UNASSIGNED: Despite the availability of effective antidepressant strategies, numerous people with depressive disorders remain untreated. The Covid-19 pandemic has affected healthcare services, especially the mental health sector. This study aims to explore the coverage of depression treatments in the general Spanish population and the impact of the Covid-19 pandemic.
UNASSIGNED: We used longitudinal data (2018 and 2022) from the general Spanish population: pre-pandemic n = 1512; mean age = 65.43 years ± 14.90; 56 % females; post-pandemic n = 909; mean age = 68.00 years ± 14.24; 54 % women. The International Classification of Disease 10th edition was used to diagnose lifetime depressive episodes and severity. We explored psychological and pharmacological treatment coverage via multiple logistic regressions adjusted for 4 covariates (sex assigned at birth, education level, age, Covid-19 pandemic) for participants with a diagnosis of depression.
UNASSIGNED: Treatment coverage for depression in the pre-pandemic and post-pandemic samples was, respectively, 53.3 % and 51.9 %. We observed an association between severe depression and treatment coverage (OR = 2.77, 95%CI 1.05 to 7.75). We found no association between the COVID-19 pandemic and treatment coverage.
UNASSIGNED: The pharmacological treatment coverage was associated with severe types of depression. The prevalence rates of treatment coverage were similar in the pre- and post-COVID-19 pandemic attesting to the resilience of the mental health system in Spain.

Previous studies have highlighted the pivotal role of emotional regulation impairment in the progression of depressive and insomnia disorders, individually. Nevertheless, to date, no study has undertaken a direct comparison of the emotional profiles in individuals experiencing insomnia with or without major depressive episode (MDE). In this study, our objective was to closely examine multiple aspects of emotional regulation among individuals experiencing insomnia, with or without concurrent depression. This descriptive observational study involved 57 participants, comprising 27 individuals with comorbid chronic insomnia and MDE, and 30 with chronic insomnia alone. All participants completed self-questionnaires assessing aspects of emotional regulation: the Affect Intensity Measure (intensity), Affective Lability Scale (lability), Temperament Evaluation of Memphis Pisa Paris and San Diego Autoquestionnaire (temperament), Cognitive Emotion Regulation Questionnaire (cognitive strategies), and Multidimensional Assessment of Thymic States (reactivity). There were statistically significant differences between the group with insomnia with MDE and insomnia without MDE in terms of anxiety/depression lability. Discrepancies also manifested in terms of activation or inhibition in motor activity and motivation. Additionally, a noteworthy variance in cognitive strategies for emotional regulation was observed, specifically in self-blame and catastrophising. From a cognitive perspective, patients with insomnia and a MDE exhibited a greater inclination towards self-blame and catastrophising, in contrast to those with insomnia only. Behaviourally, the former group demonstrated heightened inhibition of motivation and motor activity. These findings underscore the importance of larger-scale investigations to validate these insights and pave the way for clinical prospects centred around emotional regulation, ultimately fostering personalised treatments for insomnia.

OBJECTIVE: Because of similar clinical manifestations, bipolar disorder (BD) patients are often misdiagnosed as major depressive disorder (MDD). This study aimed to compare the difference between depressed patients later converting to BD and unipolar depression (UD) according to diffusion tensor imaging (DTI).
METHODS: Patients with MDD (562 participants) in depressive episode states and healthy controls (HCs) (145 participants) were recruited over 10 years. Demographic and magnetic resonance imaging (MRI) data were collected at the time of recruitment. All patients with MDD were followed up for 5 years and classified into the transfer to BD (tBD) group (83 participants) and UD group (160 participants) according to the follow-up results. DTI and functional magnetic resonance imaging at baseline were compared.
RESULTS: Common abnormalities were found in both tBD and UD groups, including left superior cerebellar peduncle (SCP.L), right anterior limb of the internal capsule (ALIC.R), right superior fronto-occipital fasciculus (SFOF.R), and right inferior fronto-occipital fasciculus (IFOF.R). The tBD showed more extensive abnormalities than the UD in the body of corpus callosum, fornix, left superior corona radiata, left posterior corona radiata, left superior longitudinal fasciculus, and left superior fronto-occipital fasciculus.
CONCLUSIONS: The study demonstrated the common and distinct abnormalities of tBD and UD when compared to HC. The tBD group showed more extensive disruptions of white matter integrity, which could be a potential biomarker for the early identification of BD.

