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Badulescu S, Le GH, Wong S, Kwan ATH, Guo Z, Teopiz KM, Phan L, Subramaniapillai M, Rosenblat JD, Mansur RB, McIntyre RS. Impact of vortioxetine on psychosocial functioning moderated by symptoms of fatigue in post-COVID-19 condition: a secondary analysis. Neurol Sci 2024; 45:1335-1342. [PMID: 38321333 DOI: 10.1007/s10072-024-07377-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Accepted: 01/30/2024] [Indexed: 02/08/2024]
Abstract
INTRODUCTION Fatigue is a prominent symptom in post-COVID condition (PCC) sequelae, termed "long COVID." Herein, we aim to ascertain the effect of fatigue on psychosocial function in persons living with PCC. METHODS This post hoc analysis evaluated the effects of vortioxetine on measures of fatigue as assessed by the Fatigue Severity Scale (FSS) in psychosocial function as measured by the Sheehan Disability Scale (SDS) in persons with PCC. We also evaluated the change in FSS on psychosocial functioning as measured by the Sheehan Disability Scale (SDS). This post hoc analysis obtained data from a recently published placebo-controlled study evaluating vortioxetine's effect on objective cognitive functions in persons living with PCC. RESULTS One hundred forty-four participants meeting World Health Organization (WHO) criteria for PCC were included in this analysis. At the end of 8 weeks of vortioxetine treatment, significant improvement of all domains was observed for psychosocial functioning. There was a significant between-group difference at treatment endpoint in the family, social, and work SDS subcategories (p < 0.001). There was a statistically significant interaction effect between the treatment condition time point and FSS effect on the SDS social (χ2 = 10.640, p = 0.014) and work (χ2 = 9.342, p = 0.025) categories but a statistically insignificant effect on the family categories ((χ2 = 5.201, p = 0.158)). DISCUSSION This post hoc analysis suggests that vortioxetine treatment significantly improves psychosocial function in persons with PCC. Our results also indicate that the improvement in psychosocial function was significantly mediated by improvement in measures of fatigue. Our results provide empirical support for recommendations to identify therapeutics for fatigue in persons living with PCC with a broader aim to improve psychosocial function in this common and severely impaired population.
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Affiliation(s)
- Sebastian Badulescu
- Brain and Cognition Discovery Foundation, 77 Bloor Street West, Suite 617, Toronto, ON, M5S 1M2, Canada
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
- Temerty Faculty of Medicine, Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Gia Han Le
- Brain and Cognition Discovery Foundation, 77 Bloor Street West, Suite 617, Toronto, ON, M5S 1M2, Canada
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
- Temerty Faculty of Medicine, Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Sabrina Wong
- Brain and Cognition Discovery Foundation, 77 Bloor Street West, Suite 617, Toronto, ON, M5S 1M2, Canada
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
- Department of Pharmacology & Toxicology, University of Toronto, Toronto, ON, Canada
| | - Angela T H Kwan
- Brain and Cognition Discovery Foundation, 77 Bloor Street West, Suite 617, Toronto, ON, M5S 1M2, Canada
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Ziji Guo
- Brain and Cognition Discovery Foundation, 77 Bloor Street West, Suite 617, Toronto, ON, M5S 1M2, Canada
- Department of Pharmacology & Toxicology, University of Toronto, Toronto, ON, Canada
| | - Kayla M Teopiz
- Brain and Cognition Discovery Foundation, 77 Bloor Street West, Suite 617, Toronto, ON, M5S 1M2, Canada
| | - Lee Phan
- Brain and Cognition Discovery Foundation, 77 Bloor Street West, Suite 617, Toronto, ON, M5S 1M2, Canada
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
| | - Mehala Subramaniapillai
- Brain and Cognition Discovery Foundation, 77 Bloor Street West, Suite 617, Toronto, ON, M5S 1M2, Canada
| | - Joshua D Rosenblat
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
- Temerty Faculty of Medicine, Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Rodrigo B Mansur
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
- Temerty Faculty of Medicine, Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Roger S McIntyre
- Brain and Cognition Discovery Foundation, 77 Bloor Street West, Suite 617, Toronto, ON, M5S 1M2, Canada.
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada.
