Anxiety in depression

Introduction

There are different clinical forms combining anxiety and depression and it is essential to identify them because they will require different management. Among these clinical forms, there is that including anxiety as a symptom within the depressive episode: the anxious depression.

Objectives

The objective is to find the characteristics of this anxious depression.

Methods

We conducted a literature review on the PubMed® site giving access to the MEDLINE® database, as well as on the Google Scholar® search engine and retained 127 articles.

Results

By studying anxiety as a symptom of the depression, we identify on the pathophysiological level different neurobiological mechanisms (neuroanatomical, biological, immunological and endocrinological) involved in types of symptoms of different anxiety. Thus, by adopting a dimensional point of view, we can say that there are various anxiety symptoms which can be included in multiple forms of anxiety within the depression: psychic anxiety (anxiety and irritability), somatic anxiety (hypochondria, sweating, cardiological, respiratory, gastrointestinal and urinary symptoms), motor anxiety (agitation), anxious arousal (somatic anxiety, fear, panic) or anxious apprehension (anticipatory anxiety and worry). The prognosis which emerges from it is of a more pejorative evolution, and has specificities on which an increased attention is required, such as suicidal behavior which is more frequently described for example. The treatment must be psychotherapeutic, sociotherapeutic, and medication by antidepressant treatment, with SSRIs in the first line.

Conclusions

It is therefore essential to identify the clinical presentation of the anxious depression because it has specific semiological, neurobiological, prognostic and therapeutic characteristics.

Disclosure

No significant relationships.

134 A Quality Improvement Project—Physiotherapy Caseload Management on the Older Person’s Unit

Introduction

Complex health issues, co-morbidities and the number of patients living with frailty are critical concerns associated with the ageing population (Kojima et al, 2019). In this wider context, there is an emphasis on targeting resources efficaciously within the NHS. A consequence of capacity constraints, inpatient physiotherapy teams across the OPU at a large urban teaching hospital, prioritise their patient caseload, but lack evidence-based guidance on dosage and frequency of physiotherapy intervention, to inform the process. The aim of the quality improvement project was to design and deliver a staff education and training package to facilitate implementation of a newly-developed, evidence-based prioritisation resource.

Method

Plan-Do-Study-Act cycles and the Com-B model to influence behaviour changes were employed between October 2019 and March 2020. Stakeholders were engaged throughout the design process. Training to all 11 physiotherapists consisted of familiarisation with the resource through content discussion and “mock-use” training sessions to ensure intra/inter-rater-reliabilty. Physiotherapist staff knowledge and confidence of prioritisation was evaluated by questionnaire. Accuracy of use of the prioritisation tool was determined by comparison of staff prioritisation decision with expert opinion.

Results

From the 11 questionnaire responses, pre to post intervention physiotherapy knowledge of the prioritisation categories increased (43% to 100%), physiotherapist rated confidence using the prioritisation tool increased (mean score, 6.9 to 8.2/10) and accuracy of prioritisation of patients improved (mean 42.1% to 92.3%).

Conclusion

The education and training package developed to support implementation of the prioritisation tool resulted in improved staff knowledge and confidence of patient prioritisation and increased the accuracy of OPU physiotherapy targeting. This project has highlighted the importance of staff training in resource allocation to ensure that decisions regarding which patients receive physiotherapy intervention are efficacious. This has increased relevance in a department with a large number of rotational staff.

Ammonium stress increases microautophagic activity while impairing macroautophagic flux in Arabidopsis roots

Plant responses to NH₄⁺ stress are complex, and multiple mechanisms underlying NH₄⁺ sensitivity and tolerance in plants may be involved. Here, we demonstrate that macro- and microautophagic activities are oppositely affected in plants grown under NH₄⁺ toxicity conditions. When grown under NH₄⁺ stress conditions, macroautophagic activity was impaired in roots. Root cells accumulated autophagosomes in the cytoplasm, but showed less autophagic flux, indicating that late steps of the macroautophagy process are affected under NH₄⁺ stress conditions. Under this scenario, we also found that the CCZ1-MON1 complex, a critical factor for vacuole delivery pathways, functions in the late step of the macroautophagic pathway in Arabidopsis. In contrast, an accumulation of tonoplast-derived vesicles was observed in vacuolar lumens of root cells of NH₄⁺ -stressed plants, suggesting the induction of a microautophagy-like process. In this sense, some SYP22-, but mainly VAMP711-positive vesicles were observed inside vacuole in roots of NH₄⁺ -stressed plants. Consistent with the increased tonoplast degradation and the reduced membrane flow to the vacuole due to the impaired macroautophagic flux, the vacuoles of root cells of NH₄⁺ -stressed plants showed a simplified structure and lower tonoplast content. Taken together, this study presents evidence that postulates late steps of the macroautophagic process as a relevant physiological mechanism underlying the NH₄⁺ sensitivity response in Arabidopsis, and additionally provides insights into the molecular tools for studying microautophagy in plants.

[Surgical and interventional management of benign prostatic obstruction: Guidelines from the Committee for Male Voiding Disorders of the French Urology Association]

OBJECTIVE

The aim of the Male Lower Urinary Tract Symptoms Committee (CTMH) of the French Urology Association was to propose an update of the guidelines for surgical and interventional management of benign prostatic obstruction (BPO).

METHODS

All available data published on PubMed® between 2018 and 2020 were systematically searched and reviewed. All papers assessing surgical and interventional management of adult patients with benign prostatic obstruction (BPO) were included for analysis. After studies critical analysis, conclusions with level of evidence and French guidelines were elaborated in order to answer the predefined clinical questions.