OBJECTIVE: Bipolar disorder (BD) is often misdiagnosed as major depressive disorder (MDD) in the early stage, which may lead to inappropriate treatment. This study aimed to characterize the alterations of spontaneous neuronal activity in patients with depressive episodes whose diagnosis transferred from MDD to BD.
METHODS: 532 patients with MDD and 132 healthy controls (HCs) were recruited over 10 years. During the follow-up period, 75 participants with MDD transferred to BD (tBD), and 157 participants remained with the diagnosis of unipolar depression (UD). After excluding participants with poor image quality and excessive head movement, 68 participants with the diagnosis of tBD, 150 participants with the diagnosis of UD, and 130 HCs were finally included in the analysis. The dynamic amplitude of low-frequency fluctuations (dALFF) of spontaneous neuronal activity was evaluated in tBD, UD and HC using functional magnetic resonance imaging at study inclusion. Receiver operating characteristic (ROC) analysis was performed to evaluate sensitivity and specificity of the conversion prediction from MDD to BD based on dALFF.
RESULTS: Compared to HC, tBD exhibited elevated dALFF at left premotor cortex (PMC_L), right lateral temporal cortex (LTC_R) and right early auditory cortex (EAC_R), and UD showed reduced dALFF at PMC_L, left paracentral lobule (PCL_L), bilateral medial prefrontal cortex (mPFC), right orbital frontal cortex (OFC_R), right dorsolateral prefrontal cortex (DLPFC_R), right posterior cingulate cortex (PCC_R) and elevated dALFF at LTC_R. Furthermore, tBD exhibited elevated dALFF at PMC_L, PCL_L, bilateral mPFC, bilateral OFC, DLPFC_R, PCC_R and LTC_R than UD. In addition, ROC analysis based on dALFF in differential areas obtained an area under the curve (AUC) of 72.7%.
CONCLUSIONS: The study demonstrated the temporal dynamic abnormalities of tBD and UD in the critical regions of the somatomotor network (SMN), default mode network (DMN), and central executive network (CEN). The differential abnormal patterns of temporal dynamics between the two diseases have the potential to predict the diagnosis transition from MDD to BD.