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
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Hewitt SRC, Habicht J, Bowler A, Lockwood PL, Hauser TU. Probing apathy in children and adolescents with the Apathy Motivation Index-Child version. Behav Res Methods 2024; 56:3982-3994. [PMID: 37537490 PMCID: PMC11133129 DOI: 10.3758/s13428-023-02184-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2023] [Indexed: 08/05/2023]
Abstract
Apathy is linked to mental health and altered neurocognitive functions such as learning and decision-making in healthy adults. Mental health problems typically begin to emerge during adolescence, yet little is known about how apathy develops due to an absence of quantitative measurements specific to young people. Here, we present and evaluate the Apathy Motivation Index-Child Version (AMI-CV) for children and adolescents. We show across two samples of young people (aged 8 to 17 years, total N = 191) tested in schools in the UK and on a smartphone app, that the AMI-CV is a short, psychometrically sound measure to assess levels of apathy and motivation in young people. Similar to adult versions, the AMI-CV captures three distinct apathy domains: Behavioural Activation, Social Motivation and Emotional Sensitivity. The AMI-CV showed excellent construct validity with an alternative measure of apathy and external validity replicating specific links with related mental health traits shown in adults. Our results provide a short measure of self-reported apathy in young people that enables research into apathy development. The AMI-CV can be used in conjunction with the adult version to investigate the impact of levels of apathy across the lifespan.
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Affiliation(s)
- Samuel R C Hewitt
- Max Planck UCL Centre for Computational Psychiatry and Ageing Research, University College London, London, UK.
- Wellcome Centre for Human Neuroimaging, University College London, 12 Queen Square, London, WC1N 3AR, UK.
| | - Johanna Habicht
- Max Planck UCL Centre for Computational Psychiatry and Ageing Research, University College London, London, UK
- Wellcome Centre for Human Neuroimaging, University College London, 12 Queen Square, London, WC1N 3AR, UK
| | - Aislinn Bowler
- Centre for Brain and Cognitive Development, Birkbeck, University of London, London, WC1E 7HX, UK
| | - Patricia L Lockwood
- Department of Experimental Psychology, University of Oxford, Oxford, UK
- Centre for Human Brain Health, School of Psychology, University of Birmingham, Birmingham, UK
- Institute for Mental Health, School of Psychology, University of Birmingham, Birmingham, UK
- Centre for Developmental Science, School of Psychology, University of Birmingham, Birmingham, UK
| | - Tobias U Hauser
- Max Planck UCL Centre for Computational Psychiatry and Ageing Research, University College London, London, UK
- Wellcome Centre for Human Neuroimaging, University College London, 12 Queen Square, London, WC1N 3AR, UK
- Department of Psychiatry and Psychotherapy, Medical School and University Hospital, Eberhard Karls University of Tübingen, Tübingen, Germany
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Daumas L, Zory R, Junquera-Badilla I, Ferrandez M, Ettore E, Robert P, Sacco G, Manera V, Ramanoël S. How does apathy impact exploration-exploitation decision-making in older patients with neurocognitive disorders? NPJ AGING 2023; 9:25. [PMID: 37903801 PMCID: PMC10616174 DOI: 10.1038/s41514-023-00121-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 09/14/2023] [Indexed: 11/01/2023]
Abstract
Apathy is a pervasive clinical syndrome in neurocognitive disorders, characterized by a quantitative reduction in goal-directed behaviors. The brain structures involved in the physiopathology of apathy have also been connected to the brain structures involved in probabilistic reward learning in the exploration-exploitation dilemma. This dilemma in question involves the challenge of selecting between a familiar option with a more predictable outcome, and another option whose outcome is uncertain and may yield potentially greater rewards compared to the known option. The aim of this study was to combine experimental procedures and computational modeling to examine whether, in older adults with mild neurocognitive disorders, apathy affects performance in the exploration-exploitation dilemma. Through using a four-armed bandit reinforcement-learning task, we showed that apathetic older adults explored more and performed worse than non-apathetic subjects. Moreover, the mental flexibility assessed by the Trail-making test-B was negatively associated with the percentage of exploration. These results suggest that apathy is characterized by an increased explorative behavior and inefficient decision-making, possibly due to weak mental flexibility to switch toward the exploitation of the more rewarding options. Apathetic participants also took longer to make a choice and failed more often to respond in the allotted time, which could reflect the difficulties in action initiation and selection. In conclusion, the present results suggest that apathy in participants with neurocognitive disorders is associated with specific disturbances in the exploration-exploitation trade-off and sheds light on the disturbances in reward processing in patients with apathy.
