Search

Objectives: Whether hippocampal volume predicts response and/or remission after antidepressant treatment of major depressive episodes (MDE) in major depressive disorder (MDD) remains unclear. We meta-analysed prospective studies comparing baseline hippocampal volume in patients with or without response/remission after antidepressant treatment. Methods: Pubmed, Embase and Google Scholar were searched for studies of patients with current MDE in MDD, with hippocampal volume assessments at baseline, initiation of antidepressant drug treatment, and prospective assessment of response/remission after treatment. Results: Six studies (374 patients), of which two were positive and four negative, were meta-analysed. Compared to responders/remitters, patients who failed to achieve response/remission had smaller total hippocampus volumes at baseline (mean volume difference¼260mm3, 95% CI [93; 427], P¼0.002). These results remained significant in patients under 60 years of age (P¼0.02), in those over 60 years old (P¼0.04), and for right (P¼0.006) and left (P¼0.02) hippocampi. The probability of non-response/non-remission was 68.6% for patients with a total hippocampal volume at least 10% lower than the average, and 47.1% for patients with a total hippocampal volume 10% higher than the average. Conclusions: In depressed patients treated with antidepressant drugs, smaller hippocampal volumes predict lower response/remission rates. [ABSTRACT FROM AUTHOR]

Background: Pioglitazone, a selective agonist of the nuclear transcription factor peroxisome proliferator-activated receptor-gamma (PPAR-γ), prescribed for the treatment of type 2 diabetes, could have antidepressant properties. However, its potential to induce remission of major depressive episodes, the optimal clinical target for an antidepressant drug, is a matter of concern. Indeed, only one out of four double-blind randomized controlled trials show higher remission rates with pioglitazone than with control treatments. Hence, the main aim of this study was to perform a meta-analysis of the efficacy of pioglitazone for the treatment of MDE, focusing on remission rates. Methods: Four double-blind randomized controlled trials, comprising 161 patients with an MDE, were included in this meta-analysis. Pioglitazone was studied either alone (one study) or as add-on therapy to conventional treatments (antidepressant drugs or lithium salts). It was compared either to placebo (three studies) or to metformin (one study). Remission was defined by a Hamilton Depression Rating Scale score <8 after treatment. Results: Pioglitazone could induce higher remission rates than control treatments (27% versus 10%, I2=17.3%, fixed-effect model: odds ratio [OR] =3.3, 95% confidence interval [95% CI; 1.4; 7.8], P=0.008). The OR was even higher in the subgroup of patients with major depressive disorder (n=80; 23% versus 8%, I2=0.0%; fixed-effect model: OR =5.9, 95% CI [1.6; 22.4], P=0.009) and in the subgroup of patients without metabolic comorbidities (n=84; 33% versus 10%, I2=0.0%; fixed-effect model: OR =5.1, 95% CI [1.5; 17.9], P=0.01). As compared to control treatments, results suggest six patients would need to be treated with pioglitazone in order to achieve the possibility of one more remission. Conclusion: Pioglitazone, either alone or as add-on therapy to conventional treatments, could induce remission of MDE, suggesting that drugs with PPAR-γ agonist properties may be true and clinically relevant antidepressants, even in patients without metabolic comorbidities. [ABSTRACT FROM AUTHOR]

Dear Editor, In their interesting paper, Wright and Caudill [[1]] highlight the importance of telemedicine in the context of the COVID-19 pandemic. In an anonymous survey I , i we assessed to which extent patients ( I n i = 1,732) and psychiatrists ( I n i = 27) of the area of the Mood Center Paris Saclay plan to continue with telepsychiatry in the post-COVID era. Since psychiatrists obtained data from their patients during the tele-consultations, the percentage of response was high: 95% of the patients responded to the survey. [Extracted from the article]