OBJECTIVE: To study the phenomenon of impulsivity, its components and aggression in patients at risk for schizophrenia at the stage of remission after the first depressive episode.
METHODS: Forty-eight male patients (mean age 19.4±2.9 years) with the first depressive episode (ICD-10 F32.1, F32.2) with attenuated positive, negative and/or disorganized symptoms were examined. According to the severity of impulsivity, the patients were divided into the clinical group (n=26) with pathological impulsivity and the comparison group (n=27) without it. The control group consisted of 41 mentally healthy young men, students of higher education of 1-3 courses, (mean age 19.7±1.6 years). HDRS, SOPS, SANS, Barratt Impulsiveness Scale (BIS-11) and Buss Perry Aggression Questionnaire (BPAQ) were used. Statistical analysis was carried out using the Statistica 12 software.
RESULTS: The differences between the clinical group and the comparison group were determined by the total score of the subscale of general symptoms of SOPS at admission (53 [41.75; 56] and 45.5 [41.75; 51.25], respectively) (U=187.5; p=0.037) and at discharge (28 [19; 37] and 25 [17.75; 29.25] points respectively) (U=166.5; p=0.012), according to the total HDRS score at admission (35 [31; 38] and 29 [26; 34.25]) (U=191.0; p=0.046). In the clinical group, the motor component of impulsivity and the factor of general impulsivity on the BIS-11 correlated with the severity of aggression on the BPAQ (r=0.395, p<0.05 and r=0.635, p<0.05, respectively). Significant differences were revealed in the clinical group depending on the presence of negative symptoms on the corresponding SOPS subscale according to the total BPAQ score (p=0.01). Correlation analysis showed numerous connections: positive between the total aggressiveness score and the duration of depression (p<0.05), negative between the factors of self-control, consistency, attention, and total scores on the SANS and SOPS (p<0.05).
CONCLUSIONS: We identify the differences in the structure of impulsivity in patients at risk of developing schizophrenia at the stage of remission after the first depressive state, the comparison group and the control group, as well as the relationship of impulsivity factors with individual clusters of psychopathological disorders.
UNASSIGNED: Изучение феномена импульсивности, ее составляющих и агрессии у больных из группы риска развития шизофрении на этапе становления ремиссии после перенесенного первого депрессивного эпизода.
UNASSIGNED: Обследованы 48 больных мужского пола (19,4±2,9 года), впервые госпитализированных в клинику ФГБНУ НЦПЗ с первым депрессивным состоянием, отвечающим диагностическим критериям F32.1 и F32.2 по МКБ-10 с аттенуированными позитивными, негативными симптомами и/или симптомами дезорганизации. По степени выраженности импульсивности больные разделены на две группы: клиническую (n=26) — с патологической импульсивностью, группу сравнения (n=27) — без нее. Группа контроля — 41 психически здоровый юноша (19,7±1,6 года) из числа студентов высших учебных заведений 1—3-го курса. Применялись психометрические шкалы HDRS, SOPS, SANS, опросники Барратта и Басса—Перри.
UNASSIGNED: Уставлены различия между клинической группой и группой сравнения по суммарному баллу подшкалы общих симптомов SOPS при поступлении (53 [41,75; 56] и 45,5 [41,75; 51,25] соответственно) (U=187,5; p=0,037) и при выписке (28 [19; 37] и 25 [17,75; 29,25] баллов соответственно) (U=166,5; p=0,012), по суммарному баллу по шкале HDRS при поступлении (35 [31; 38] и 29 [26; 34,25]) (U=191,0; p=0,046). В клинической группе моторный компонент импульсивности и фактор общей импульсивности по шкале Барратта коррелировали с выраженностью агрессии по шкале Басса—Перри (r=0,395, p<0,05 и r=0,635, p<0,05 соответственно). Выявлены достоверные различия в клинической группе в зависимости от наличия негативных симптомов по соответствующей подшкале SOPS по суммарному баллу шкалы Басса—Перри (p=0,01). Корреляционный анализ показал многочисленные связи: положительные — между суммарным баллом агрессивности и длительностью депрессии (p<0,05), отрицательные — между факторами самоконтроля, последовательности, внимания, и между общими баллами по шкалам SANS и SOPS (p<0,05).
UNASSIGNED: Выявлены различия по структуре импульсивности у больных из группы риска развития шизофрении на этапе становления ремиссии после перенесенного первого депрессивного состояния, группы сравнения и контроля, а также связь факторов импульсивности с отдельными кластерами психопатологических расстройств.

