Psychiatry and Psychology Commons^™

Pharmacotherapies Targeting Gaba-Glutamate Neurotransmission For Treatment-Resistant Depression, Courtney M Vecera, Alan C Courtes, Gregory Jones, Jair C Soares, Rodrigo Machado-Vieira

Faculty, Staff and Student Publications

Treatment-resistant depression (TRD) is a term used to describe a particular type of major depressive disorder (MDD). There is no consensus about what defines TRD, with various studies describing between 1 and 4 failures of antidepressant therapies, with or without electroconvulsive therapy (ECT). That is why TRD is such a growing concern among clinicians and researchers, and it explains the necessity for investigating novel therapeutic targets beyond conventional monoamine pathways. An imbalance between two primary central nervous system (CNS) neurotransmitters, L-glutamate and γ-aminobutyric acid (GABA), has emerged as having a key role in the pathophysiology of TRD. In this …

Examining The Evidence Base For Burnout, Renzo Bianchi, Irvin Schonfeld

Publications and Research

Burnout has elicited growing interest among occupational health specialists in recent decades. Since 2019, the World Health Organization has characterized burnout as a syndrome resulting from chronic, unmanageable workplace stress. Accordingly, three symptoms define the entity: (i) feelings of energy depletion or exhaustion; (ii) increased mental distance from one’s job or feelings of negativism or cynicism towards one’s job; and (iii) a sense of ineffectiveness and lack of accomplishment. We call into question the definition of burnout embodied in the Maslach Burnout Inventory and incorporated into the ICD-11. We draw stakeholders’ attention to the fact that burnout’s symptoms and etiology …

Examining The Evidence Base For Burnout, Renzo Bianchi, Irvin Sam Schonfeld

Publications and Research

Burnout has elicited growing interest among occupational health specialists in recent decades. Since 2019, the World Health Organization has characterized burnout as a syndrome resulting from chronic, unmanageable workplace stress. According to the ICD-11, three symptoms define the entity: feelings of exhaustion, increased mental distance from one’s job, and a sense of ineffectiveness at work, all of which correspond to the structure of the Maslach Burnout Inventory. The ICD-11 includes burnout among the factors that influence health status. This paper calls into question that conceptualization based on a number of lines of evidence. The evidence includes the following: burnout was …

Prevalence Of Depression, Anxiety And Stress After The Covid-19 Pandemic Period Among Students At The Medical University Of Sofia; Significance Of Demographic, Educational, And Pandemic-Related Variables, Nadya Avramova

Journal of Mind and Medical Sciences

This cross-sectional study aimed to determine the prevalence of depression, anxiety, and stress among undergraduate dental students at Sofia Medical University and to investigate its associations with some demographic, educational and pandemic-related variables. A self-reported questionnaire that included the validated DASS-21 scale was administered to a group of 2nd, 3rd, 4th, and 5th year students (n=70, response rate 95.7%). Results indicated abnormal levels of depression, anxiety, and stress in 34.3%, 65.7% and 59.7% of the participants, respectively. A much larger proportion of females suffered from abnormal levels of anxiety (56.6%) as compared with males (9%), p=.003. Single students exhibited significantly …

Assessing The Mental Health Of Older Hispanic/Latinx Adults: Focus On The Impact Of The Hispanic Cultural Value Of Fatalismo On Depressive Symptomatology, Anna J. Prado, Amie Bostic, Mario Gil

Research Colloquium

Introduction: The impact of depression in older Hispanic/Latinx adults in the United States is poorly understood. The influence of the deeply embedded Hispanic/Latinx cultural value of fatalismo, referring to the belief that one’s future is predetermined and related to feelings of helplessness, has been found to negatively impact their psychological health [1, 2]. The present study explores the association between the Hispanic/Latinx cultural value of fatalismo and mental health.

Objective: To contribute to the identification and understanding of psycho-social-cultural determinants of depression in the Hispanic/Latinx population.