It is unclear whether pre-COVID medical conditions are risk factors for post-COVID major depressive episode (MDE). We aimed to determine which pre-COVID medical conditions are risk factors for post-COVID MDE after a hospitalization for COVID-19. We conducted a nested retrospective case-cohort study within a cohort of 650 patients evaluated six months after hospitalization for COVID-19 at Bicêtre hospital, France. Nine medical conditions present before COVID-19 (High blood pressure, obesity, type 2 diabetes, cardiac, respiratory and renal disease, immune deficiency, neoplasia and liver disease) were extracted from medical records. MDE was assessed using the Structured Clinical Interview for DSM-5 Disorders-Clinician Version (SCID-5-CV). Bivariate and multivariable analyses were performed to determine which pre-COVID medical conditions are independent risk factors for post-COVID new-onset MDE. Patients mean age was 62.8 (15.8), 258 (39.7 %) were women; 301 (46.3 %) had high blood pressure, 205 (32.4 %) had obesity, and 186 (28.6 %) had type 2 diabetes. Thirty-six (5.5 %) patients were diagnosed with a new-onset MDE. In contrast to other medical conditions, type 2 diabetes was significantly associated with new-onset MDE (OR = 2.51 [1.19–5.29]). Unlike other pre-COVID medical conditions, type 2 diabetes is a risk factor for post-COVID MDE. Patients with type 2 diabetes should be screened for MDE after a hospitalization for COVID-19. • Post-COVID major depression is frequent. • We evaluated 650 patients 6 months after COVID-19. • Pre-COVID somatic comorbidities and post-COVID depression were assessed. • Type 2 diabetes is a risk factor for new-onset post-COVID major depression. [ABSTRACT FROM AUTHOR]

Background: Despite the growing interest in the prevalence and consequences of loneliness, the way it is measured still raises a number of questions. In particular, few studies have directly compared the psychometric properties of very short measures of loneliness to standard measures., Methods: We conducted a large epidemiological study of midwife students ( n = 1742) and performed a head-to-head comparison of the psychometric properties of the standard (20 items) and short version (3 items) of the UCLA Loneliness Scales (UCLA-LS). All participants completed the UCLA-LS-20, UCLA-LS-3, as well as other measures of mental health, including anxiety and depression., Results: First, as predicted, we found that the two loneliness scales were strongly associated with each other. Second, when using the dimensional scores of the scales, we showed that the internal reliability, convergent-, discriminant-, and known-groups validities were high and of similar magnitude between the UCLA-LS-20 and the UCLA-LS-3. Third, when the scales were dichotomized, the results were more mixed. The sensitivity and/or specificity of the UCLA-LS-3 against the UCLA-LS-20 were systematically below acceptable thresholds, regardless of the dichotomizing process used. In addition, the prevalence of loneliness was strikingly variable as a function of the cut-offs used., Conclusions: Overall, we showed that the UCLA-LS-3 provided an adequate dimensional measure of loneliness that is very similar to the UCLA-LS-20. On the other hand, we were able to highlight more marked differences between the scales when their scores were dichotomized, which has important consequences for studies estimating, for example, the prevalence of loneliness.