OBJECTIVE: To conduct an exploratory analysis of comorbidity patterns and the structure of depressive episodes among Russian patients with bipolar disorder (BD) and major depressive disorder (MDD).
METHODS: This multicenter cross-sectional study included 178 patients with mood disorders, of which 78.1% (n=139) were women. The diagnosis of BD was made in 68.0% (n=121) patients, of them 37.1% (n=66) were diagnosed with BD type I. All study participants underwent a structured Mini International Neuropsychiatric Interview to verify the clinical diagnosis and identify concomitant mental disorders, and also filled out an electronic case report form. Statistical analysis was performed in RStudio v. 1.4.1717 using the standard R package and the «psych» package.
RESULTS: According to the results of stepwise regression, comorbid diagnoses of panic disorder (OR=5.3; 95% CI 1.9-19.1) and eating disorders (OR=7.7; 95% CI 2.8-27.4) were more associated with BD. In addition, depressive episodes in BD were more associated with symptoms of hypersomnia (OR=2.5; 95% CI 1.2-5.3) and psychomotor retardation (OR=3.2; 95% CI 1.5-7.6). Symptoms such as increased appetite (47.1% (n=57) vs 26.3% (n=15); p=0.009), ideas of guilt (92.6% (n=112) vs 7.2% (n=44); p=0.006) and thoughts of self-harm or death (70.2% (n=85) vs 45.6% (n=25); p=0.003) were also nominally more common in depressive episodes within the BD compared to MDD.
CONCLUSIONS: Mood disorders such as BD and MDD have significant differences in the patterns of comorbidity and the structure of depressive episodes, which is important to consider when conducting differential diagnosis of these disorders. The results also indicate the need for a comprehensive diagnostic interview with patients with mood disorders to assess the presence of comorbid mental disorders during life and the structure of depressive episodes throughout the clinical course from the moment of onset.
UNASSIGNED: Проведение разведочного анализа паттернов коморбидности и структуры депрессивных эпизодов (ДЭ) у российских пациентов с биполярным аффективным расстройством (БАР) и рекуррентным депрессивным расстройством (РДР).
UNASSIGNED: В данное мультицентровое кросс-секционное исследование включены 178 пациентов с расстройствами настроения, из которых 78,1% (n=139) женщины. Диагноз БАР диагностирован у 68,0% (n=121) пациентов, из них с БАР I типа — у 37,1% (n=66). Все участники исследования проходили структурированное интервью Mini International Neuropsychiatric Interview для верификации клинического диагноза и выявления сопутствующих психических расстройств, а также заполняли электронную карту исследования. Статистический анализ проводился в RStudio v. 1.4.1717 с использованием стандартного пакета R и пакета psych.
UNASSIGNED: Согласно результатам пошаговой регрессии, с БАР в большей степени были ассоциированы коморбидные диагнозы панического расстройства (OR=5,3; 95% ДИ 1,9—19,1) и расстройств пищевого поведения (OR=7,7; 95% ДИ 2,8—27,4). Кроме того, ДЭ при БАР в большей степени были ассоциированы с симптомами гиперсомнии (OR=2,5; 95% ДИ 1,2—5,3) и психомоторной заторможенности (OR=3,2; 95% ДИ 1,5—7,6). Такие симптомы, как повышенный аппетит (47,1% (n=57) против 26,3% (n=15); p=0,009), идеи вины (92,6% (n=112) против 77,2% (n=44); p=0,006) и мысли о самоповреждениях или смерти (70,2% (n=85) против 45,6% (n=25); p=0,003), также номинально чаще встречались при ДЭ в рамках БАР в сравнении с РДР.
UNASSIGNED: Такие расстройства настроения, как БАР и РДР, имеют значимые различия в паттернах коморбидности и структуре ДЭ, что важно учитывать при проведении дифференциальной диагностики данных расстройств. Полученные результаты также указывают на необходимость проведения всеобъемлющего диагностического интервью с пациентами с расстройствами настроения для оценки наличия коморбидных психических расстройств в течение жизни и структуры ДЭ на протяжении всего клинического течения с момента манифеста.

Nowadays, nervous tissue damage proteins in serum are considered promising drug targets and biomarkers of Mood Disorders. In a cross-sectional naturalistic study, the S100B, MBP and GFAP levels in the blood serum were compared between two diagnostic groups (patients with Depressive Episode (DE, n = 28) and patients with Recurrent Depressive Disorder (RDD, n = 21)), and healthy controls (n = 25). The diagnostic value of serum markers was assessed by ROC analysis. In the DE group, we did not find changed levels of S100B, MBP and GFAP compared with controls. In the RDD group, we found decreased S100B level (p = 0.011) and increased MBP level (p = 0.015) in comparison to those in healthy controls. Provided ROC analysis indicates that MBP contributes to the development of a DE (AUC = 0.676; 95%Cl 0.525-0.826; p = 0.028), and S100B and MBP have a significant effect on the development of RDD (AUC = 0.732; 95%Cl 0.560-0.903; p = 0.013 and AUC = 0.712; 95%Cl 0.557-0.867; p = 0.015, correspondingly). The study of serum markers of nervous tissue damage in patients with a current DE indicates signs of disintegration of structural and functional relationships, dysfunction of gliotransmission, and impaired secretion of neurospecific proteins. Modified functions of astrocytes and oligodendrocytes are implicated in the pathophysiology of RDD.