Methods: Using data from the Health and Retirement Study (HRS) …

Neural Complexity Eeg Biomarkers Of Rapid And Post-Rapid Ketamine Effects In Late-Life Treatment-Resistant Depression: A Randomized Control Trial, Nicholas Murphy, Amanda J F Tamman, Marijn Lijffijt, Dania Amarneh, Sidra Iqbal, Alan Swann, Lynnette A Averill, Brittany O'Brien, Sanjay J Mathew

Staff and Researcher Publications

Ketamine is an effective intervention for treatment-resistant depression (TRD), including late-in-life (LL-TRD). The proposed mechanism of antidepressant effects of ketamine is a glutamatergic surge, which can be measured by electroencephalogram (EEG) gamma oscillations. Yet, non-linear EEG biomarkers of ketamine effects such as neural complexity are needed to capture broader systemic effects, represent the level of organization of synaptic communication, and elucidate mechanisms of action for treatment responders. In a secondary analysis of a randomized control trial, we investigated two EEG neural complexity markers (Lempel-Ziv complexity [LZC] and multiscale entropy [MSE]) of rapid (baseline to 240 min) and post-rapid ketamine (24 …

Community Mobility And Depressive Symptoms During The Covid-19 Pandemic In The United States, Roy H. Perlis, Kristin Lunz Trujillo, Alauna Safarpour, Alexi Quintana, Matthew D. Simonson, Jasper Perlis, Mauricio Santillana, Katherine Ognyanova, Matthew A. Baum, James N. Druckman, David Lazer

Political Science Faculty Publications

Importance Marked elevation in levels of depressive symptoms compared with historical norms have been described during the COVID-19 pandemic, and understanding the extent to which these are associated with diminished in-person social interaction could inform public health planning for future pandemics or other disasters.

Objective To describe the association between living in a US county with diminished mobility during the COVID-19 pandemic and self-reported depressive symptoms, while accounting for potential local and state-level confounding factors.

Design, Setting, and Participants This survey study used 18 waves of a nonprobability internet survey conducted in the United States between May 2020 and April …

The Difficulty In The Diagnosis And Management Of Antidepressant Discontinuation Syndrome, Sidney Charm D. Reyes

School of Medicine Publications

Background: Antidepressant discontinuation syndrome (ADS) is a condition that occurs in about 20% of patients following the abrupt reduction/stoppage of any antidepressant medication that has been taken continuously for at least one month.

Case Presentation: We present a 36-year-old Hispanic woman who initially presented for evaluation of flu-like symptoms (subjective fever, rhinorrhea) and worsening body aches, trouble sleeping, and headaches for the past three days. She also reported recent exposure to a sick co-worker. Rapid flu, strep, and COVID tests came back negative. Pt was diagnosed with a viral URI and was discharged with counseling on supportive treatment. The patient …

Assessing The Severity Of Cervical Dystonia: Ask The Doctor Or Ask The Patient?, Adam C Cotton, Laura Scorr, William Mcdonald, Cynthia Comella, Joel S Perlmutter, Christopher G Goetz, Joseph Jankovic, Laura Marsh, Stewart Factor, H A Jinnah

Faculty, Staff and Students Publications

BACKGROUND: Assessing disease severity can be performed using either clinician-rated scales (CRS) or patient-rated outcome (PRO) tools. These two measures frequently demonstrate poor correlations.

OBJECTIVES: To determine if the correlation between a CRS and PRO for motor features of cervical dystonia (CD) improves by accounting for non-motor features.

METHODS: Subjects with CD (N = 209) were evaluated using a CRS (Toronto Western Spasmodic Torticollis Rating Scale, TWSTRS) and a PRO (Cervical Dystonia Impact Profile, CDIP-58).

RESULTS: Linear regression revealed a weak correlation between the two measures, even when considering only the motor subscales of each. The strength of this relationship …

Reminiscence Therapy For Prevention Of Post-Stroke Anxiety And Depression In Adults, Carly Porter

Master of Science in Physician Assistant Studies Capstone Presentations (Center City)

Introduction

Anxiety and depression are prevalent after a stroke.^1,2 Peer support is a non-pharmacologic intervention utilized to manage post-stroke anxiety and depression with inconsistent results.³ Reminiscence therapy is an intervention that has been studied in the dementia population but is a relatively new intervention for the stroke population and has the potential to impact the psychological care provided to stroke patients.⁴

The Association Between Covid-19 Preventive Behaviors And Mental Health Conditions, Elizabeth Wachira, Bhakti Chavan, Carolyn Nganga-Good, Caroline Kingori

Faculty Publications

Our findings highlight that individuals with mental health conditions reported more psychological distress. Specifically, feeling depressed, anxious, lonely, and hopeless were triggered and exacerbated as a result of the pandemic and may have long-term effects on general well-being and productivity. Therefore, our findings have important implications on the need to include mental health promotion as part of pandemic response efforts. This includes developing policies and allocating funding so as to ensure sustainable mental health interventions and support, public and provider education on the importance of screening for mental health issues.