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Affiliation(s)
- Lyne Daumas
- Université Côte d'Azur, LAMHESS, Nice, France.
- Université Côte d'Azur, CoBTeK, Nice, France.
| | - Raphaël Zory
- Université Côte d'Azur, LAMHESS, Nice, France
- Institut Universitaire de France, Paris, France
| | | | - Marion Ferrandez
- Université Côte d'Azur, CoBTeK, Nice, France
- Université Côte d'Azur, Centre Hospitalier Universitaire de Nice, service Clinique Gériatrique de Soins Ambulatoires, Centre Mémoire de Ressources et de Recherche, Nice, France
| | - Eric Ettore
- Université Côte d'Azur, CoBTeK, Nice, France
- Université Côte d'Azur, Centre Hospitalier Universitaire de Nice, service Clinique Gériatrique de Soins Ambulatoires, Centre Mémoire de Ressources et de Recherche, Nice, France
- Association Innovation Alzheimer, Nice, France
| | - Philippe Robert
- Université Côte d'Azur, CoBTeK, Nice, France
- Association Innovation Alzheimer, Nice, France
| | - Guillaume Sacco
- Université Côte d'Azur, CoBTeK, Nice, France
- Université Côte d'Azur, Centre Hospitalier Universitaire de Nice, service Clinique Gériatrique de Soins Ambulatoires, Centre Mémoire de Ressources et de Recherche, Nice, France
- Association Innovation Alzheimer, Nice, France
- Univ Angers, Université de Nantes, LPPL, SFR CONFLUENCES, 49000, Angers, France
| | - Valeria Manera
- Université Côte d'Azur, CoBTeK, Nice, France
- Association Innovation Alzheimer, Nice, France
| | - Stephen Ramanoël
- Université Côte d'Azur, LAMHESS, Nice, France
- Sorbonne Université, INSERM, CNRS, Institut de la Vision, 17 rue Moreau, 75012, Paris, France
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Reis RDC, Souza INB, Dias MCR, Mendes CMDM, Almeida KJ. Association of Parental Support with Reduced Stereotypy in Children with Autism Spectrum Disorder: A Cross-Sectional Study. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1667. [PMID: 37763786 PMCID: PMC10534513 DOI: 10.3390/medicina59091667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 08/24/2023] [Accepted: 09/11/2023] [Indexed: 09/29/2023]
Abstract
Background and Objectives: To analyze the influence of parental presence and use of risperidone on social interaction and apathy among patients with Autism Spectrum Disorder (ASD). Materials and Methods: Cross-sectional study in a reference center for patients with ASD in a city in northeastern Brazil. The research was carried out using a sociodemographic questionnaire, the Dimensional Apathy Scale, and the Social Communication Questionnaire (SCQ) with the domains of social interaction, language, stereotypy, and communication. The referred questionnaire was answered by the parents or guardians of the children with ASD according to the DSM V criteria. Data were analyzed via independent t-test using the SPSS software version 20. Results: Interviews were conducted with 51 parents/guardians of autistic children with a mean age of 8.8 years (±2.95) and a predominance of males, 34 (66.7%). Of this total, 49 (96.1%) of the children attended school; 40 (78.4%) children were on medication, of which 38 (74.5%) were on risperidone. Those children on risperidone had a higher score on the SCQ scale (p = 0.049) and on the domain of stereotyped behaviors (p = 0.033), which indicated greater impairment. Another statistically relevant variable was the presence of married parents, whereby children who did not have the presence of married parents had a higher average of stereotyped behaviors compared to those who had married parents. Conclusions: The results showed differences in the means of social interactions for children on risperidone, especially regarding stereotyped behaviors. However, it is not possible to state whether this difference was due to the use of risperidone or whether they used risperidone precisely because of these behaviors. Also important was that children who had the presence of married parents showed fewer stereotyped behaviors. There was no difference in apathetic behavior between children.
