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Vidya KL, Srivastava S, Singh B, Kar SK. Effect of priming on adjunctive repetitive transcranial magnetic stimulation in treatment of late life depression: Protocol of a prospective randomized sham-controlled study. CNS Spectr 2022; 28:1-21. [PMID: 36205026 DOI: 10.1017/s1092852922001018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjectivePriming stimulation, which involves high-frequency repetitive transcranial magnetic stimulation (rTMS) followed by low-frequency, has been shown to enhance neural response and is one of the novel paradigms found beneficial in adult patients with depression and has not been studied in late-life depression (LLD). This study aims to compare the effect of adjunctive priming vis-a-vis no priming rTMS over right dorso-lateral prefrontal cortex (DLPFC), on treatment of LLD.MethodsThis trial is registered in Clinical Trial Registry-India (CTRI) on www.ctri.nic.in. CTRI registration number: CTRI/2020/08/027230. Forty patients of LLD who are symptomatic after an adequate antidepressant trial will be randomized into 2 groups (active priming and sham priming rTMS); each receiving 10 sessions of rTMS over 2 weeks. Patients will remain blind to treatment allocation. Assessments will be done using Hamilton rating scale for depression, Geriatric Depression Scale, Hamilton rating scale for Anxiety, Somatic Symptom Severity Scale 8, Hindi Mental Status Examination, and Clinical Global Impression scale at baseline, week 1, 2, and 4. Side effect checklist will be applied after each session in both groups and at the end of 4 weeks.ResultData will be analyzed using statistical software Statistical Package for Social Sciences. Both the groups (active and sham groups) will be compared at the four given timepoints. Also, the baseline characteristics will be compared with the 3 follow-up points for any change.ConclusionThe findings of the study will give an insight to the possible role of priming to augment the effect of low-frequency rTMS in LLD.
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L’utilisation des antidépresseurs dans l’épisode dépressif caractérisé unipolaire du sujet âgé. Encephale 2022; 48:445-454. [DOI: 10.1016/j.encep.2021.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 11/01/2021] [Accepted: 11/23/2021] [Indexed: 10/19/2022]
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Marín-Rincón HA, Machado-Duque ME, Machado-Alba JE. For what indications are antidepressants being used in adults in Colombia? REVISTA COLOMBIANA DE PSIQUIATRIA (ENGLISH ED.) 2022; 51:192-198. [PMID: 36075858 DOI: 10.1016/j.rcpeng.2022.08.004] [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: 07/10/2020] [Accepted: 11/02/2020] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Antidepressants are useful in the pharmacological treatment of different depressive and anxiety disorders, as well as being potentially useful in other indications. The aim of the study was to determine the indications for which antidepressants are being prescribed in patients over 18 years of age registered with the Colombian Health System. METHODS Retrospective study with data from patients over 18 years old, of either sex, registered with the Colombian Health System, who are prescribed antidepressants. Medical records were reviewed, looking for indications approved and not approved by regulatory agencies. Patients were identified randomly, as well as the sociodemographic, clinical and pharmacological variables that could be associated with prescriptions for unapproved indications. RESULTS 351 patients were evaluated, with a mean age of 60.4 ± 15.3 years, of whom 72.6% were women. They were attended in 34 cities, with prescriptions mainly by general practitioners (n = 276; 78.6%), and psychiatrists (n = 42; 12.0%). Selective serotonin reuptake inhibitors were the most widely prescribed antidepressants (n = 204; 58.1%), followed by atypicals (n = 76; 21.7%). The most frequent indications were for depression (n = 169; 48.1%), anxiety (n = 48; 13.7%), pain (n = 22; 6.3%) and sleep disorders (n = 17; 4.8%). A total of 188 prescriptions (53.6%) were made for approved indications, and the remaining 163 (46.4%) were classified as unapproved. CONCLUSIONS Antidepressants are being prescribed for the treatment of depression, anxiety, pain and sleep disorders, especially in older adult women, but almost half of the formulations were for unapproved indications.
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Affiliation(s)
- Hamilton Andrés Marín-Rincón
- Grupo de Investigación en Farmacoepidemiología y Farmacovigilancia, Universidad Tecnológica de Pereira-Audifarma S.A., Pereira, Risaralda, Colombia
| | - Manuel E Machado-Duque
- Grupo de Investigación en Farmacoepidemiología y Farmacovigilancia, Universidad Tecnológica de Pereira-Audifarma S.A., Pereira, Risaralda, Colombia; Grupo Biomedicina, Facultad de Medicina, Fundación Universitaria Autónoma de las Américas, Pereira, Colombia
| | - Jorge E Machado-Alba
- Grupo de Investigación en Farmacoepidemiología y Farmacovigilancia, Universidad Tecnológica de Pereira-Audifarma S.A., Pereira, Risaralda, Colombia.
