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Get PDF“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Get PDFWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Bipolar Disorder and Manic-Like Symptoms in Alzheimer’s, Vascular and Frontotemporal Dementia: A Systematic Review
No full textAn increased risk of manic episodes has been reported in patients with neurodegenerative disorders, but the clinical features of bipolar disorder (BD) in different subtypes of dementia have not been thoroughly investigated
The impact of mild behavioral impairment on the prognosis of geriatric depression: preliminary results
Get PDF: Our study aimed to examine how the presence of Mild Behavioral Impairment (MBI) symptoms influenced the outcome of late-life depression (LLD). Twenty-nine elderly (≥ 60 years) depressive patients, including eleven (37.9%) with MBI, were recruited and followed-up on average for 33.41 ± 8.24 weeks. Psychiatric symptoms severity and global functioning were assessed, respectively, using the Brief Psychiatric Rating Scale (BPRS) and the Global Assessment of Functioning (GAF) scale. BPRS total score significantly decreased from baseline to follow-up (P < 0.001, d = 1.33). The presence of MBI had no significant effect on mood and cognitive symptoms improvement. On the contrary, while a significant increase in GAF score was observed in patients without MBI (P = 0.001, d = 1.01), no significant improvement of global functioning was detected in those with MBI (P = 0.154, d = 0.34) after 6-month follow-up. The presence of MBI in patients with LLD may negatively affect long-term outcome, slowing or preventing functional improvement
Dispelling the Myths Behind First-author Citation Counts
Get PDFWe conducted a full-scale evaluative citation analysis study of scholars in the XML research field to explore just how different from each other author rankings resulting from different citation counting methods actually are, and to demonstrate the capability of emerging data and tools on the Web in supporting more realistic citation counting methods. Our results contest some common arguments for the continued
use of first-author citation counts in the evaluation of scholars, such as high correlations between author rankings by first-author citation counts and other citation
counting methods, and high costs of using more realistic citation counting methods that are not well-supported by the ISI databases. It is argued that increasingly available digital full text research papers make it possible for citation analysis studies to go beyond what the ISI databases have directly supported and to employ more
sophisticated methods
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