Identification Of Structural Brain Alterations In Adolescents With Depressive Symptomatology, J. Bashford‑Largo, R. James R. Blair, Karina S. Blair, Matthew Dobbertin, Ahria Dominguez, Melissa Hatch, Sahil Bajaj

Center for Brain, Biology, and Behavior: Faculty Publications

Introduction: Depressive symptoms can emerge as early as childhood and may lead to adverse situations in adulthood. Studies have examined structural brain alternations in individuals with depressive symptoms, but findings remain inconclusive. Furthermore, previous studies have focused on adults or used a categorical approach to assess depression. The current study looks to identify grey matter volumes (GMV) that predict depressive symptomatology across a clinically concerning sample of adolescents.

Methods: Structural MRI data were collected from 338 clinically concerning adolescents (mean age = 15.30 SD=2.07; mean IQ = 101.01 SD=12.43; 132 F). Depression symptoms were indexed via the Mood …

Association Of Delirium And Depression With Respiratory And Outcome Measures In Covid-19 Inpatients, Alessio Simonetti, Cristina Pais, Vezio Savoia, Maria Camilla Cipriani, Matteo Tosato, Delfina Janiri, Evelina Bernardi, Ottavia Marianna Ferrara, Stella Margoni, Georgios D Kotzalidis, Daniela Chieffo, Massimo Fantoni, Rosa Liperoti, Francesco Landi, Roberto Bernabei, Gabriele Sani

Faculty, Staff and Students Publications

Delirium (DEL) and depression (DEP) may impair the course and severity of acute respiratory illness. The impact of such syndromes on respiratory and outcome parameters in inpatients with COVID-19 needs clarification. To clarify the relationship between DEL and DEP and respiratory outcome measures, we enrolled 100 inpatients from COVID-19 units of the Fondazione Policlinico Universitario Agostino Gemelli IRCCS of Rome. Participants were divided into those with DEL, DEP, or absence of either delirium or depression (CONT). Delirium severity was assessed with the Neelson and Champagne Confusion Scale (NEECHAM). Psychopathology was assessed with the Hamilton Rating Scale for Depression (HAM-D), the …

Lower Urinary Tract Symptoms In Depression: A Review, Danyon J. Anderson, Alise Aucoin, Colton R. Toups, Devin Cormier, Matthew Mcdonald, Jamal Hasoon, Omar Viswanath, Alan D. Kaye, Ivan Urits

School of Medicine Faculty Publications

Lower Urinary Tract Symptoms (LUTS) are frequently present in the general population as patients age with approximately a third of individuals experiencing LUTS during their lifetime. LUTS can be further defined as having any of the following symptoms: urinary hesitancy, straining, nocturia, increased urination frequency, and dysuria. LUTS has the potential for patients to contribute their symptoms to what can normally occur as we age. This can lead to a decrease in patients seeking care and could negatively impact patients’ health-related quality of life (HRQL). In conjunction with LUTS, we obtained from our analysis that LUTS and depression are closely …

Reward Processing In Psychiatric Inpatients With Depression, Hyuntaek Oh, Jaehoon Lee, Michelle A Patriquin, John Oldham, Ramiro Salas

Staff and Researcher Publications

Background: Previous neuroimaging studies have investigated reward-processing dysfunction in major depressive disorder and have led to the common finding that major depressive disorder is associated with reduced reward responses within the reward circuit. Yet it is unclear whether such reward-processing dysfunction is specifically associated with the severity of depressive symptoms in major depressive disorder or is associated with common comorbidities.

