Mark L. Fuerst

Slideshows

Three studies highlight sedentary behavior and memory, cognitive decline in psychosis, and risk of dementia with anticholinergic drugs.

Brain Health in Aging Adults

 associated with tardive dyskinesia (TD) among patients with psychiatric disorders taking antipsychotic medications.

Antipsychotic medications have been extensively used to treat people with chronic mental illnesses, such as schizophrenia. These drugs, however, have also been associated with a wide range of adverse effects, including movement disorders, such as TD, a problem often seen as repetitive involuntary movements around the mouth and face.

TD is often irreversible and can be debilitating. “The symptoms can increase the social stigma of patients with comorbid psychiatric disorders, negatively impact quality of life, and potentially increase medical morbidity and mortality,” stated researchers, led by Oscar Patteron-Lomba, Manager, Analysis Group in Boston, MA. “An increased risk of developing tardive dyskinesia has been associated with factors such as older age, female sex, underlying mental illness, and long-term use and higher doses of antipsychotics.”

The association of TD with the use of typical versus atypical antipsychotics has been evaluated, with mixed results. No predictive models to assess the joint effect of clinical characteristics on TD risk have been developed or validated in the US.

Using a retrospective database analysis, Patterson-Lomba and colleagues

 identified a total of 189,415 patients; 66,723 with bipolar disorder; 68,573 with depressive disorder; and 54,119 with schizophrenia. These adult patients, who had 6 months of data prior to the index date, were identified from Medicaid claims from six US states. The index date was defined as the date of the first claim for an antipsychotic drug after a claim for the underlying disorder but before TD diagnosis.

The selected prediction model had a clinically meaningful concordance of 70% and was well calibrated. The researchers identified four treatment characteristics associated with TD. Patient’s age at index date, diagnosis of schizophrenia, dosage of antipsychotic at index date (up to 100 mg/day chlorpromazine equivalent), and presence of bipolar and related disorders were significantly associated with an increased risk of TD diagnosis. In addition, the use of atypical antipsychotics at index date was associated with a modest reduction in the risk of TD.

In conclusion, the researchers stated: “This study identified a group of factors associated with the development of tardive dyskinesia among patients with psychiatric disorders treated with antipsychotics. This may allow physicians to better monitor their patients receiving antipsychotics, allowing for the prompt identification and treatment of tardive dyskinesia to help maintain quality of life.”

Various strategies have been examined to reduce the cumulative exposure to antipsychotics, including dose reduction, intermittent dosing strategies, such as drug holidays, and antipsychotic cessation. A 

 included 13 randomized controlled trials with 711 participants to examine antipsychotic reduction and/or cessation and antipsychotics as specific treatments for TD.

 However, limited data from the small studies using antipsychotic reduction or specific antipsychotic drugs as treatments for TD did not provide any convincing evidence of the value of these approaches.

1. Patterson-Lomba O, Ayyagari R, Carroll B. 

62 Predictors of Tardive Dyskinesia in Psychiatric Patients Taking Concomitant Antipsychotics

2. Bergman H1, Rathbone J, Agarwal V, Soares-Weiser K. 

Antipsychotic reduction and/or cessation and antipsychotics as specific treatments for tardive dyskinesia

Articles

A prediction model may help identify treatment characteristics associated with TD among patients with psychiatric disorders taking antipsychotic medications.

Advances in Predicting Tardive Dyskinesia

Three news studies show how eating habits and other lifestyle factors affect cognition and brain imaging may be useful in predicting dementia.

Geriatric Psychiatry Research Update: December 2018

Three new studies shed light on the role of cardiac health in developing Alzheimer disease, depression, anxiety, and dementia.

Psychocardiology in Older Adults

Findings from three new studies in major depression indicate that 

1 Vagus nerve stimulation improves the quality of life of patients with treatment-resistant depression;

2 Higher blood levels of omega-3 fatty acids have been linked to improved depression symptoms in patients with both depression and heart failure;

3 Treating depression in teens may benefit parents’ mental health.

Vagus nerve stimulation improves quality of life in patients with depression

Adding vagus nerve stimulation (VNS) to antidepressant therapy significantly improved the quality of life of patients with treatment-resistant depression.

 Self-reported quality of life assessments were used in a multicenter, longitudinal registry to compare the antidepressant efficacy of VNS plus antidepressant treatment (328 patients) with antidepressant treatment alone (271 patients). The patients had either unipolar or bipolar depression and experienced treatment failure in at least 4 antidepressant trials.