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Yang H, Deng HM, Chen HY, Tang SH, Deng F, Lu YG, Song JC. The Impact of Age on Propofol Requirement for Inducing Loss of Consciousness in Elderly Surgical Patients. Front Pharmacol 2022; 13:739552. [PMID: 35418861 PMCID: PMC8996377 DOI: 10.3389/fphar.2022.739552] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 03/09/2022] [Indexed: 11/28/2022] Open
Abstract
It is generally accepted that geriatric patients are more sensitive to propofol than adults; thus, a dose-adjusted propofol is recommended for these patients during the induction of anesthesia. However, for patients aged 75 years and over, established guidelines for propofol induction doses do not provide dose references. To this end, we observed 80 surgical patients (female 39, male 41, American Society of Anesthesiologists physical status score I ∼ II) to access the appropriate dose of propofol for inducing loss of consciousness (LOC). Accordingly, patients were subdivided into group A (20 patients, 45–64 years), group B (20 patients, 65–74 years), group C (20 patients, 75–84 years), and group D (20 patients, ≥ 85 years). All patients received propofol (at a rate of 0.3 mg/kg/min) alone for inducing LOC, which was defined by loss of both eyelash reflex and verbal response. Compared with group A, the propofol requirement for LOC in Group B, C and D decreased by 14.8, 25.2 and 38.5%, respectively. Bivariate linear correlation analysis showed that propofol requirement was negatively correlated with age. After adjusting for potential confounders, age was still an independent factor affecting propofol requirement. In conclusion, the propofol requirement for inducing LOC decreased significantly in elderly patients. We demonstrated that age was an independent factor impacting propofol requirement for LOC during the induction of general anesthesia, implying that the propofol dose for anesthesia induction should be further reduced in elderly surgical patients, especially those aged 75 years and over.
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Affiliation(s)
- Hua Yang
- Department of Anesthesiology, Shidong Hospital Affiliated to University of Shanghai for Science and Technology, Shanghai, China
| | - Hui-Min Deng
- Department of Anesthesiology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Hai-Yan Chen
- Department of Anesthesiology, Shidong Hospital Affiliated to University of Shanghai for Science and Technology, Shanghai, China
| | - Shu-Heng Tang
- Department of Anesthesiology, Shidong Hospital Affiliated to University of Shanghai for Science and Technology, Shanghai, China
| | - Fang Deng
- Department of Anesthesiology, Shidong Hospital Affiliated to University of Shanghai for Science and Technology, Shanghai, China
| | - Yu-Gang Lu
- Department of Anesthesiology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Jin-Chao Song
- Department of Anesthesiology, Shidong Hospital Affiliated to University of Shanghai for Science and Technology, Shanghai, China
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Ön BI, Vidal X, Berger U, Sabaté M, Ballarín E, Maisterra O, San-Jose A, Ibáñez L. Antidepressant use and stroke or mortality risk in the elderly. Eur J Neurol 2021; 29:469-477. [PMID: 34632668 DOI: 10.1111/ene.15137] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 10/04/2021] [Accepted: 10/06/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE Current evidence on antidepressant-related stroke or mortality risk is inconsistent. Because the elderly have the highest exposure to antidepressants, the aim was to quantify their association with stroke and mortality risks in this vulnerable population. METHODS Persons over 65 years old and registered in the Information System for Research in Primary Care of Catalonia during 2010-2015 comprised the study population. Antidepressant exposure was categorized into current-users, recent-users, past-users and antidepressant non-users (controls). The effect of antidepressant exposure on stroke or death, whichever came first, was analyzed by Cox regression adjusted for established risk factors. RESULTS Of the 1,068,117 participants included, 20% had antidepressant reimbursements during follow-up, 17% had a stroke and 3% died. The risk of experiencing stroke or death was higher in antidepressant current-users (hazard ratio [HR] 1.04; 95% confidence interval [CI] 1.02-1.06), recent-users (HR 3.34; 95% CI 3.27-3.41) and past-users (HR 2.06; 95% CI 2.02-2.10) compared to antidepressant non-users. Antidepressant current-use was associated with increased stroke (HR 1.56; 95% CI 1.50-1.61) but decreased mortality risk (HR 0.93; 95% CI 0.91-0.94). During antidepressant recent-use and past-use, both stroke and mortality risks were significantly increased compared to no antidepressant use. CONCLUSIONS Antidepressant use may be associated with increased stroke risk in the elderly. When using antidepressants in this population, the potential risks should be considered.