Methods: We investigated reward-processing differences using a classic juice-delivery functional magnetic resonance imaging experiment to compare psychiatric patients with severe depressive symptoms (DEPs) to both psychiatric control subjects (PCs) and healthy control subjects. In this study, the DEPs (n = …

Obsessive-Compulsive Disorder In Youth And Young Adults With Depression: Clinical Characteristics Of Comorbid Presentations, David B Riddle, Andrew Guzick, Abu Minhajuddin, Orri Smárason, Gabrielle M Armstrong, Holli Slater, Taryn L Mayes, Lynnel C Goodman, Denise L Baughn, Sarah L Martin, Sarah M Wakefield, Joseph Blader, Ryan Brown, Wayne K Goodman, Madhukar H Trivedi, Eric A Storch

Faculty, Staff and Students Publications

Obsessive-compulsive disorder (OCD), anxiety disorders, and depressive disorders are highly comorbid, and each contribute to significant functional impairment for affected youth. Comorbid anxiety disorders in depressed youth have been associated with greater depressive symptom severity and impairment, but the impact of comorbid OCD in this population remains unclear. Accordingly, the present study examined the differential clinical characteristics of youth with depression and comorbid OCD relative to age/gender matched depressed youth with no such comorbidity and to those with depression and a comorbid (non-OCD) anxiety disorder. A sample of 797 youth and young adults ages 8-20 years who met diagnostic criteria …

The Role Of Expressed Emotion On Post-Traumatic Stress Disorder, Steven Drosky, Natasha Reddy, Eduardo Espiridion

Transformative Medicine

Introduction: This case report explores the impact of expressed emotion (EE) on the management of a patient with post-traumatic stress disorder. EE is a term used to denote the attitude of familial caregivers toward a person with a mental disorder.

Clinical Findings: We describe the case of a paraplegic patient living in an environment of high expressed emotion. The patient had no history of psychiatric illness prior to suffering a spinal cord injury. Since the injury the patient reports recurring symptoms consistent with post-traumatic stress disorder and worsening of symptoms due to family members expressing negative attitudes.

Conclusion: The construct …

The Novel Uncompetitive Nmda Receptor Antagonist Esmethadone (Rel-1017) Has No Meaningful Abuse Potential In Recreational Drug Users, Megan J Shram, Jack E Henningfield, Glen Apseloff, Charles W Gorodetzky, Sara De Martin, Frank L Vocci, Frank L Sapienza, Thomas R Kosten, Jeff Huston, August Buchhalter, Judy Ashworth, Ryan Lanier, Franco Folli, Andrea Mattarei, Clotilde Guidetti, Stefano Comai, Cedric O'Gorman, Sergio Traversa, Charles E Inturrisi, Paolo L Manfredi, Marco Pappagallo

Faculty, Staff and Students Publications

Esmethadone (REL-1017) is the opioid-inactive dextro-isomer of methadone and a low-affinity, low-potency uncompetitive NMDA receptor antagonist. In a Phase 2, randomized, double-blind, placebo-controlled trial, esmethadone showed rapid, robust, and sustained antidepressant effects. Two studies were conducted to evaluate the abuse potential of esmethadone. Each study utilized a randomized, double-blind, active-, and placebo-controlled crossover design to assess esmethadone compared with oxycodone (Oxycodone Study) or ketamine (Ketamine Study) in healthy recreational drug users. Esmethadone 25 mg (proposed therapeutic daily dose), 75 mg (loading dose), and 150 mg (Maximum Tolerated Dose) were evaluated in each study. Positive controls were oral oxycodone 40 mg …

Stress Reactivity After Pediatric Traumatic Brain Injury: Relation With Behavioral Adjustment, Taiane De Azevedo Cardoso, Ritele H Silva, Jessica L Fernandes, Camila O Arent, Graziela Amboni, Laura A Borba, Alex Paulo Z Padilha, Maria Eduarda M Botelho, Amanda L Maciel, Tatiana Barichello, Rodrigo Morales, Silvio José B Soares, Margarete D Bagatini, Claudia Dallagnol, Marta Elisa Brighenti, Zuleide Maria Ignácio, João Quevedo, Luciane B Ceretta, Gislaine Z Réus

Faculty, Staff and Student Publications

BACKGROUND: Although many studies have pointed out a possible relationship between COVID-19 and the presence of psychiatric disorders, the majority of the studies have significant limitations. This study investigates the influence of COVID-19 infection on mental health.

METHODS: This cross-sectional study included an age- and sex-matched sample of adult individuals positive (cases) or negative (controls) for COVID-19. We evaluated the presence of psychiatric conditions and C-reactive protein (CRP).