Introduction: The 2019 coronavirus (COVID-19) pandemic has caused a public health crisis worldwide. Concerns have been expressed about the rapid deterioration of mental health among primary care physicians among whom burnout already had a high prevalence prior to the pandemic. However, there is little data on private doctors during the pandemic. France experienced a second wave with a second lockdown. We aimed to assess and compare physicians' burnout, anxiety and depression symptoms and insomnia between general practitioners (GP) and all other private specialists during the second Covid-19 wave., Methods: We conducted an online survey of private practitioners registered on Doctolib® (n=32,655), the interface software most used by private practitioners for booking medical appointments in France. Doctors were invited by email to complete an online survey in November 2020. Inclusions were closed on 1st December. The 2nd lockdown lasted from 30th October to 15th December 2020. We used the Copenhagen Burnout Inventory (CBI) to assess burnout syndrome. A mean score of>50 in at least one subscale defined burnout. The Hospital Anxiety and Depression Scale assessed anxiety and depression symptoms. We used two cut-offs, 8 (>7) and 11 (>10), as both are validated in the ability to find cases. The Insomnia Severity Index (ISI) measures sleep-related complaints among physicians (cut-off >7). To link variations in the psychological scales to the COVID-19 pandemic, one of the items asked explicitly whether participants considered that "the COVID-19 epidemic we are currently experiencing is a source of excess stress, psychological suffering or burnout". Approval for this study was obtained from the local institutional review board of the University of Paris-Saclay, France. The questionnaires were collected anonymously. Statistical significance was tested using the chi-square test and student's t-test to compare the prevalence between GPs and other specialities. Subsequently, logistic regression models were run for statistically significant associations., Results: 1992 physicians replied, a response rate of 12.8% of those who received the invitation email. Among them, 79.4% suffered from psychological distress (symptoms of anxiety or depression or burnout), of which 71.3% suffered from burnout, 26.7% from depressive symptoms, 58.9% from anxiety symptoms and 45.8% from insomnia. There was no difference in gender between GPs and specialists, but there was an age difference (P<0.001). GPs had a higher prevalence of burnout (OR=1.33 CI95 [1.09;1.63]) and took more psychotropic drugs (1.38 CI95 [1.05;1.81]). They were also more likely to perceive their stress as work-related (OR=1.50 CI95 [1.23;1.81]) or COVID-19-related (OR=1.43 CI95 [1.16;1.77])., Conclusion: Our study is the first to assess the mental health of private practitioners in the second wave in association with COVID-19 stress. Firstly, GPs who provide primary care have a significantly higher burnout rate than other doctors. Secondly, COVID-19 stress is associated with more significant psychological distress. Thirdly, almost 80% of the private doctors surveyed suffer from psychological pain, and 71% suffer from burnout. This study has strengths and limitations. Firstly, this study assesses mental health and stress related to its COVID-19 association. Second, this is the largest population of private physicians during the COVID-19 pandemic. The low response rate is the main limit of this study. The alarming rates of psychological distress among private doctors and, in particular, GPs should lead to intervention to help doctors reduce stress, burnout and other mental disorders. This study gives a picture of the situation during the second wave and the lock-in, and we need to be cautious with the next waves., (Copyright © 2023 L'Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.)

In the aftermath of acute infection with the severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2), a large number of symptoms persist or appear, constituting a real syndrome called "long COVID-19" or "post-COVID- 19" or "post-acute COVID-19 syndrome". Its incidence is very high, half of patients showing at least one symptom at 4-6 months after Coronarovirus infectious disease 2019 (COVID-19). They can affect many organs. The most common symptom is persistent fatigue, similar to that seen after other viral infections. Radiological pulmonary sequelae are relatively rare and not extensive. On the other hand, functional respiratory symptoms, primarily dyspnoea, are much more frequent. Dysfunctional breathing is a significant cause of dyspnoea. Cognitive disorders and psychological symptoms are also very common, with anxiety, depression and post-traumatic stress symptoms being widely described. On the other hand, cardiac, endocrine, cutaneous, digestive or renal sequelae are rarer. The symptoms generally improve after several months, even if their prevalence at two years remains significant. Most of the symptoms are favored by the severity of the initial illness, and the psychic symptoms by the female sex. The pathophysiology of most symptoms is poorly understood. The influence of the treatments used in the acute phase is also important. Vaccination, on the other hand, seems to reduce their incidence. The sheer number of affected patients makes long-term COVID-19 syndrome a public health challenge., (© 2023 Published by Elsevier Masson SAS on behalf of l'Académie nationale de médecine.)

