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Neuromodulation therapies and treatment-resistant depression
Al-Harbi KS, Qureshi NA
Medical Devices: Evidence and Research , 2012, DOI: http://dx.doi.org/10.2147/MDER.S33198
Abstract: romodulation therapies and treatment-resistant depression Review (1866) Total Article Views Authors: Al-Harbi KS, Qureshi NA Published Date July 2012 Volume 2012:5 Pages 53 - 65 DOI: http://dx.doi.org/10.2147/MDER.S33198 Received: 22 April 2012 Accepted: 13 May 2012 Published: 13 July 2012 Khalid Saad Al-Harbi,1 Naseem Akhtar Qureshi2 1National Guard Hospital, King Abdulaziz Medical City, Riyadh, Saudi Arabia; 2General Administration for Research and Studies and Mental Health and Social Services, Riyadh, Saudi Arabia Background: Patients with treatment-resistant depression (TRD) who showed partial response to pharmacological and psychotherapeutic interventions need a trial of neuromodulation therapies (NTs). Objective: This paper aims to review evidence-based data on the use of NTs in TRD. Method: Using keywords and combined-word strategy, multiple computer searches of PubMed, Google Scholar, Quertle(R), and Medline were conducted for retrieving relevant articles published in English-language peer-reviewed journals (2000–2012). Those papers that addressed NTs in TRD were retained for extensive review. Results: Despite methodological challenges, a range of 30%–93% of TRD patients showed substantial improvement to one of the NTs. One hundred–percent improvement was reported in two single-case studies on deep brain stimulation. Some studies reported no benefits from transcranial direct current stimulation. NTs were reported to have good clinical efficacy, better safety margin, and benign side-effect profile. Data are limited regarding randomized clinical trials, long-term efficacy, and cost-effectiveness of these approaches. Both modified electroconvulsive therapy and magnetic seizure therapy were associated with reversible but disturbing neurocognitive adverse effects. Besides clinical utility, NTs including approaches on the horizon may unlock the biological basis underlying mood disorders including TRD. Conclusion: NTs are promising in patients with TRD, as the majority of them show good clinical response measured by standardized depression scales. NTs need further technological refinements and optimization together with continuing well-designed studies that recruit larger numbers of participants with TRD.
Neuromodulation therapies and treatment-resistant depression
Al-Harbi KS,Qureshi NA
Medical Devices: Evidence and Research , 2012,
Abstract: Khalid Saad Al-Harbi,1 Naseem Akhtar Qureshi21National Guard Hospital, King Abdulaziz Medical City, Riyadh, Saudi Arabia; 2General Administration for Research and Studies and Mental Health and Social Services, Riyadh, Saudi ArabiaBackground: Patients with treatment-resistant depression (TRD) who showed partial response to pharmacological and psychotherapeutic interventions need a trial of neuromodulation therapies (NTs).Objective: This paper aims to review evidence-based data on the use of NTs in TRD.Method: Using keywords and combined-word strategy, multiple computer searches of PubMed, Google Scholar, Quertle(R), and Medline were conducted for retrieving relevant articles published in English-language peer-reviewed journals (2000–2012). Those papers that addressed NTs in TRD were retained for extensive review.Results: Despite methodological challenges, a range of 30%–93% of TRD patients showed substantial improvement to one of the NTs. One hundred–percent improvement was reported in two single-case studies on deep brain stimulation. Some studies reported no benefits from transcranial direct current stimulation. NTs were reported to have good clinical efficacy, better safety margin, and benign side-effect profile. Data are limited regarding randomized clinical trials, long-term efficacy, and cost-effectiveness of these approaches. Both modified electroconvulsive therapy and magnetic seizure therapy were associated with reversible but disturbing neurocognitive adverse effects. Besides clinical utility, NTs including approaches on the horizon may unlock the biological basis underlying mood disorders including TRD.Conclusion: NTs are promising in patients with TRD, as the majority of them show good clinical response measured by standardized depression scales. NTs need further technological refinements and optimization together with continuing well-designed studies that recruit larger numbers of participants with TRD.Keywords: treatment-resistant depression, neuromodulation therapies, modified electroconvulsive therapy, deep brain stimulation, transcranial direct current stimulation, magnetic seizure therapy
Pharmacological strategies in treatment-resistant depression
AO Alao, K Malhotra, R Pies, MJ Dewan
West African Journal of Medicine , 2003,
Abstract: Treatment-resistant depression may be due to factors such as co-morbid psychiatric or medical illnesses, chronic psychosocial stresses, and medication nonadherence. Alternative treatment strategies such as optimization, switching to a different antidepressant, augmentation or combination with another antidepressant are strategies useful in such patients. The first strategy in treating resistant depression is to optimize monotherapy. A switch should be made to another agent if there is no response to treatment after an adequate duration. Augmentation and combination strategies are useful if there is sub-optimal response to the initial antidepressant. With several antidepressants (selective serotonin reuptake inhibitors, tricyclic antidepressants, monoamine oxidase inhibitors and the newer antidepresssants) and various antidepressant augmentation and combination strategies available to clinicians, the outcome of treating patients with depression should improve.