RESULTS: Findings showed greater severity of depressive symptoms, higher levels of stress, and greater CRP in cases. The severity of depressive and insomnia symptoms, as well as the CRP were more remarkable …

Exercise As A Prescription For Patients With Depressive Disorders: A Quality Improvement Project, Sydney Roscoe, Rachelle Pace

Doctor of Nursing Practice Final Manuscripts

Purpose: The aim of this Doctor of Nursing Practice project was to increase exercise counseling rates in the treatment of depression by (1) implementing a focused educational training program and (2) understanding factors that impacted utilization of the practice change.

Background: Approximately 280 million individuals suffer globally from depressive disorders. Depression remains the fourth leading cause of disabilities, significantly contributing toward the global burden of disease by increasing morbidity and mortality risk. Psychopharmacology and psychotherapy are current gold standards of treatment; however, providers often overlook the significant role exercise serves in reducing depressive symptoms and severity, as it remains underutilized. …

The Associations Between Adolescent Motives For Social Media Use With Body Dysmorphia, Eating Disorder, And Anxiety And Depression Symptoms, Kaylan Melvin

Honors Theses

Adolescents spend a large amount of time on social media sites. This is notable, as adolescence is a crucial time for body image development. Additionally, recent findings suggest that using image-oriented social media sites, such as Facebook and Instagram, is associated with more body dissatisfaction and disordered eating. Among previous studies, certain social media motivations have been found to have an association with poor body satisfaction and well-being in adolescents. To our knowledge, no studies have directly examined the association between social media motivations and eating disorder, body dysmorphic disorder, and anxiety and depression symptoms in adolescents. The current study …

The Influence Of Nutrition On The Gut Microbiota And Psychiatric Disorders: A Review, Megha Bhagavan, Francis Jenney

Research Day

The symbiotic harboring of gut microorganisms within the gastrointestinal tract has a profound influence on host physiology, well-being, and disease pathology. More specifically, the gut bacteria are able to interact with dietary components from foods chosen by the host and consequently relay their beneficial or precarious effects locally and systemically. The gut bacteria have the capacity to maintain a healthy gut microbiome or perpetuate intestinal imbalance, known as gut dysbiosis. Gut dysbiosis has both local effects in gastrointestinal pathologies, such as intestinal bowel syndrome (IBS) and intestinal bowel disorder (IBD), as well as systemic pathologies, such as type II diabetes, …

Rapid Neuroplasticity Changes And Response To Intravenous Ketamine: A Randomized Controlled Trial In Treatment-Resistant Depression, Jared Kopelman, Timothy A Keller, Benjamin Panny, Angela Griffo, Michelle Degutis, Crystal Spotts, Nicolas Cruz, Elizabeth Bell, Kevin Do-Nguyen, Meredith L Wallace, Sanjay J Mathew, Robert H Howland, Rebecca B Price

Staff and Researcher Publications

Intravenous ketamine is posited to rapidly reverse depression by rapidly enhancing neuroplasticity. In human patients, we quantified gray matter microstructural changes on a rapid (24-h) timescale within key regions where neuroplasticity enhancements post-ketamine have been implicated in animal models. In this study, 98 unipolar depressed adults who failed at least one antidepressant medication were randomized 2:1 to a single infusion of intravenous ketamine (0.5 mg/kg) or vehicle (saline) and completed diffusion tensor imaging (DTI) assessments at pre-infusion baseline and 24-h post-infusion. DTI mean diffusivity (DTI-MD), a putative marker of microstructural neuroplasticity in gray matter, was calculated for 7 regions of …

Improving Depression Remission Screening Compliance, Crystal Wingerter

Doctor of Nursing Practice Projects

Depressive disorders are widespread in the United States and are diagnosed and treated in the primary care setting. In 2019, there were an estimated 19.4 million adults that had at least one major depressive episode. The purpose of this project was to improve follow up and depression remission assessment for patients with a diagnosis of depression at a metropolitan family care practice clinic. The Patient Health Questionnaire (PHQ–9) was utilized for remission assessment. Front desk staff and providers were trained and granted access to the quality information system (QIS) in the electronic medical records (EMR) system which allowed easy identification …

Mental Health Of Medical Students Regarding The Covid-19 Pandemic, Parth Patel, Richard Jermyn, Arvind Venkataraman