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Affiliation(s)
- Renandro de Carvalho Reis
- Department of Medicine, University Center UNINOVAFAPI, Teresina 64073-505, Brazil
- Department of Medicine, University Center IDOMED/UniFacid, Teresina 64073-505, Brazil
- Pharmaceutical Sciences Graduation Program, Federal University of Piauí, Teresina 64049-550, Brazil
| | | | | | | | - Kelson James Almeida
- Department of Medicine, University Center IDOMED/UniFacid, Teresina 64073-505, Brazil
- Pharmaceutical Sciences Graduation Program, Federal University of Piauí, Teresina 64049-550, Brazil
- Department of Neurology, Federal University of Piauí, Teresina 64049-550, Brazil
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Rouault M, Pereira I, Galioulline H, Fleming SM, Stephan KE, Manjaly ZM. Interoceptive and metacognitive facets of fatigue in multiple sclerosis. Eur J Neurosci 2023; 58:2603-2622. [PMID: 37208934 DOI: 10.1111/ejn.16048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 04/28/2023] [Accepted: 05/15/2023] [Indexed: 05/21/2023]
Abstract
Numerous disorders are characterised by fatigue as a highly disabling symptom. Fatigue plays a particularly important clinical role in multiple sclerosis (MS) where it exerts a profound impact on quality of life. Recent concepts of fatigue grounded in computational theories of brain-body interactions emphasise the role of interoception and metacognition in the pathogenesis of fatigue. So far, however, for MS, empirical data on interoception and metacognition are scarce. This study examined interoception and (exteroceptive) metacognition in a sample of 71 persons with a diagnosis of MS. Interoception was assessed by prespecified subscales of a standard questionnaire (Multidimensional Assessment of Interoceptive Awareness [MAIA]), while metacognition was investigated with computational models of choice and confidence data from a visual discrimination paradigm. Additionally, autonomic function was examined by several physiological measurements. Several hypotheses were tested based on a preregistered analysis plan. In brief, we found the predicted association of interoceptive awareness with fatigue (but not with exteroceptive metacognition) and an association of autonomic function with exteroceptive metacognition (but not with fatigue). Furthermore, machine learning (elastic net regression) showed that individual fatigue scores could be predicted out-of-sample from our measurements, with questionnaire-based measures of interoceptive awareness and sleep quality as key predictors. Our results support theoretical concepts of interoception as an important factor for fatigue and demonstrate the general feasibility of predicting individual levels of fatigue from simple questionnaire-based measures of interoception and sleep.
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Affiliation(s)
- Marion Rouault
- Institut du Cerveau et de la Moelle Épinière (ICM), Centre National de la Recherche Scientifique (CNRS), Hôpital Pitié Salpêtrière, Paris, France
- Département d'Études Cognitives, École Normale Supérieure, Université Paris Sciences et Lettres (PSL University), Paris, France
| | - Inês Pereira
- Translational Neuromodeling Unit (TNU), Institute for Biomedical Engineering, University of Zurich and ETH, Zurich, Switzerland
| | - Herman Galioulline
- Translational Neuromodeling Unit (TNU), Institute for Biomedical Engineering, University of Zurich and ETH, Zurich, Switzerland
| | - Stephen M Fleming
- Wellcome Centre for Human Neuroimaging, University College London, London, UK
- Department of Experimental Psychology, University College London, London, UK
- Max Planck UCL Centre for Computational Psychiatry and Ageing Research, University College London, London, UK
| | - Klaas Enno Stephan
- Translational Neuromodeling Unit (TNU), Institute for Biomedical Engineering, University of Zurich and ETH, Zurich, Switzerland
- Max Planck Institute for Metabolism Research, Cologne, Germany
| | - Zina-Mary Manjaly
- Department of Neurology, Schulthess Clinic, Zurich, Switzerland
- Department of Health Sciences and Technology, ETH, Zurich, Switzerland
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Fatigue in Patients with Idiopathic/Isolated REM Sleep Behavior Disorder. Brain Sci 2022; 12:brainsci12121728. [PMID: 36552187 PMCID: PMC9775466 DOI: 10.3390/brainsci12121728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 11/25/2022] [Accepted: 12/15/2022] [Indexed: 12/23/2022] Open
Abstract
Introduction: Fatigue is one of the most common and disabling symptoms of Parkinson’s Disease (PD). The occurrence and clinical features of fatigue in patients with prodromal PD remain largely elusive. This study aimed to investigate the prevalence and clinical characteristics of fatigue in patients with idiopathic/isolated REM sleep behavior disorders (iRBD). Methods: A total of 97 polysomnography-confirmed iRBD patients were enrolled in this study. A comprehensive neurological assessment (including motor and non-motor assessment) was performed. Fatigue was assessed using the Fatigue Severity Scale (FSS). Motor and non-motor characteristics were compared between iRBD patients with and without fatigue. Logistic regression was used to identify the factors associated with fatigue. Results: The prevalence of fatigue was 35.05%. Compared to the non-fatigue patients, patients with fatigue had higher non-motor symptom scale (NMSS) score (p = 0.009), higher Hamilton Depression Rating Scale (HAMD) score (p = 0.002), and a higher prevalence of orthostatic hypotension (p = 0.021). Multivariate regression analysis showed that depression (OR 4.17, 95% CI 1.13−15.49, p = 0.033) and orthostatic hypotension (OR 2.80, 95% CI 1.09−7.18, p = 0.032) were significantly associated with fatigue in iRBD patients. Additionally, both NMSS (rs = 0.310, p = 0.002) and HAMD (rs = 0.385, p < 0.001) scores were mildly correlated with fatigue severity. Conclusion: Our study showed that fatigue is common in patients with iRBD. In addition, depression and orthostatic hypotension were independently associated with fatigue in iRBD patients.