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Affiliation(s)
- Begüm Irmak Ön
- Institute for Medical Information Processing, Biometry and Epidemiology, LMU Munich, Munich, Germany
| | - Xavier Vidal
- Clinical Pharmacology Service, Department of Pharmacology Therapeutics and Toxicology, Vall d'Hebron University Hospital, Fundació Institut Català de Farmacologia, Autonomous University of Barcelona, Barcelona, Spain
| | - Ursula Berger
- Institute for Medical Information Processing, Biometry and Epidemiology, LMU Munich, Munich, Germany
| | - Mònica Sabaté
- Clinical Pharmacology Service, Department of Pharmacology Therapeutics and Toxicology, Vall d'Hebron University Hospital, Fundació Institut Català de Farmacologia, Autonomous University of Barcelona, Barcelona, Spain
| | - Elena Ballarín
- Clinical Pharmacology Service, Department of Pharmacology Therapeutics and Toxicology, Vall d'Hebron University Hospital, Fundació Institut Català de Farmacologia, Autonomous University of Barcelona, Barcelona, Spain
| | - Olga Maisterra
- Vall d'Hebron University Hospital Neurology Service, Barcelona, Spain
| | - Antonio San-Jose
- Vall d'Hebron University Hospital Internal Medicine Service, Barcelona, Spain
| | - Luisa Ibáñez
- Clinical Pharmacology Service, Department of Pharmacology Therapeutics and Toxicology, Vall d'Hebron University Hospital, Fundació Institut Català de Farmacologia, Autonomous University of Barcelona, Barcelona, Spain
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[Old and depressed and/or demented? - Pseudodepression vs. pseudodementia]. Dtsch Med Wochenschr 2021; 146:487-492. [PMID: 33780998 DOI: 10.1055/a-1180-2417] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Many elderly patients suffer from both, depressive symptoms and cognitive deficits. Clinically, it oftentimes appears unclear whether the affective or the cognitive problems are primary or secondary. Modern molecular and imaging markers contribute to a more efficient distinction between depression and incipient dementia due to neurodegenerative, vascular, and other diseases. A careful history and clinical investigations are necessary to identify the underlying diseases, but they do not always offer sufficient therapeutic guidance. If in doubt, the condition should always be considered as potentially reversible and treated emphatically (but with age-appropriate caution).
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Marín-Rincón HA, Machado-Duque ME, Machado-Alba JE. For What Indications are Antidepressants Being Used in Adults in Colombia? REVISTA COLOMBIANA DE PSIQUIATRIA (ENGLISH ED.) 2020; 51:S0034-7450(20)30116-5. [PMID: 33735040 DOI: 10.1016/j.rcp.2020.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 09/17/2020] [Accepted: 11/02/2020] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Antidepressants are useful in the pharmacological treatment of different depressive and anxiety disorders, as well as being potentially useful in other indications. The aim of the study was to determine the indications for which antidepressants are being prescribed in patients over 18 years of age registered with the Colombian Health System. METHODS Retrospective study with data from patients over 18 years old, of either sex, registered with the Colombian Health System, who are prescribed antidepressants. Medical records were reviewed, looking for indications approved and not approved by regulatory agencies. Patients were identified randomly, as well as the sociodemographic, clinical and pharmacological variables that could be associated with prescriptions for unapproved indications. RESULTS 351 patients were evaluated, with a mean age of 60.4±15.3 years, of whom 72.6% were women. They were attended in 34 cities, with prescriptions mainly by general practitioners (n=276; 78.6%), and psychiatrists (n=42; 12.0%). Selective serotonin reuptake inhibitors were the most widely prescribed antidepressants (n=204; 58.1%), followed by atypicals (n=76; 21.7%). The most frequent indications were for depression (n=169; 48.1%), anxiety (n=48; 13.7%), pain (n=22; 6.3%) and sleep disorders (n=17; 4.8%). A total of 188 prescriptions (53.6%) were made for approved indications, and the remaining 163 (46.4%) were classified as unapproved. CONCLUSIONS Antidepressants are being prescribed for the treatment of depression, anxiety, pain and sleep disorders, especially in older adult women, but almost half of the formulations were for unapproved indications.
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Affiliation(s)
- Hamilton Andrés Marín-Rincón
- Grupo de Investigación en Farmacoepidemiología y Farmacovigilancia, Universidad Tecnológica de Pereira-Audifarma S.A., Pereira, Risaralda, Colombia
| | - Manuel E Machado-Duque
- Grupo de Investigación en Farmacoepidemiología y Farmacovigilancia, Universidad Tecnológica de Pereira-Audifarma S.A., Pereira, Risaralda, Colombia; Grupo Biomedicina, Facultad de Medicina, Fundación Universitaria Autónoma de las Américas, Pereira, Colombia
| | - Jorge E Machado-Alba
- Grupo de Investigación en Farmacoepidemiología y Farmacovigilancia, Universidad Tecnológica de Pereira-Audifarma S.A., Pereira, Risaralda, Colombia.
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Henkel K. [Exercise and physical training as interventions in gerontopsychiatry]. Z Gerontol Geriatr 2020; 53:728-734. [PMID: 33231761 DOI: 10.1007/s00391-020-01810-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 10/15/2020] [Indexed: 12/01/2022]
Abstract
The treatment of mental disorders in older adults is often restricted by limitations in efficacy and tolerability of pharmacologically dominated standard therapeutic strategies. Therefore, nonpharmacological therapeutic alternatives and supplements play a crucial role in these patients. Structured exercise and training are interventions that are associated with a high level of evidence in prevention and treatment of mental and cognitive disorders. This article is based on a selective search of the literature and provides an overview of the current scientific evidence with respect to the mechanisms of action, the effects on frequently occurring clinical disorders and modalities of the exercise interventions.