Rowan-Virtua Research Day

Mental health has taken a global priority as more realize that it is just as important as physical health in the overall health of a person. Medical students have faced mental health issues for decades and have been shown to suffer more than the general population. The recent COVID-19 pandemic has only deteriorated this issue. Many primary databases such as PubMed were used. The results indicate that medical students have extremely high rates of depression, burnout, anxiety, and stress that can affect their education but also carry over into their professions. Although many interventions increase mental wellness in medical school, …

Improving Depression Screening Completion Rates For Medicare Patients In A Primary Care Setting, Kenneth J. Haluska

Evidence-Based Practice Project Reports

The United States Preventative Services Task Force recommends screening the general adult population for depression (Siu et al., 2016). Despite increasing clinical practice guidelines recommending depression screening, only 40-50% of depressed older adults are recognized and treated (Phoh et al., 2017). The purpose of this evidence-based practice (EBP) project was to implement a medical assistant (MA) depression screening protocol, using the PHQ-9 and staff education, to improve depression screening completion rates in Medicare patients in a primary care setting. An exhaustive literature search of eight databases yielded 14 pieces of evidence that made recommendations for best practice. The evidence was …

One-Year Outcomes Following Intravenous Ketamine Plus Digital Training Among Patients With Treatment-Resistant Depression: A Secondary Analysis Of A Randomized Clinical Trial, Rebecca B Price, Meredith L Wallace, Sanjay J Mathew, Robert H Howland

Staff and Researcher Publications

This secondary analysis of a randomized clinical trial examines whether automated self-association training can prolong the antidepressant effect of a single infusion of ketamine beyond 1 month in patients with treatment-resistant depression.

Phq -9 Utilization In The Primary Care Setting, Michael Armstrong, Ramisa Rahman, Ceferino Cruz Iv, Afsha Rais Kaisani

North Texas GME Research Forum 2023

INTRODUCTION: The Patient Health Questionnaire-9 (PHQ-9) is a tool used to help diagnose depression and assess a patient’s response to treatment. Quality metric (QM) 371 is a measure of PHQ-9 utilization in patients with depression, and Medical City Family Medicine tracks QM 371 in order to improve the quality of care provided to our patients. This project sought to assess utilization of the PHQ-9 in our clinical practice. At the time of this QI project’s inception, QM 371 was reporting at 0%.

METHODS: Our intervention was to give an educational presentation regarding depression, the PHQ-9, as well as how to …

Evaluation Of Burning Mouth Syndrome And Salivary Chromogranin A In Major Depressive Disorder Patients, Ameer Ali Althabhawee, Taghreed Fadhil Zaidan

Maaen Journal for Medical Sciences

Major depressive disorder represents a growing concern as its prevalence keeps rising worldwide; with this rising, there is also an increased demand in the field of oral medicine in developed countries, and since many disorders and orofacial pain have been linked to be associated with psychiatric disorders and conditions, this study was aimed to evaluate burning mouth syndrome and salivary chromogranin A in major depressive disorder patients. The study sample included 49 patients who received a diagnosis of major depressive disorder, being under treatment for at least two weeks. The control group consists of 34 healthy subjects with no signs …

Mixed Depression In The Post-Covid-19 Syndrome: Correlation Between Excitatory Symptoms In Depression And Physical Burden After Covid-19, Alessio Simonetti, Evelina Bernardi, Stella Margoni, Antonello Catinari, Antonio Restaino, Valentina Ieritano, Marta Palazzetti, Federico Mastrantonio, Delfina Janiri, Matteo Tosato, Francesco Landi, Gabriele Sani

Faculty, Staff and Students Publications

The relationship between depression and post-COVID-19 disease syndrome (post-COVID-19 syndrome) is established. Nevertheless, few studies have investigated the association between post-COVID-19 syndrome and mixed depression, i.e., a specific sub-form of depression characterized by high level of excitatory symptoms. Aims of the present study are: (a) to compare the post-COVID-19 syndrome's burden in depressed and non-depressed patients, and (b) to investigate the correlation between post-COVID-19 syndrome's burden and the severity of mixed depression. One thousand and forty six (n = 1460) subjects with post-COVID-19 syndrome were assessed. Subjects were divided into those with (DEP) or without (CONT) depression. Sociodemographically, post-COVID-19 syndrome's …