Post-traumatic stress (PTSD) disorder is a mental health condition that can occur after experiencing or witnessing a traumatic event. The 27-F earthquake that struck Chile in 2010 was one such event that had a significant impact on the mental health of the population. A study was conducted to investigate the prevalence of PTSD and its associated factors among survivors of this earthquake. The study was a longitudinal design, involving a sample of 913 patients aged 18 to 75 years who attended 10 Primary Care Centers in Concepción, Chile. The Composite International Diagnostic Interview (CIDI) was used to assess both depressive episodes (DE) and PTSD before and after the earthquake. The study also involved genotyping studies using saliva samples from the participants, specifically focusing on the Val66Met and 5-HTTLPR polymorphisms. Statistical analysis was performed to examine the association between different variables and the presence of PTSD. These variables included demographic factors, family history of psychiatric disorders, DE, childhood maltreatment experiences, and critical traumatic events related to the earthquake. The results showed that the incidence of post-earthquake PTSD was 11.06%. No significant differences were found between the groups of participants who developed post-earthquake PTSD regarding the Val66Met or 5-HTTLPR polymorphisms. However, a significant association was found between the concomitant diagnosis of DE and the development of post-earthquake PTSD. The presence of DE doubled the risk of developing post-earthquake PTSD. The number of traumatic events experienced also had a statistically significant association with an increased risk of developing post-earthquake PTSD. The study\'s limitations include the potential interference of different DE subtypes, the complexity of quantifying the degree of earthquake exposure experienced by each individual, and events entailing social disruption, such as looting, that can profoundly influence distress. In conclusion, the study found that PTSD following the 27-F earthquake in Chile was associated with a concomitant diagnosis of DE and the number of traumatic events experienced. The study did not find a significant association between PTSD and the Val66Met or 5-HTTLPR polymorphisms. The researchers recommend that mental health professionals should prioritize the detection and treatment of concomitant depressive episodes and exposure to critical traumatic events in survivors of disasters. They also suggest that further research is needed to better understand the relationship between genetic factors and post-disaster PTSD.

Depression is a major cause of disability worldwide. Screening in at-risk populations is important in identifying those at most need of treatment. Pengpid et al report on high rates of incident and persistent symptoms of depression identified in an epidemiological study in a Thai population and their association with physical comorbidities. However, there are limitations to screening, due to both resource implications and the risk of diagnostic overshadowing. Although screening is useful in providing an overview of the prevalence of depressive symptoms from an epidemiological perspective, there may be justified concerns in translating this approach to clinical settings. This is especially true where the resources to provide further comprehensive assessment and treatment may be inadequate. Clinically there is a need to consider a more complete approach to screening that utilises screening tools embedded in a wider diagnostic approach which allows the detection and management of other confounding conditions.

This meta-analysis of randomized controlled trials (RCTs) evaluated the overall efficacy and safety of bilateral theta-burst stimulation (TBS) as an intervention for patients with mood disorders.
A systematic search (up to December 7, 2022) of RCTs was conducted to address the study aims. A random-effects meta-analysis was performed by including study-defined responses and remission as primary outcomes.
Analyses included six RCTs comprising 285 participants with major depressive disorder (MDD) (n = 233) or a depressive episode in the course of bipolar disorder (BD) (n = 52) who had undergone active bilateral TBS (n = 142) versus sham stimulation (n = 143). Active bilateral TBS outperformed sham stimulation with respect to study-defined improvements (55.1 % versus 20.3 %, 4 RCTs, n = 152, 95%CI: 1.63 to 4.39, P < 0.0001; I2 = 0 %) and remission rates (37.2 % versus 14.3 %, 2 RCTs, n = 85, 95%CI: 1.13 to 5.95, P = 0.02; I2 = 0 %) in MDD patients but not those with bipolar or unipolar mixed depression. Superiority of active bilateral TBS over sham stimulation was confirmed for improvements in depressive symptoms at post-bilateral TBS assessments and 8-week follow-ups in patients with either MDD or mixed depression (all P < 0.05). Discontinuation rates due to any reason and adverse events (i.e., headache, dizziness) were similar between TBS and sham stimulation groups with MDD or mixed depression (all P > 0.05).
Bilateral TBS targeting the dorsolateral prefrontal cortex (DLPFC) appears to be a well-tolerated form of repetitive transcranial magnetic stimulation (rTMS) that has substantial antidepressant effects, particularly in patients with MDD. Effects of bilateral TBS on bipolar and unipolar mixed depression should be further investigated.