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Affiliation(s)
- Karsten Henkel
- Klinik für Gerontopsychiatrie, Klinikum Christophsbad Göppingen, Faurndauer Str. 6-28, 73035, Göppingen, Deutschland. .,Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Uniklinik RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland.
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Akechi T, Sugishita K, Chino B, Itoh K, Ikeda Y, Shimodera S, Yonemoto N, Miki K, Ogawa Y, Takeshima N, Kato T, Furukawa TA. Whose depression deteriorates during acute phase antidepressant treatment? J Affect Disord 2020; 260:342-348. [PMID: 31521872 DOI: 10.1016/j.jad.2019.09.052] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Revised: 07/10/2019] [Accepted: 09/08/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND Few studies have investigated the proportion of patients with depression who experience worsening of depression symptoms during adequate antidepressant treatment. The current study aimed to investigate the proportion and predictors of worsening depression during antidepressant treatment in a multi-center randomized trial involving patients with major depression. METHODS We defined the deterioration of depression using depression symptom severity evaluated by total Patient Health Questionnaire (PHQ-9) score increases from week 0 to week 9 during acute phase antidepressant treatment. Patients' baseline demographic and clinical data, change in PHQ-9 scores from week 0 to week 3, and side effects at week 3 were evaluated as potential predictors of subsequent deterioration of depression. RESULTS Of 1,647 patients, 99 (6.0%) exhibited deterioration of depression, and this proportion was smaller when reliable change index criteria were applied. Logistic regression analysis revealed that the following factors were significantly associated with deterioration of depression: younger age at onset of first episode of major depressive disorder, current older age, and greater increase in PHQ-9 scores between week 0 and week 3. LIMITATIONS The time of the primary endpoint might not have been sufficiently long. The present study did not include a placebo arm, and potentially relevant predictors might not have been comprehensively investigated. CONCLUSIONS A small proportion of patients may experience deterioration of depression during acute phase antidepressant treatment. Age at onset at first depressive episode, current age, and early negative response to antidepressants may be useful predictors of subsequent worsening of depression.
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Affiliation(s)
- Tatsuo Akechi
- Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan.
| | | | | | | | | | | | - Naohiro Yonemoto
- Department of Biostatistics, Kyoto University School of Public Health
| | | | - Yusuke Ogawa
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University
| | - Nozomi Takeshima
- Kyoto University Graduate School of Medicine/School of Public Health Department of Health Promotion of Human Behavior
| | | | - Toshi A Furukawa
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University
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Viscogliosi G, Donfrancesco C, Lo Noce C, Giampaoli S, Vanuzzo D, Carle F, Palmieri L. Association Between Antidepressant Medication Use and Prevalence and Control of Cardiovascular Risk Factors in Community-Dwelling Older Adults: The Italian Health Examination Survey 2008-2012. Metab Syndr Relat Disord 2019; 18:73-78. [PMID: 31821103 DOI: 10.1089/met.2019.0088] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: To assess the association of antidepressant (AD) medication use with prevalence and control of cardiovascular (CV) risk factors. Methods: Data of older adults from the population-based Italian Osservatorio Epidemiologico Cardiovascolare/Health Examination Survey (OEC/HES) Study 2008-2012 were used. CV risk factors were measured using standardized procedures. Information on clinical features, lifestyles, and medications was collected using standardized questionnaires. Logistic regression models were elaborated to assess associations between AD use and prevalence and control of CV risk factors. Results: Around 2549 participants (age 71.4 ± 4.2 years, 51.3% men) were studied; 268 (10.5%) were AD users. Of these, 72.4% used selective serotonin reuptake inhibitors (SSRI). AD users had less favorable CV risk factor profile and were less likely to achieve control of blood pressure and total cholesterol. After multiple adjustment for potentially confounding variables, AD use was associated with greater likelihood of having diabetes (OR = 1.05, 95% CI = 1.02-1.10, P = 0.008), hypertension (OR = 1.10, 95% CI = 1.05-1.20, P = 0.003), and hypercholesterolemia (OR = 1.08, 95% CI = 1.04-1.14, P < 0.001). Among participants treated for hypertension and hypercholesterolemia, AD use was associated with poorer control of BP (OR = 1.07, 95% CI = 1.03-1.12, P = 0.001) and cholesterol (OR = 1.06, 95% CI = 1.01-1.12, P = 0.021). Results persisted virtually unchanged when analyses were restricted to participants on SSRI. Conclusions: AD use was associated with greater prevalence and poorer control of traditional risk factors for CV disease in a population-based sample of older adults. Such results highlight the need for surveillance of CV risk factors and promotion of healthy lifestyles in older adults with psychopathology and, in particular, in those under AD treatment.