Big Data Computing and Clouds: Trends and Future Directions  [PDF]
Marcos D. Assuncao,Rodrigo N. Calheiros,Silvia Bianchi,Marco A. S. Netto,Rajkumar Buyya
Computer Science , 2013, DOI: 10.1016/j.jpdc.2014.08.003
Abstract: This paper discusses approaches and environments for carrying out analytics on Clouds for Big Data applications. It revolves around four important areas of analytics and Big Data, namely (i) data management and supporting architectures; (ii) model development and scoring; (iii) visualisation and user interaction; and (iv) business models. Through a detailed survey, we identify possible gaps in technology and provide recommendations for the research community on future directions on Cloud-supported Big Data computing and analytics solutions.
Clinical and therapeutic management in postpartum depression
Lidia Nica UDANGIU,Mona MOLDOVAN,Eduard Petru MO?OESCU,Crina PAPUC
Management in Health , 2010,
Abstract: Postpartum depression (PPD) is a mental disorder commonly encountered in mothers, but also in their partners in the first months after birth. Early recognition of the signs and symptoms of this disease by the medical staff in the department of obstetrics and gynecology or by the generalist practitioner and an appropriate treatment determines a favorable outcome of the mother and an optimal development for the newborn. We discuss the need for a prenatal screening, in order to detect women at risk of developing this condition and the need to monitor them in the first months after birth.
Depression: Theory, assessment, and new directions in practice
E. Thomas Dowd
International Journal of Clinical and Health Psychology , 2004,
Abstract: Este artículo describe el fenómeno de la depresión y el uso de la terapia cognitiva como tratamiento. Se explora la naturaleza de la depresión, la terapia cognitiva,así como instrumentos de evaluación cognitiva. La depresión se muestra en cinco manifestaciones diferentes (emocional, cognitiva, motivacional, vegetativa y física, y delusoria), aunque es la manifestación emocional la que solemos considerar como depresión. Tres niveles de cognición son discutidos: autoverbalizaciones, distorsiones cognitivas y creencias cognitivas. La modificación de autoverbalizaciones (o contenido cognitivo) se enfoca en la evaluación y en el cambio de los actuales pensamientos automáticos. Las distorsiones cognitivas (o procesos cognitivos) son errores sistemáticos de la lógica y el razonamiento que dan resultado a pensamientos negativos automáticos. Las creencias cognitivas o esquemas son grupos de autoverbalizaciones cognitivas basadas en uno o más temas y que también se refieren a creencias condicionales o estructuras de conocimiento táctico. Se describen diversos instrumentos de evaluación cognitiva de la depresión: Automatic Thoughts Questionnaire, Beck Depression Inventory, Dysfunctional Attitude Scale, etc. Se presenta una gran variedad de intervenciones terapéuticas para superar la depresión y se advierte al lector que la pauta de recaída de la depresión es alta.
An overview of Brazilian mammalogy: trends, biases and future directions
Brito, Daniel;Oliveira, Leonardo C.;Oprea, Monik;Mello, Marco A. R.;
Zoologia (Curitiba) , 2009, DOI: 10.1590/S1984-46702009000100011
Abstract: mammals are among the most charismatic and well-studied organisms, and brazil harbors the largest mammal diversity of the world. the brazilian society of mammalogy was established in 1985, and since 2001 it organizes the brazilian congress of mammalogy. we used the proceedings of all three editions of this congress together with papers indexed in web of science and scielo to evaluate trends in brazilian mammalogy. all contributions were categorized according to mammalian order, biome, topic of research and state of authors' affiliation. our results show that mammalian orders with higher species richness receive more attention, but the ranking is different between abstracts and papers. higher species richness did not translate into more attention for more speciose biomes, and again the ranking was different between papers and abstracts. there are research topics that receive much higher attention than others, and also other important ones, like taxonomy, that have been neglected. states with greater human populations produce both more papers and abstracts. we conclude that the higher number of publication in the atlantic forest is caused by the concentration of mammalogists in the south and southeastern regions of the country. contrary to what is normally believed, mammalian orders received attention according to their species richness, and not their charisma, probably because richer orders provide more study models. we suggest that additional funding mechanisms should be set in place in order to encourage more research on mammalian orders, topics, and states which have been neglected so far, in order to improve the knowledge on important brazilian mammal biodiversity.