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Esteban-Burgos AA, Fernández-Alcántara M, Escribano S, Perpiñá-Galvañ J, Campos-Calderón CP, Cabañero-Martínez MJ. Psychometric Properties of the Spanish Version of the Fatigue Assessment Scale in Caregivers of Palliative Care Patients. J Clin Med 2022; 11:3999. [PMID: 35887763 PMCID: PMC9320379 DOI: 10.3390/jcm11143999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 07/01/2022] [Accepted: 07/08/2022] [Indexed: 02/01/2023] Open
Abstract
Symptoms of fatigue and lack of energy are very common in caregivers of palliative care (PC) patients, traditionally associated with variables such as burden or depression. There are no Spanish-language instruments validated for assessing fatigue levels in this population. The Fatigue Assessment Scale (FAS) is a useful and simple instrument for assessing fatigue in this group. The aim of this study was to examine its psychometric properties (factor structure, reliability and validity) in a sample of caregivers of PC patients. Instrumental design for instrument validation was performed. One hundred and eight caregivers of PC patients participated and completed measures of fatigue, family functioning, life satisfaction, caregiver burden, anxiety, depression, resilience and quality of life. A confirmatory factor analysis was performed; non-linear reliability coefficient and Pearson correlations and t-tests were conducted to assess evidence of reliability and validity. The Spanish version of the FAS was found to have a one-dimensional structure. Reliability was 0.88. Validity evidence showed that FAS scores were positively associated with levels of burden, anxiety and depression. They were negatively associated with family functioning, life satisfaction, resilience and quality of life. The Spanish version of the FAS in caregivers of PC patients shows adequate psychometric properties.
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Affiliation(s)
- Ana A. Esteban-Burgos
- Department of Nursing, Faculty of Health Sciences, Instituto de Investigación Biosanitaria (ibs.GRANADA), University of Granada, 18016 Granada, Spain;
- Department of Health Psychology, Campus de San Vicente del Raspeig, University of Alicante, San Vicente de el Raspeig, 03690 Alicante, Spain
| | - Manuel Fernández-Alcántara
- Department of Health Psychology, Campus de San Vicente del Raspeig, University of Alicante, San Vicente de el Raspeig, 03690 Alicante, Spain
| | - Silvia Escribano
- Department of Nursing, Faculty of Health Sciences, Institute for Health and Biomedical Research (ISABIAL), University of Alicante, San Vicente del Raspeig, 03690 Alicante, Spain; (S.E.); (J.P.-G.); (M.J.C.-M.)
| | - Juana Perpiñá-Galvañ
- Department of Nursing, Faculty of Health Sciences, Institute for Health and Biomedical Research (ISABIAL), University of Alicante, San Vicente del Raspeig, 03690 Alicante, Spain; (S.E.); (J.P.-G.); (M.J.C.-M.)
| | | | - María José Cabañero-Martínez
- Department of Nursing, Faculty of Health Sciences, Institute for Health and Biomedical Research (ISABIAL), University of Alicante, San Vicente del Raspeig, 03690 Alicante, Spain; (S.E.); (J.P.-G.); (M.J.C.-M.)
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