Background: Dyspnoea is a common persistent symptom after COVID-19. Whether it is associated with functional respiratory disorders remains unclear., Methods: We assessed the proportion and characteristics of patients with "functional respiratory complaints" (FRCs) (as defined by Nijmegen Questionnaire >22) among 177 post-COVID-19 individuals who benefited from outclinic evaluation in the COMEBAC study ( i.e. , symptomatic and/or intensive care unit (ICU) survivors at 4 months). In a distinct explanatory cohort of 21 consecutive individuals with unexplained post-COVID-19 dyspnoea after routine tests, we also analysed the physiological responses to incremental cardiopulmonary exercise testing (CPET)., Findings: In the COMEBAC cohort, 37 patients had significant FRCs (20.9%, IC95: 14.9-26.9). The prevalence of FRCs ranged from 7.2% (ICU patients) to 37.5% (non-ICU patients). The presence of FRCs was significantly associated with more severe dyspnoea, lower 6-min walk distance, more frequent psychological and neurological symptoms (cognitive complaint, anxiety, depression, insomnia and post-traumatic stress disorders) and poorer quality of life (all p<0.01). In the explanatory cohort, seven out of 21 patients had significant FRCs. Based on CPET, dysfunctional breathing was identified in 12 out of 21 patients, five out of 21 had normal CPET, three out of 21 had deconditioning and one out of 21 had evidence of uncontrolled cardiovascular disease., Interpretation: FRCs are common during post-COVID-19 follow-up, especially among patients with unexplained dyspnoea. Diagnosis of dysfunctional breathing should be considered in those cases., Competing Interests: Conflict of interest: A. Beurnier reports personal fees from Sanofi and AstraZeneca, outside the submitted work. Conflict of interest: L. Savale reports personal fees and nonfinancial support from Janssen and MSD, and grants, personal fees and nonfinancial support from GSK, outside the submitted work. Conflict of interest: X. Jaïs reports grants and personal fees from Janssen, grants and personal fees from MSD, and grants from Bayer and GSK, outside the submitted work. Conflict of interest: T. Gille reports personal fees from Roche SAS, and other support from Oxyvie (oxygen provider), Vivisol France (oxygen provider) and Menarini France, outside the submitted work. Conflict of interest: O. Sitbon reports grants from Acceleron, AOP Orphan, Janssen, GSK and MSD; consulting fees from Altavant, Gossamer Bio, Janssen and MSD; lecture honoraria from AOP Orphan, Janssen, Ferrer and MSD; and participation on advisory boards for Acceleron, Altavant, Gossamer Bio, Janssen, MSD and Ferrer, all outside the submitted work. Conflict of interest: Marc Humbert reports grants from Acceleron, AOP Orphan, Janssen, Merck and Shou Ti; consulting fees from Acceleron, Aerovate, Altavant, AOP Orphan, Bayer, Chiesi, Ferrer, Janssen, Merck, MorphogenIX, Shou Ti and United Therapeutics; lecture honoraria from Janssen and Merck; and advisory board participation for Acceleron, Altavant, Janssen, Merck and United Therapeutics, all outside the submitted work. Conflict of interest: D. Montani reports grants from Acceleron, Janssen and Merck; consulting fees from Acceleron; and lecture honoraria from Bayer, Janssen and Merck, all outside the submitted work. Conflict of interest: All other authors have nothing to disclose., (Copyright ©The authors 2023.)

Objective: Psychiatric symptoms and mental disorders are common after Coronavirus Disease-19 (COVID-19). Some drugs used to treat acute COVID-19 have psychiatric side effects. We assessed the psychiatric symptoms and mental disorders of patients treated for acute COVID-19 with hydroxychloroquine (HCQ), interleukin-6 receptor antagonists (anti-IL-6), and corticoids (CTC)., Methods: We evaluated 177 patients in a day hospital 4 months after acute infection., Results: In a multivariate analysis, HCQ was associated with significant anxiety symptoms (odds ratio [OR] = 5.9, 95% confidence interval [95% CI] = 1.8-20.0, p = 0.003) and mental disorders (OR = 4.1, 95% CI = 1.2-13.9, p = 0.02). In a bivariate analysis with propensity matched cohorts, HCQ was associated with significant anxiety symptoms (9 patients [50.0%] with significant symptoms in the HCQ group versus 15 [20.1%] in the control group, OR = 3.8, 95% CI = 1.3-11.3, p = 0.01). Anti-IL-6 and CTC were not associated with significant psychiatric symptoms or mental disorders., Conclusion: We recommend monitoring psychiatric symptoms, especially anxiety, in patients treated with HCQ during COVID-19 infection. Further studies with larger samples and prospective assessments are needed to confirm our results.