Quality of Life in Carotid Atherosclerosis: The Role of Co-morbid Mood Disorders

Carotid Revascularization is Associated with Improved Mood in Patients with Advanced Carotid Disease

OBJECTIVE

To investigate the impact of carotid interventions on patients' mental condition in patients with carotid stenosis.

SUMMARY BACKGROUND DATA

Ongoing research highlights the impact of carotid interventions on neurocognitive function in patients with advanced carotid atherosclerosis. However, data regarding the impact of carotid revascularization on mood is scarce.

METHODS

A total of 157 patients undergoing carotid revascularization were prospectively recruited. The primary outcome was depression, evaluated pre-operatively, and at 1-,6- and 12-month post-intervention using the long form of the geriatric depression scale (GDS-30) questionnaire. Other tests were also used to assess cognition at the respective timepoints. Statistical analyses were performed to assess the postoperative outcomes compared to baseline.

RESULTS

Baseline depression (GDS>9) was observed in 49(31%) subjects, whereas 108(69%) patients were not depressed (GDS≤9). The average pre-operative GDS score was 15.42 ± 4.40(14.2-16.7) and 4.28 ±2.9(3.7-4.8) in the depressed and non-depressed groups, respectively. We observed a significant improvement in GDS scores within the depressed group at 1-month (P=0.002), 6-months (P=0.027), and 1-year (P<0.001) post-intervention compared to preop, whereas the non-depressed group had similar post-op GDS scores at all time points compared to baseline. Significant improvement in measures of executive function was seen in non-depressed patients at all three timepoints whereas depressed patients showed an improvement at 1-year follow-up.

CONCLUSIONS

Our study highlights improvement in mood among patients with advanced carotid disease who screened positive for depression at baseline. Further studies with larger sample sizes are warranted to investigate the association between depression, carotid disease, and carotid intervention.

The impact of MDQ positivity on quality of life impairment: Does it support the hypothesis of "Dysregulation of Mood, Energy, and Social Rhythms Syndrome" (DYMERS)?

Background

DSM-5 separates bipolar (BD) from depressive disorders, but some experts consider BD as part of a spectrum of mood disorders. The interpretation of numerous false positives of BD screened by the Mood Disorders Questionnaire (MDQ) is part of this debate. Recent study results suggest that the worsening of health-related quality of life (H-Qol) associated with MDQ positivity does not depend solely on mood disorders. This study aims to clarify whether the impairment may be due to other concomitant disorders, unrelated to mood disorders, leading to a worsening of H-Qol. Additionally, the study aims to explore if MDQ positivity itself observe clinical significance.

Design and methods

The study involved pairs of cases (MDQ+) and controls (MDQ-) matched for sex, age, and absence of DSM-IV psychiatric comorbidity. The impact of MDQ positivity on the quality of life in a sample of MDQ+ comorbid with MDD was measured and compared to impact of MDD in other chronic disorders.

Results

The H-Qol was significantly worse in MDQ+ than in controls (both groups without any psychiatric co-morbidity). The worsening was similar to severe chronic disorders The burden of worsening quality of life due to MDD was mild in another sample of MDQ positives with comorbid MDD.

Conclusion

The study hypothesizes that MDQ positivity may be related to hyperactivation and dysregulation of rhythms typical of stress disorders. In fact, MDQ+ was found strongly related to sleep disturbances. Future studies could verify if a "Dysregulation of Mood, Energy, and Social Rhythms Syndrome" (DYMERS), causes worsening the H-Qol in MDQ+.

Prevalence Estimates, Severity, and Risk Factors of Depressive Symptoms among Coronary Artery Disease Patients after Ten Days of Percutaneous Coronary Intervention

BACKGROUND

Depression and cardiovascular disorders are significant determinants of health that affect the quality of life and life expectations. Despite the high importance of depression screening among Coronary Artery Disease (CAD) patients, the time being to assess and treat it remains controversial.

OBJECTIVES

This study aims to assess the prevalence estimates and severity of depressive symptoms and determine the risk factors associated with developing such symptoms among CAD patients after ten days of Percutaneous Coronary Intervention (PCI).

