Mary Rosedale

Using Transcranial Direct Current Stimulation to Treat Depression in HIV-Infected Persons: The Outcomes of a Feasibility Study

Transcranial direct current stimulation (tDCS) is a novel non-invasive neuromodulatory method that influences neuronal firing rates and excitability of neuronal circuits in the brain. tDCS has been shown to relieve Major Depressive Disorder (MDD) in the general population, suggesting its potential for other vulnerable populations with high MDD prevalence. Aims: This study evaluated the feasibility, safety, acceptability, and clinical outcomes of a 2-week tDCS antidepressant treatment in HIV-MDD co-diagnosed patients, and the feasibility of collecting serum and saliva for analysis of immunity biomarkers. Methods: Ten enrolled patients underwent baseline evaluation and started the tDCS treatment (Monday–Friday for 2 weeks) delivered with Phoresor II 850 PM for 20 min at 2 mA at each visit, using two saline-soaked sponge electrodes placed over the F3 position of EEG 10–20 system and the contralateral supraorbital region. Outcome measures were collected at baseline, after the last tDCS and 2 weeks later. A quantitative microarray (Ray Bio Tech Inc.) for TH1/TH2 cytokines was used for saliva and plasma analysis. Results: Analyzable outcome-data were obtained from eight subjects. Depression scores significantly decreased (p < 0.0005) after the treatment. No serious adverse events occurred. Several transient minor AEs and occasional changes of blood pressure and heart rate were noted. Mini-mental state examination scores remained unchanged or increased after the treatment. All subjects were highly satisfied with the protocol and treatment results and described the desire to find new treatments for HIV-MDD as motivating participation. Conclusion: Findings support feasibility and clinical potential of tDCS for HIV-MDD patients, and justify larger-sample, sham-controlled trials.

Low Vitamin D levels predict clinical features of schizophrenia

Vitamin D plays crucial roles in neuroprotection and neurodevelopment, and low levels are commonly associated with schizophrenia. We considered if the association was spurious or causal by examining the association of Vitamin D with Leukocyte Telomere Length (LTL), a marker of cellular aging. Vitamin D levels in 22 well-characterized schizophrenia cases were examined with respect to symptoms, cognition, and functioning. LTL was assessed using quantitative polymerase chain reaction (qPCR). The results showed that 91% (20) had deficient or insufficient Vitamin D levels, which were associated with excitement and grandiosity, social anhedonia, and poverty of speech. Sex-specific analyses showed strong associations of hypovitamintosis D to negative symptoms and decreased premorbid adjustment in males, and to lesser hallucinations and emotional withdrawal, but increased anti-social aggression in females. In females LTL was furthermore associated with Vitamin D levels. This study demonstrates a relationship of low vitamin D levels with increased cellular aging in females. It is also the first study to demonstrate potential sex-specific profiles among schizophrenia cases with hypovitaminosis.

Olfactory acuity is associated with mood and function in a pilot study of stable bipolar disorder patients

OBJECTIVES Olfactory dysfunction is described in several neuropsychiatric disorders but there is little research on olfactory processing in bipolar disorder. METHODS We assessed odor detection threshold (sensitivity) and smell identification test scores, along with symptoms, cognition, and social function in 20 DSM-IV bipolar disorder patients and 44 control subjects. RESULTS The patient and control groups had similar demographic measures, intelligence, and mean olfaction scores, but significantly differed in social domains, including adjustment, function, and anxiety. Odor detection sensitivity showed significantly opposite correlations for the depressive and manic mood domains in bipolar disorder (r to z = 2.83, p = 0.005). Depressive symptoms were related to increased sensitivity (the ability to detect odors at a lower concentration) and mania symptoms were related to decreased sensitivity for odor detection. Increased sensitivity for odor detection also predicted significantly better employment (r = -0.642, p = 0.024), whereas less sensitivity was associated with social avoidance (r = 0.702, p =0.024) and social fear (r = 0.610, p = 0.046). CONCLUSIONS Diminished odor detection sensitivity predicted mania and social avoidance, whereas more sensitive odor detection predicted more depressive symptoms but better employment functioning in bipolar disorder patients. Odor acuity may be an illness state marker of mood syndromes in bipolar disorder. Alternatively, differences in odor acuity may identify heterogeneous subgroups within the bipolar spectrum. Longitudinal assessments in a large, sex-stratified sample are needed to understand the implications of odor sensitivity in patients with bipolar disorder.