Pharmacological and therapeutic directions in ADHD: Specificity in the PFC
Florence Levy
Behavioral and Brain Functions , 2008, DOI: 10.1186/1744-9081-4-12
Abstract: The actions of dopaminergic vs noradrenergic agents, currently available for the treatment of ADHD have overlapping, but different actions in the prefrontal cortex (PFC) and subcortical centers. While stimulants act on D1 receptors in the dorsolateral prefrontal cortex, they also have effects on D2 receptors in the corpus striatum and may also have serotonergic effects at orbitofrontal areas. At therapeutic levels, dopamine (DA) stimulation (through DAT transporter inhibition) decreases noise level acting on subcortical D2 receptors, while NE stimulation (through alpha-2A agonists) increases signal by acting preferentially in the PFC possibly on DAD1 receptors. On the other hand, alpha-2A noradrenergic transmission is more limited to the prefrontal cortex (PFC), and thus less likely to have motor or stereotypic side effects, while alpha-2B and alpha-2C agonists may have wider cortical effects. The data suggest a possible hierarchy of specificity in the current medications used in the treatment of ADHD, with guanfacine likely to be most specific for the treatment of prefrontal attentional and working memory deficits. Stimulants may have broader effects on both vigilance and motor impulsivity, depending on dose levels, while atomoxetine may have effects on attention, anxiety, social affect, and sedation via noradrenergic transmission.At a theoretical level, the advent of possible specific alpha-2A noradrenergic therapies has posed the question of the role of working memory in ADHD. Head to head comparisons of stimulant and noradrenergic alpha-2A, alpha-2B and alpha-2C agonists, utilizing vigilance and affective measures should help to clarify pharmacological and therapeutic differences.Recent directions in the treatment of ADHD have involved both a broadening of pharmacological perspectives to include nor-adrenergic as well as dopaminergic agents. This offers an opportunity, in conjunction with animal studies for a better understanding of the differential selectivity
Trends in multidrug-resistant tuberculosis
Dias-Baptista, I. M. F.;Usó, S. M. R. S.;Marcondes-Machado, J.;
Journal of Venomous Animals and Toxins including Tropical Diseases , 2008, DOI: 10.1590/S1678-91992007007500001
Abstract: multidrug-resistant tuberculosis (mdr-tb) is an increasing global problem. the extent and burden of mdr-tb varies significantly from country to country and region to region. globally, about three per cent of all newly diagnosed patients have mdr-tb and the proportion is higher in patients who had previously received anti-tuberculosis (anti-tb) treatment reflecting the failure of programs designed to ensure complete cure of patients with tuberculosis. the management of mdr-tb is a challenge that should be undertaken by experienced clinicians at centers equipped with reliable laboratory services and implementation of dots-plus strategy.
After Star-D: Treatment Resistant Depression  [PDF]
Olcay YAZICI
N?ropsikiyatri Ar?ivi , 2009,
Abstract: Although the lack of evidence in literature for the treatment of resistant depression has not been totally overcome by Star-D Study, and the basic questions are still unanswered; we can assume that now we have much more reliable data regarding the topic. The recent data can be seen as such: 1.The definition of treatment-resistant depression as ‘not to have response (or remission) after two appropriate trials of different antidepressants’ seems to be true. 2. Antidepressant therapy should start as monotherapy with optimal dose. Most of the patients require 6-8 weeks for response or remission. A dose increase towards the maximal or the highest tolerated dose must start in the 4th week, if there is no response. The same dose can be maintained if there is a partial response. 3. In case of an absolute unresponsiveness in the 6 th week, switching the antidepressant can be considered after the exclusion of the factors of pseudo-resistance; and a partial response may suggest an augmentation or combination strategy. 4. The predictors of those strategies are unknown yet. For a severe depression it may be safer to choose augmentation or combination instead of switch. For a worsening depression, on the other hand, ECT may be the safest and most correct option. 5. At present, the data show that augmentation and combination have almost the same efficacy in case of resistance. 6. Regarding the available data, T3, lithium or buspirone options can be considered for augmentation. 7. SSRI+bupropione, venlafaxine+mirtazapine, SSRI+TCA, TCA+mianserine, SSRI+mirtazapine, and SSRI+reboxetine can be seen as options for combination strategy. 8. In regard to switching, venlafaxine, TCA’s, bupropione, mirtazapine, and another SSRI seem to be the options in case of an SSRI‘s failure. 9. Since the available data show that all the medication alternatives have a very limited success after two failures with different antidepressants, considering ECT in that step can be rational. (Archives of Neuropsychiatry 2009; 46: 61-9)
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