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Affiliation(s)
- Giovanni Viscogliosi
- Department of Cardiovascular, Dysmetabolic and Aging-Associated Diseases, National Institute of Health, Rome, Italy.,Centre of Epidemiology and Biostatistics, Polytechnic University of Marche, Ancona, Italy
| | - Chiara Donfrancesco
- Department of Cardiovascular, Dysmetabolic and Aging-Associated Diseases, National Institute of Health, Rome, Italy
| | - Cinzia Lo Noce
- Department of Cardiovascular, Dysmetabolic and Aging-Associated Diseases, National Institute of Health, Rome, Italy
| | - Simona Giampaoli
- Department of Cardiovascular, Dysmetabolic and Aging-Associated Diseases, National Institute of Health, Rome, Italy
| | - Diego Vanuzzo
- National Association Hospital Cardiologists, Florence, Italy
| | - Flavia Carle
- Centre of Epidemiology and Biostatistics, Polytechnic University of Marche, Ancona, Italy
| | - Luigi Palmieri
- Department of Cardiovascular, Dysmetabolic and Aging-Associated Diseases, National Institute of Health, Rome, Italy
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Chang Z, Ghirardi L, Quinn PD, Asherson P, D’Onofrio BM, Larsson H. Risks and Benefits of Attention-Deficit/Hyperactivity Disorder Medication on Behavioral and Neuropsychiatric Outcomes: A Qualitative Review of Pharmacoepidemiology Studies Using Linked Prescription Databases. Biol Psychiatry 2019; 86:335-343. [PMID: 31155139 PMCID: PMC6697582 DOI: 10.1016/j.biopsych.2019.04.009] [Citation(s) in RCA: 83] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 04/02/2019] [Accepted: 04/07/2019] [Indexed: 12/24/2022]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) medication is one of the most commonly prescribed medication classes in child and adolescent psychiatry, and its use is increasing rapidly in adult psychiatry. However, major questions and concerns remain regarding the benefits and risks of ADHD medication, especially in real-world settings. We conducted a qualitative systematic review of studies that investigated the effects of ADHD medication on behavioral and neuropsychiatric outcomes using linked prescription databases from the last 10 years and identified 40 studies from Europe, North America, and Asia. Among them, 18 used within-individual designs to account for confounding by indication. These studies suggested short-term beneficial effects of ADHD medication on several behavioral or neuropsychiatric outcomes (i.e., injuries, motor vehicle accidents, education, substance use disorder), with estimates suggesting relative risk reduction of 9% to 58% for these outcomes. The within-individual studies found no evidence of increased risks for suicidality and seizures. Replication studies are needed for several other important outcomes (i.e., criminality, depression, mania, psychosis). The available evidence from pharmacoepidemiology studies on long-term effects of ADHD medication was less clear. We discuss time-varying confounding and other limitations that should be considered when interpreting results from pharmacoepidemiology studies. Furthermore, we highlight several knowledge gaps to be addressed in future research and implications for research on mechanisms of outcomes of ADHD medications.
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Affiliation(s)
- Zheng Chang
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
| | - Laura Ghirardi
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Patrick D. Quinn
- Department of Applied Health Science, School of Public Health, Indiana University, Bloomington, IN
| | - Philip Asherson
- Social Genetic and Developmental Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, UK
| | - Brian M. D’Onofrio
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden,Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden,School of Medical Sciences, Örebro University, Örebro, Sweden
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Schäfer W, Princk C, Kollhorst B, Schink T. Antidepressants and the Risk of Hemorrhagic Stroke in the Elderly: a Nested Case–Control Study. Drug Saf 2019; 42:1081-1089. [DOI: 10.1007/s40264-019-00837-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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13
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Harerimana B, Forchuk C, O'Regan T. The use of technology for mental healthcare delivery among older adults with depressive symptoms: A systematic literature review. Int J Ment Health Nurs 2019; 28:657-670. [PMID: 30666762 DOI: 10.1111/inm.12571] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/12/2018] [Indexed: 12/30/2022]
Abstract
Depression has been identified as the single largest contributor to poor health and functioning worldwide. Global estimates indicate that 4.4% of the world's population lives with depression, equating to about 322 million individuals. Research demonstrates that telehealth interventions (i.e. delivering therapy by phone or videoconferencing) have potential for improving mental health care among community-based older adults. This review analyses scholarly literature on telehealth interventions among older adults with depressive symptoms. Following PRISMA guidelines, a systematic search of peer-reviewed papers was conducted using the following key terms: telemedicine, telepsychogeriatrics, telepsychiatry, eHealth, mental health, depression, and geriatric. The review included nine articles examining telehealth for mental health care, published in English between 1946 and 26 September 2017. Telehealth for mental health care among older adults demonstrates a significant impact on health outcomes, including reduced emergency visits, hospital admissions, and depressive symptoms, as well as improved cognitive functioning. Positive or negative influences on the use of telehealth among older adults are identified. This review highlights keys aspects to consider in using telehealth interventions, including levels of education, cognitive function, and prior technology experience. The review highlights vital factors for designing interventions which aim to capitalize on the benefits of the use of telehealth for mental healthcare service delivery, especially in older adults with depressive symptoms.