Loneliness: An Exploration of Meaning

Although loneliness is acknowledged as a common human experience and a variable of concern for psychiatric clinicians, the nursing literature has primarily treated it as a social deficit or pathological phenomenon. Loneliness has been studied in conjunction with other variables but rarely as a central focus itself. A review of the literature shows more multifaceted ways of viewing loneliness and thinking about its meaning. Examining dictionary, sacred, philosophical, psychological, and nursing views and theories of loneliness, it is apparent that nurses have only begun to investigate this ubiquitous phenomenon. Consistent with her own research findings of survivor-loneliness following breast cancer, the author suggests that nurses look beyond the contemporary encapsulated meaning of loneliness and begin asking patients to inform them of their understanding about its meaning. J Am Psychiatr Nurses Assoc, 2007; 13(4), 201-209.

A Novel Intraoral Diabetes Screening Approach in Periodontal Patients: Results of a Pilot Study

BACKGROUND This pilot study examines whether a novel diabetes screening approach using gingival crevicular blood (GCB) could be used to test for hemoglobin A1c (HbA1c) during periodontal visits. METHODS Finger-stick blood (FSB) samples from 120 patients and GCB samples from those patients with adequate bleeding on probing (BOP) were collected on special blood collection cards and analyzed for HbA1c levels in a laboratory. The Pearson correlation coefficient was used to measure correlation between FSB and GCB HbA1c values for 75 paired FSB and GCB samples. A receiver-operator characteristic curve (ROC) analysis was performed to determine an optimal GCB HbA1c criterion value for a positive diabetes screen. RESULTS For the 75 paired samples, the Pearson correlation coefficient was 0.842. The ROC analysis identified a criterion value of 6.3% for the GCB HbA1c test with high sensitivity (0.933) and high specificity (0.900), corresponding to FSB HbA1c values ≥6.5% (in the diabetes range). Using this GCB HbA1c criterion value for 27 additional paired samples, in which there was an unidentified component observed to coelute within the elution window of GCB HbA1c in the laboratory, there was agreement between FSB and GCB values for 24 of the pairs according to whether both were within or outside of the diabetes range. CONCLUSION Using a criterion value of 6.3%, GCB samples are acceptable for HbA1c testing to screen for diabetes in most persons with BOP at the GCB collection site.

How Persons With Chronic Hepatitis C in Residential Substance Abuse Treatment Programs Think About Depression and Interferon Therapy

OBJECTIVE: This secondary analysis of existing qualitative descriptive data is the first to specifically report on how persons undergoing residential treatment for substance abuse think about depression and the risks of neuropsychiatric side effects associated with interferon (IFN) treatment for hepatitis C virus (HCV) infection. METHOD: Krippendorff ’s method for qualitative content analysis was used to describe patient perspectives about psychiatric symptoms and potential side effects of IFN treatment. Transcripts from face-to-face, semistructured interviews with 20 patients in 3 residential substance abuse treatment programs were analyzed. RESULTS: Themes included patients’ powerlessness and their evaluation of risk and confidence. Participants commented that residential substance abuse treatment programs offered a unique opportunity to undergo antiviral treatment because they capitalized on a patient’s heightened readiness for change. Barriers to treatment included perceived obstacles, such as compulsory waiting periods before treatment initiation, fear that neuropsychiatric treatment side effects would sabotage addiction recovery, and concern that psychiatric providers lacked sufficient HCV knowledge. However, when patients perceived clinicians as knowledgeable and genuinely caring, they were amenable to considering antiviral treatment. CONCLUSION: Increasing HCV-specific psychiatric education and staff training, exploring combined psychiatric and antiviral treatment combinations, and therapeutically supporting patient decision making are needed to better use substance abuse residential treatment programs as sites for treating HCV infection. Novel antidepressant treatment approaches are required in this population. Advanced practice psychiatric nurses are well-positioned to develop new integrative models of care addressing the medical, psychiatric, and substance abuse comorbidities in this highly vulnerable group.