METHODS

All patients who underwent elective PCI between October 5, 2019, and Mid-March 2020 and diagnosed with CAD were included in this cross-sectional study. CAD was defined as intra-luminal stenosis of ≥ 50% in one or more of the coronary arteries. Depressive symptoms were screened after ten days of the PCI utilizing the patient health questionnaire-9 (PHQ-9) tool. A linear regression model was used to assess the adjusted effects of independent variables on PHQ-9 scores. Electronic medical records, clinical charts, and PCI and echocardiogram reports were reviewed.

RESULTS

Out of 385 CAD patients, a total of 335 were included in this study, with a response rate of 87%. The participants' mean (±SD) age was 57.5±10.7 years, 75.2% were males, 43% were current smokers, and 73.7% had below bachelor's education. The prevalence estimates of patients with moderate to severe depressive symptoms (PHQ-9 ≥10) was 34%, mild depression 45.1%, and normal 20.9%. Female gender, low educational level and diabetes mellitus were found to be the significant independent predictors of depression among our cohort with (t(333) = 3.68, p<0.001); (t(333) = 5.13, p<0.001); and (t(333) = 2.79, p=0.042), respectively.

CONCLUSION

This study suggests a high prevalence of depressive symptoms among CAD patients after ten days of PCI. Approximately one out of three patients with CAD have significant symptoms of depression, which is an alarming finding for clinicians. Moreover, this study demonstrates a lack of sufficient depression recognition and management in similar study settings. Integration of mental health assessment and treatment among patients with CAD as soon as after PCI is recommended for optimal and effective treatment and to obtain the best outcomes.

The Burden of Depressive and Bipolar Disorders in Celiac Disease

Introduction:

Aims: to measure the association between Celiac Disease (CD) and affective disorders, particularly Bipolar Disorder (BD), since it has not been studied yet, and to measure how much the quality of life (QoL) of a person with CD is affected by comorbidity with these disorders.

Methods:

Design: Case-control study. Cases: 60 consecutive patients with CD. Controls: 240 subjects without CD, randomly selected after sex- and age-matching from a database of an epidemiological study. Psychiatric diagnoses according to DSM-IV carried out by physicians using structured interview tools (ANTAS-SCID). QoL was measured by means of SF-12.

Results:

The lifetime prevalence of Major Depressive Disorder (MDD) was higher in CD than in controls (30.0% vs 8.3%, P<0.0001) as well as Panic Disorder (PD) (18.3% vs 5.4%, P<0.001) and BD (4.3% vs 0.4%, P<0.005). Patients with CD show a lower mean score than controls on SF12 (35.8±5.7 vs. 38.2±6.4; p=0.010), but those without comorbidity with MDD, PD and BD do not. The attributable burden of CD in worsening QoL - when comorbid with these disorders - was found comparable to that of serious chronic diseases like Wilson’s Disease, and lower than Multiple Sclerosis only.

Conclusion:

MDD, PD and BD are strictly associated with CD. The comorbidity with these disorders is the key determinant of impaired quality of life in CD. Thus a preventive action on mood and anxiety disorders in patients suffering from CD is required. Moreover a screening for CD in people with affective disorders and showing key symptoms or family history of CD is recommended.

Patients with carotid atherosclerosis who underwent or did not undergo carotid endarterectomy: outcome on mood, cognition and quality of life

BACKGROUND

To compare the six-month outcome on mood, cognition and quality of life (QoL) in patients with severe carotid atherosclerosis (CA) who underwent carotid endarterectomy (CEA) with subjects who refused treatment.

METHODS

Cohort study on consecutive inpatients with CA (stenosis ≥ 50 %) (N = 46; age 72.56 ± 7.26; male 65.2 %). Intervention cohort: subjects who decided to undergo CEA (N = 35); Control cohort patients who refused CEA (N = 11). DSM-IV-Psychiatric diagnosis made by clinicians using interviews, QoL measured by Short Form Health Survey (SF-12); cognitive performance by WAIS Intelligent Coefficient (IC).

RESULTS

The study showed a better improvement during six months in Overall IC, Performance IC and Verbal IC in the group that underwent CEA. QoL in the two cohorts did not reach statistical significance. Percentages of patients who improved in the CEA group were significantly higher with regard to Overall and Verbal IC scores, and at the limits of statistical significance in Performance IC. The differences of subject with improvement in SF-12 score in the two groups did not reach statistical significance. Ages below 68 were found to be determinant of a good outcome in Overall IC score. Limit: study conducted with a small sample size.

CONCLUSIONS

Patients with severe carotid atherosclerosis who underwent CEA enhanced their cognitive performance.