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Affiliation(s)
- Boniface Harerimana
- Arthur Labatt Family School of Nursing, Western University, London, Ontario, Canada.,Lawson Health Research Institute, London, Ontario, Canada
| | - Cheryl Forchuk
- Arthur Labatt Family School of Nursing, Western University, London, Ontario, Canada.,Aging, Mental Health, Rehabilitation and Recovery, Lawson Health Research Institute, London, Ontario, Canada
| | - Tony O'Regan
- Lawson Health Research Institute, London, Ontario, Canada
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Abstract
Stroke remains the second leading cause of death in the world, and its prevalence is projected to rise in the United States and globally. The main driver for increased stroke prevalence is aging of the population; however, best evidenced-based strategies for stroke treatment and prevention are not always followed for older patients. Furthermore, considerable gaps in knowledge exist for stroke prevention and treatment in elderly and very elderly patients. In this chapter, we discuss various aspects of stroke care in the elderly, including the evidence that guides stroke prevention and treatment. We focus on the challenges in managing stroke in the very elderly including the paucity of data to guide management. The sections span the continuum of stroke care, from primary prevention to management of stroke complications. Finally, we highlight the most significant unanswered questions regarding stroke care in the elderly.
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Affiliation(s)
- Anjail Sharrief
- Department of Neurology, McGovern Medical School, University of Texas Health Science Center, Houston, TX, United States
| | - James C Grotta
- Clinical Innovation and Research Institute, Memorial Hermann Hospital, Houston, TX, United States.
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Farioli Vecchioli S, Sacchetti S, Nicolis di Robilant V, Cutuli D. The Role of Physical Exercise and Omega-3 Fatty Acids in Depressive Illness in the Elderly. Curr Neuropharmacol 2018; 16:308-326. [PMID: 28901279 PMCID: PMC5843982 DOI: 10.2174/1570159x15666170912113852] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2017] [Revised: 06/20/2017] [Accepted: 07/30/2017] [Indexed: 02/07/2023] Open
Abstract
Background: In adulthood, depression is the most common type of mental illness and will be the second leading cause of disease by 2020. Major depression dramatically affects the function of the central nervous system and degrades the quality of life, especially in old age. Several mechanisms underlie the pathophysiology of depressive illness, since it has a multifactorial etiology. Human and an-imal studies have demonstrated that depression is mainly associated with imbalances in neurotransmitters and neurotrophins, hypothalamic-pituitary-adrenal axis alterations, brain volume changes, neurogenesis dysfunction, and dysregulation of in-flammatory pathways. Also the gut microbiota may influence mental health outcomes. Although depression is not a consequence of normal aging, depressive disorders are common in later life, even if often undi-agnosed or mis-diagnosed in old age. When untreated, depression reduces life expectancy, worsens medical illnesses, en-hances health care costs and is the primary cause of suicide among older people. To date, the underpinnings of depression in the elderly are still to be understood, and the pharmacological treatment is the most commonly used therapy. Objective: Since a sedentary lifestyle and poor eating habits have recently emerged as crucial contributors to the genesis and course of depression, in the present review, we have focused on the effects of physical activity and omega-3 fatty acids on depressive illness in the elderly. Results: A growing literature indicates that both exercise and dietary interventions can promote mental health throughout one’s lifespan. Conclusion: There thus emerges the awareness that an active lifestyle and a balanced diet may constitute valid low-cost pre-vention strategies to counteract depressive illness in the elderly.
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Affiliation(s)
- Stefano Farioli Vecchioli
- Institute of Cell Biology and Neurobiology, CNR/Fondazione Santa Lucia, Via del Fosso di Fiorano 64, 00143, Rome, Italy
| | - Stefano Sacchetti
- Laboratory of Experimental and Behavioral Neurophysiology, Fondazione Santa Lucia, Via del Fosso di Fiorano 64, 00143, Rome, Italy.,Department of Psychology, University Sapienza of Rome, Via dei Marsi 78, 00185, Rome, Italy
| | - V Nicolis di Robilant
- Institute of Cell Biology and Neurobiology, CNR/Fondazione Santa Lucia, Via del Fosso di Fiorano 64, 00143, Rome, Italy
| | - Debora Cutuli
- Laboratory of Experimental and Behavioral Neurophysiology, Fondazione Santa Lucia, Via del Fosso di Fiorano 64, 00143, Rome, Italy.,Department of Psychology, University Sapienza of Rome, Via dei Marsi 78, 00185, Rome, Italy
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Ly M, Andreescu C. Advances and Barriers for Clinical Neuroimaging in Late-Life Mood and Anxiety Disorders. Curr Psychiatry Rep 2018; 20:7. [PMID: 29492705 DOI: 10.1007/s11920-018-0870-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
PURPOSE OF REVIEW Mood and anxiety disorders are very commonly experienced by older adults and are becoming a growing concern due to the rapidly aging global population. Recent advances in neuroimaging may help in improving outcomes in late-life mood and anxiety disorders. The elucidation of mechanisms contributing to late-life mental health disorders may ultimately lead to the identification of novel therapeutic interventions. Alternatively, clinically validated imaging biomarkers may allow for the prediction of treatment response and identification of better therapeutic approaches in late-life mood and anxiety disorders. RECENT FINDINGS In community samples, late-life depression and late-life generalized anxiety disorder occur up to 38 and 15%, respectively, while late-life bipolar disorder is less common and occur in approximately 0.5% of the population. There are significant challenges in treating and improving outcome in late-life mood and anxiety disorders. Time to treatment response and treatment resistance are increased in older adults. Novel neuroimaging techniques have the potential to improve diagnostic and therapeutic outcome in late-life mood and anxiety disorders either through "personalized pharmacotherapy" or through identifying dysfunction regions/networks to be subsequently used for direct interventions such as transcranial magnetic stimulation. This review will provide an overview of recent literature that substantiates the potential role of neuroimaging in clinical practice, as well as the barriers that must be overcome prior to clinical translation.