RESULTS/GUIDELINES

Offer a trans-uretral incision of the prostate to treat patients with moderate to severe lower urinary tract symptoms (LUTS) with a prostate volume<30cm³, without a middle lobe. TUIP increases the chances of preserving ejaculation. Propose mono- or bipolar trans-urethral resection of the prostate (TURP) to treat patients with moderate to severe LUTS with a prostate volume between 30 and 80cm³. Vaporization by Greenlight™ or by bipolar energy can be offered as an alternative to TURP. Offer a Greenlight™ laser vaporization to patients at risk of bleeding. Offer endoscopic prostate enucleation to surgically treat patients with moderate to severe LUTS as an alternative to TURP and open prostatectomy (OP). Minimally invasive prostatectomy is an alternative to OP in centers without access to adequate endoscopic procedures. Embolization of the prostatic arteries may be offered in the event of a contraindication or refusal of surgery for prostates with a volume>80cm³. Prostatic uretral lift is an alternative in patients interested in preserving their ejaculatory function and with a prostate volume<70cm³ without a middle lobe. Aquablation and Rezum™ are under evaluation and should be offered in research protocols.

CONCLUSION

Major changes in surgical management of BPO have occurred and aim at reducing morbidity and improving quality of life of patients.

[Cost analysis of GreenLight photoselective vaporization of the prostate versus standard transurethral resection of the prostate: Benefit of ambulatory care]

PURPOSE

To compare the costs associated with GreenLight XPS 180W photoselective vaporization of the prostate (PVP) for an outpatient versus standard transurethral resection of the prostate (TURP) with a three nights hospitalization in a French private hospital.

MATERIAL AND METHODS

A retrospective cost minimization analysis was performed between 2017 and 2019 in a French private hospital for the hospital stays associated with TURP and PVP procedures for benign prostatic hyperplasia (BPH). The peri-operative cost-benefit assessment of the two procedures was analyzed from the establishment's point of view according to the micro-costing method.

RESULTS

871 surgical treatment for BPH had been performed during the period of the study, including 743 photoselective laser vaporization (85%). The average length of stay of patients undergoing TURP was 3,7 days versus 0,9 days for PVP including 64,7% ambulatory. The cost-benefit was more of 500€ per patient in favor of ambulatory PVP compared with TURP in conventional three nights hospitalization for level 1 hospital stays.

CONCLUSION

In this private hospital center, ambulatory PVP seemed more cost-effective than TURP with a three nights hospitalization for a severity level 1 patient. The financial profit for the establishment was mostly due to reduction of the main length of stay and ambulatory care.

LEVEL OF EVIDENCE

3.

Structural abnormalities associated with poor outcome of a major depressive episode: The role of thalamus

An identification of precise biomarkers contributing to poor outcome of a major depressive episode (MDE) has the potential to improve therapeutic strategies by reducing time to symptomatic relief. In a cross-sectional volumetric study with a 6 month clinical follow-up, we performed baseline brain grey matter volume analysis between 2 groups based on illness improvement: 27 MDD patients in the "responder" (R) group (Clinical Global Impression- Improvement (CGI-I) score ≤ 2) and 30 in the "non-responder" (NR) group (CGI-I > 2), using a Voxel Based-Morphometry analysis. NR had significantly smaller Grey Matter (GM) volume in the bilateral thalami, in precentral gyrus, middle temporal gyrus, precuneus and middle cingulum compared to R at baseline. Additionally, they exhibited significant greater GM volume increase in the left anterior lobe of cerebellum and posterior cingulate cortex. The latter result was not significant when participants with bipolar disorder were excluded from the analysis. NR group had higher baseline anxiety scores. Our study has pointed out the role of thalamus in prognosis of MDE. These findings highlight the involvement of emotion regulation in the outcome of MDE. The present study provides a step towards the understanding of neurobiological processes of treatment resistant depression.

[Predictive factors of active surveillance interruption for prostate cancer after 5years of follow-up]

INTRODUCTION AND PURPOSE

The objective of this work was to identify the risk factors (RFs) of active surveillance (AS) interruption in a prostate cancer (PCa) single-center retrospective cohort of patients.

MATERIAL AND METHOD

All patients in AS between January 2011 and October 2019 were retrospectively included in a computerized database. The group of patients who had an AS interruption was compared to the one still under AS, in order to identify potential risk factors for the interruption of the surveillance protocol.

RESULTS

Two hundred and two patients have been included in the AS cohort with a median follow-up of 32months. At the time of analysis, 72 patients (36%) were not under the AS protocol anymore, 118 (58%) were still under AS and 12 (6%) were lost of follow-up. Sixty-six patients (92%) had left SA due to PCa progression, 4 (5%) by personal choice and 2 (3%) switched to watchful waiting. A PSA doubling Time<3years (PSADT<3years) has been identified as the only statistically significant RF for AS interruption, both in the unvaried (P<0.001) and multivariate (OR=5.403, P<0.01) analysis. It was also the only RF of AS interruption in the early analysis in the first three years of AS, in the unvaried analysis (P=0.021) and the multivariate analysis (OR=3.612, P=0.018).

CONCLUSION

PSADT was the only RF of AS early and late interruption in our study. It represents a major inclusion criterion in AS protocol during the initial assessment.

LEVEL OF EVIDENCE

3.