Transcranial Direct Current Stimulation to Enhance Cognition and Functioning in Schizophrenia

Schizophrenia is a heterogeneous disorder with characteristic symptoms, including cognitive impairments that are associated with the illness and its outcome. Cognitive impairments include deficits in processing speed and working memory, inattention, and impaired problem-solving ability. These cognitive insufficiencies are considered to reflect the core of the disorder and to worsen as the disorder progresses, further impairing functioning. Novel approaches to treat cognitive impairments are greatly needed and transcranial Direct Current Stimulation (tDCS) is a promising modality that may address these cognitive impairments. TDCS is a noninvasive, non-pharmacological neuromodulation technique that has demonstrated efficacy in improving attention processing in normal controls and in persons with diverse pathologies. By modulating cortical excitability, anodal (excitatory) tDCS to the Prefrontal Cortex (PFC) may facilitate access to existing PFC neural reserves in people with schizophrenia, potentially improving attention. However, this possibility has been only minimally investigated to date. Because cognitive deficits are the strongest determinant of poor functional outcomes in schizophrenia, the development of novel treatments and the combination of innovative neuromodulation and medication strategies to improve cognition and functional capacity are needed. In addition to reviewing cognitive impairments in schizophrenia, this article discusses the potential of tDCS targeting the PFC in patients. It also describes the use of measurement tools as proposed by the National Institute of Mental Health (NIMH) initiative “Measurement and Treatment Research to Improve Cognition in Schizophrenia” (MATRICS), to improve attention processing and to isolate distinct cognitive disruptions in patients with schizophrenia. Recommendations are made for future research approaches.

The Structure of the Lived Experience for Persons Having Undergone rTMS for Depression Treatment

OBJECTIVE: This phenomenological research study reports preliminary findings about experiences of persons undergoing repeated transcranial magnetic stimulation (rTMS) for depression treatment. METHODS: Giorgi’s phenomenology was the method used to describe the structure of the lived experience for persons having undergone rTMS treatment for depression. Participants were recruited from the OPT-TMS pivotal depression study that resulted in the October 2008 FDA approval of rTMS. Thus far, nine persons comprise the purposive sample. Each participant was asked to describe the experience of undergoing rTMS for depression treatment and encouraged to provide as much details as possible. RESULTS: Four preliminary themes emerged to describe participants’ experiences of rTMS for depression treatment: (a) a narrative of frustration and helplessness with medication treatment resistance, (b) the sensory experience of rTMS, (c) mindfulness— an enhanced awareness of the content of consciousness, and (d) the importance of connection with clinicians. CONCLUSIONS: Preliminary results of this phenomenological study make the struggle of persons with treatment-resistant depression more visible and should assist clinicians to understand how rTMS is experienced by depressed persons undergoing treatment. Moreover, results shed new light on the changes participants observe and describe with rTMS and the high value they place on a therapeutic relationship with clinicians administering treatment.

Awareness of Prediabetes and Diabetes among Persons with Clinical Depression.

Background. Major depressive disorder (MDD) is highly comorbid with diabetes, a relationship underappreciated by clinicians. Purpose. Examine the proportion of nonpregnant individuals ≥20 years with MDD and elevated glucose and the demographic and clinical characteristics associated with unrecognized elevated glucose. Methods. 14,373 subjects who participated in the National Health and Nutrition Examination Survey (2007–2012) completed the PHQ-9 depression screen and had hemoglobin A1C (HbA1c) measured. PHQ-9 scores ≥10 and HbA1c scores ≥5.7% were defined as MDD and elevated HbA1c, respectively. Data were analyzed using complex survey sampling software. Results. 38.4% of the sample with MDD had elevated HbA1c readings. Compared with nondepressed subjects, they were significantly more likely to have elevated glucose readings (P = 0.003) and to be aware of their elevated glucose levels if they had a higher body mass index, family history of diabetes, more doctor visits in the past year, a usual care source, health insurance, or were taking hypertension or hypercholesterolemia medications. Conclusions. Many adults with MDD have elevated HbA1c levels, have never been advised of elevated HbA1c, have not received diabetes screening, and have minimal contact with a healthcare provider. Additional opportunities for diabetes risk screening in people with MDD are needed.

Latinas with elevated fasting plasma glucose: an analysis using NHANES 2009-2010 data.

For Latinas with fasting plasma glucose (FPG) levels in the prediabetes and diabetes ranges, early detection can support steps to optimize their health. Data collected in 2009-2010 indicate that 36.7% of Latinas in the United States had elevated FPG levels. Latinas with elevated FPG who were unaware of their diabetes status were significantly less likely than non-Hispanic White and non-Hispanic Black women to have seen a health care provider in the past year (75.8%, 92.9%, and 90.2%, respectively; p = .018). With almost 1 million Latinas in the United States with elevated FPG unaware of their diabetes risk, and less likely than other at-risk women to see health care providers, there is an urgent need to establish alternate sites of opportunity for their diabetes screening.