On about 10 of the 14 measures, patients in the VNS group had a clinically meaningful quality of life improvement of 34% to 40%, which was below the classically defined antidepressant response of 50%. Patients in this group also had significant gains in quality-of-life measures, such as mood, ability to work, social relationships, family relationships, and leisure activities compared with those who received only treatment as usual.

Clinical implications. “When evaluating patients with treatment-resistant depression, we need to focus more on their overall well-being. A lot of patients are on as many as three, four, or five antidepressant medications, and they are just barely getting by. But when you add a vagus nerve stimulator, it really can make a big difference in people’s everyday lives,” said principal investigator Charles R. Conway, MD, professor of psychiatry at Washington University.

Omega-3 supplementation eases depression in heart failure

Supplementation with omega-3 fatty acids can improve cognitive depressive symptoms and social functioning in patients with comorbid heart failure and depression.

 A randomized, double-blind, placebo-controlled pilot clinical trial included 108 patients with chronic heart failure and MDD.

The patients received a combination of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) fish oil, an almost pure EPA, or a matched placebo daily for 12 weeks. Higher omega-3 blood levels were related to lower cognitive depression scores on the Beck Depression Inventory. The social functioning sub-score of the SF-36 was significantly improved on the EPA/DHA supplement and tended to improve with the high EPA supplement.

Clinical implications. “Generally, we think of the function of omega-3s as preventative rather than as treatment. If used as treatment, the dose must be fairly high (4 grams is a typical drug dose) and blood levels must be measured. Linking higher blood levels of omega-3s to improved depression symptoms in people with both depression and heart failure hopefully leads to better treatment for their conditions,” said co-author William Harris, MD, of the Sanford School of Medicine in Sioux Falls, South Dakota.

Symptoms of depression linked in teens and parents

A long-term study included 325 teens who had a diagnosis of depression and 325 of their parents or caregivers.

 The teens were randomly assigned to receive cognitive behavioral therapy, an antidepressant, or a combination of both. The first treatment period ran for nearly one year, with an additional year of follow-up visits. One-quarter of the parents who participated also reported moderate to severe levels of depression before the treatment period.

The results showed that depressive symptoms improved in parents during treatment for adolescent depression in their children. In addition, improvement in adolescent depressive symptoms was associated with improvement in parental depressive symptoms. This supports the link between parent and youth mood and suggests that treatment for youth depression may benefit parents.

Clinical implications. “Depression is a massive public health concern that will take a variety of approaches to better manage. We believe our study is among the first to evaluate how the emotional health of a child can impact that of the parent,” said co-author Mark A. Reinecke, PhD, Professor of Psychiatry and Behavioral Sciences at the Northwestern University Feinberg School of Medicine. Lead author Kelsey R. Howard, MS, of Northwestern University, added: “The concept of emotions being ‘contagious’ and spreading from person to person is well-known by psychologists. This work opens up a range of possibilities for future research on the family wide effects of treatment for adolescent depression.”

 Conway CR, Kumar A, Xiong W, et al. Chronic vagus nerve stimulation significantly improves quality of life in treatment-resistant major depression. 

 Jiang W, Whellan DJ, Adams KF, et al. Long-chain omega-3 fatty acid supplements in depressed heart failure patients: results of the OCEAN trial. 

 Howard KR. Parental depressive symptoms over the course of treatment for adolescent depression. Presented at the American Psychological Association Annual Convention. San Francisco; August 9-12, 2018. â

Results from these studies yield important clinical implications to improve treatment and prognosis for patients with major depression.

Three New Studies in Major Depression

Three new studies highlight the link between depression and opioid overdoses; “early birds” are less prone to depression; and consuming fish may reduce the risk of depression.

3 New Studies About Depression and Lifestyle

A research roundup about long-term prescribing guidelines, “psychogenic death,” and implications for patients with depression and pain.

3 Must-Read Stories in Geriatric Psychiatry

New studies in major depression find VNS improves the quality of life of patients with treatment-resistant depression and two other findings.

Depression Research: Vagus Nerve Stimulation, Omega-3 Supplementation, Adolescent Psychiatry

New research brings us closer to learning about the associations between psychological states, quality of life, and cardiovascular health.

At the Heart of Depression: 3 New Studies

New data indicate that dementia is largely undiagnosed or unrecognized; exposure to general anesthesia and surgery can lead to a subtle decline in memory and thinking skills in older adults; and sarcopenic obesity in older adults may predict dementia.

Author | Mark L. Fuerst