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Affiliation(s)
- Maria Ly
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, 3811 O'Hara Street, Pittsburgh, PA, USA
| | - Carmen Andreescu
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, 3811 O'Hara Street, Pittsburgh, PA, USA.
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Li Y, Sanchez C, Gulinello M. Distinct Antidepressant-Like and Cognitive Effects of Antidepressants with Different Mechanisms of Action in Middle-Aged Female Mice. Int J Neuropsychopharmacol 2017; 20:510-515. [PMID: 28158336 PMCID: PMC5458342 DOI: 10.1093/ijnp/pyx004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Accepted: 01/25/2017] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Cognitive dysfunction is among the key symptoms of major depressive disorder and can be affected by antidepressants. Cognitive decline also occurs in normal aging. The effects of different antidepressants on affective and cognitive domains in older subjects are seldom assessed simultaneously. METHODS Healthy middle-aged female mice received vehicle or antidepressant (vortioxetine, vilazodone, duloxetine, or fluoxetine) at therapeutic doses. After 1 month treatment, mice were accessed for visuospatial memory and depression-like behavior. A separate cohort of mice received 3 months of treatment and was test for recognition memory and depression-like behavior. RESULTS After 1 month treatment, vortioxetine improved visuospatial memory and reduced depression-like behavior. Vilazodone reduced depression-like behavior. Duloxetine and fluoxetine were ineffective in both tests. After 3 months treatment, vortioxetine reduced depression-like behavior without affecting recognition memory, while fluoxetine impaired recognition memory. Duloxetine and vilazodone had no effect in both tests. CONCLUSION Different antidepressants have distinct effects in middle-aged female mice.
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Affiliation(s)
- Yan Li
- Lundbeck Research USA, Paramus, New Jersey (Drs Li and Sanchez); Behavioral Core Facility, Neuroscience Dept., Albert Einstein College of Medicine (Dr Gulinello)
| | - Connie Sanchez
- Lundbeck Research USA, Paramus, New Jersey (Drs Li and Sanchez); Behavioral Core Facility, Neuroscience Dept., Albert Einstein College of Medicine (Dr Gulinello)
| | - Maria Gulinello
- Lundbeck Research USA, Paramus, New Jersey (Drs Li and Sanchez); Behavioral Core Facility, Neuroscience Dept., Albert Einstein College of Medicine (Dr Gulinello)
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Gentile G, Cipolla F, Capi M, Simmaco M, Lionetto L, Borro M. Precise medical decision making in geriatric anti-depressant therapy. EXPERT REVIEW OF PRECISION MEDICINE AND DRUG DEVELOPMENT 2016. [DOI: 10.1080/23808993.2016.1199951] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Giovanna Gentile
- Department of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome, Rome, Italy
| | - Fabiola Cipolla
- Department of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome, Rome, Italy
| | - Matilde Capi
- Department of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome, Rome, Italy
| | - Maurizio Simmaco
- Department of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome, Rome, Italy
| | - Luana Lionetto
- Advanced Molecular Diagnostics, IDI, Istituto Dermopatico dell’Immacolata-IRCCS, Rome, Italy
| | - Marina Borro
- Department of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome, Rome, Italy
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Abstract
BACKGROUND Hip fracture is often complicated by depressive symptoms in older adults. We sought to characterize trajectories of depressive symptoms arising after hip fracture and examine their relationship with functional outcomes and walking ability. We also investigated clinical and psychosocial predictors of these trajectories. METHOD We enrolled 482 inpatients, aged ⩾60 years, who were admitted for hip fracture repair at eight St Louis, MO area hospitals between 2008 and 2012. Participants with current depression diagnosis and/or notable cognitive impairment were excluded. Depressive symptoms and functional recovery were assessed with the Montgomery-Asberg Depression Rating Scale and Functional Recovery Score, respectively, for 52 weeks after fracture. Health, cognitive, and psychosocial variables were gathered at baseline. We modeled depressive symptoms using group-based trajectory analysis and subsequently identified correlates of trajectory group membership. RESULTS Three trajectories emerged according to the course of depressive symptoms, which we termed 'resilient', 'distressed', and 'depressed'. The depressed trajectory (10% of participants) experienced a persistently high level of depressive symptoms and a slower time to recover mobility than the other trajectory groups. Stressful life events prior to the fracture, current smoking, higher anxiety, less social support, antidepressant use, past depression, and type of implant predicted membership of the depressed trajectory. CONCLUSIONS Depressive symptoms arising after hip fracture are associated with poorer functional status. Clinical and psychosocial variables predicted membership of the depression trajectory. Early identification and intervention of patients in a depressive trajectory may improve functional outcomes after hip fracture.
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Affiliation(s)
- P. Cristancho
- Department of Psychiatry, Healthy Mind Lab, Washington University School of Medicine, St Louis, MO, USA
| | - E. J. Lenze
- Department of Psychiatry, Healthy Mind Lab, Washington University School of Medicine, St Louis, MO, USA
| | - M. S. Avidan
- Department of Anesthesiology, Washington University School of Medicine, St Louis, MO, USA
| | - K. S. Rawson
- Department of Psychiatry, Healthy Mind Lab, Washington University School of Medicine, St Louis, MO, USA
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Colle R, Corruble E. La vortioxétine : un nouvel antidépresseur pour traiter les épisodes dépressifs caractérisés. Encephale 2016; 42:48-58. [DOI: 10.1016/j.encep.2015.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 07/31/2015] [Indexed: 10/23/2022]
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Abstract
BACKGROUND The manifestation of attention-deficit/hyperactivity disorder (ADHD) among older adults has become an interesting topic of interest due to an increasing number of adults aged 50 years and older (≥50 years) seeking assessment for ADHD. Unfortunately, there is a lack of research on ADHD in older adults, and until recently only a few case reports existed. METHOD A systematic search was conducted in the databases Medline/PubMed and PsycINFO in order to identify studies regarding ADHD in adults ≥50 years. RESULTS ADHD persists into older ages in many patients, but the prevalence of patients fulfilling the criteria for the diagnosis at age ≥50 years is still unknown. It is reason to believe that the prevalence is falling gradually with age, and that the ADHD symptom level is significantly lower in the age group 70-80 years than the group 50-60 years. There is a lack of controlled studies of ADHD medication in adults ≥50 years, but this review suggests that many patients aged ≥50 years experience beneficial effects of pharmacological treatment. The problem with side effects and somatic complications may rise to a level that makes pharmacotherapy for ADHD difficult after the age of 65 years. Physical assessment prior to initiation of ADHD medication in adults ≥50 years should include a thorough clinical examination, and medication should be titrated with low doses initially and with a slow increase. In motivated patients, different psychological therapies alone or in addition to pharmacotherapy should be considered. CONCLUSION It is essential when treating older adult patients with ADHD to provide good support based on knowledge and understanding of how ADHD symptoms have affected health, quality of life, and function through the life span. Individualized therapy for each elderly patient should be recommended to balance risk-benefit ratio when pharmacotherapy is considered to be a possible treatment.
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Affiliation(s)
- Terje Torgersen
- Department of Østmarka, St Olav’s Hospital, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway
| | - Bjorn Gjervan
- Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Psychiatry, Helse Nord-Trondelag Hospital Trust, Kirkegata, Levanger, Norway
| | - Michael B Lensing
- NevSom, Norwegian Center of Expertise for Neurodevelopmental Disorders and Hypersomnias, Women and Children’s Division, Oslo University Hospital, Oslo, Norway
| | - Kirsten Rasmussen
- St Olav’s Hospital, Broset Center for Research and Education in Forensic Psychiatry, Trondheim, Norway
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
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Valiengo LDCL, Stella F, Forlenza OV. Mood disorders in the elderly: prevalence, functional impact, and management challenges. Neuropsychiatr Dis Treat 2016; 12:2105-14. [PMID: 27601905 PMCID: PMC5003566 DOI: 10.2147/ndt.s94643] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Despite the lower prevalence of severe mood disorders in the elderly as compared to younger adults, late-life depression and bipolar disorder (BD) are more strongly associated with negative outcomes related to the presence of medical comorbidities, cognitive deficits, and increased suicide risk and overall mortality. The mechanisms that contribute to these associations are probably multifactorial, involving pathological factors related directly and indirectly to the disease itself, ranging from biological to psychosocial factors. Most of the accumulated knowledge on the nature of these associations derives from naturalistic and observational studies, and controlled data are still scarce. Nonetheless, there has clearly been a recent growth of the scientific interest on late-life BD and geriatric depression. In the present study, we review the most relevant studies on prevalence, clinical presentation, and cognitive/functional impact of mood disorders in elderly. Several clinical-epidemiological studies were dedicated to the study of the prevalence of mood disorders in old age in distinct settings; however, fewer studies investigated the underlying neurobiological findings and treatment specificities in late-life depression and BD. In the present study, we further discuss the implications of these findings on the management of mood disorders in older adults.
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Affiliation(s)
- Leandro da Costa Lane Valiengo
- Laboratory of Neuroscience (LIM-27), Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, Sao Paulo
| | - Florindo Stella
- Laboratory of Neuroscience (LIM-27), Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, Sao Paulo; Biosciences Institute, Universidade Estadual Paulista, Rio Claro, Brazil
| | - Orestes Vicente Forlenza
- Laboratory of Neuroscience (LIM-27), Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, Sao Paulo
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