Depression Treatment: Long-Term Changes in the Personality and Psychopathological Profile of Opiate Addicts After Nucleus Accumbens Ablative Surgery Are Associated With Treatment Outcome.

Long-Term Changes in the Personality and Psychopathological Profile of Opiate Addicts after Nucleus Accumbens Ablative Surgery Are Associated with Treatment Outcome.

Filed under: Depression Treatment

Stereotact Funct Neurosurg. 2012 Nov 13; 91(1): 30-44
Ge S, Chang C, Kalanithi PS, Adler JR, Zhao H, Chang X, Gao L, Wu H, Wang J, Li N, Wang X, Gao G

Objective: To investigate the long-term outcome and changes of the personality and psychopathological profile of opiate addicts after bilateral stereotactic nucleus accumbens (NAc) ablative surgery. Methods: 60 patients were followed up for 5 years and abstinent status and adverse events were evaluated. NAc lesion volumes and locations were obtained by postoperative MRI scans. The Chinese version of the Eysenck Personality Questionnaire (EPQ-RSC), the Symptom Checklist-90-Revised (SCL-90-R), the Beck Depression Inventory (BDI), the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and the World Health Organization’s Quality of Life Questionnaire – Brief Version (WHOQOL-BREF) were administered to the patients before and 5 years after the stereotactic surgery. Results: The total abstinence rate of all patients in their 5th postoperative year was 47.4%. The abstinent patients had a significantly larger lesion volume than the relapsed ones, but a larger lesion volume also increased the risk of adverse events. 5 years after surgery, the abstinent patients showed significant decreases on the Psychoticism (EPQ-P) and Neuroticism (EPQ-N) scores by EPQ-RSC, a significant decline on the Global Severity Index and the subscores in all 10 dimensions by SCL-90-R, significant decreases on the BDI and Y-BOCS scores, and significant improvements on the scores of all domains by WHOQOL-BREF, while for the relapsed patients, only the subscores of obsessive-compulsive by SCL-90-R and the Y-BOCS scores significantly decreased. Postoperative analysis revealed that the abstinent patients had a significantly better score than the relapsed ones by various instruments, and NAc lesion volumes and locations did not correlate with the outcome of any of these instruments. Conclusion: The bilateral ablation of NAc by stereotactic neurosurgery was a feasible method for alleviating psychological dependence on opiate drugs and preventing a relapse. Long-term follow-up suggested that surgery can improve the personality and psychopathological profile of opiate addicts with a trend towards normal levels, provided persistent abstinence can be maintained; relapse, on the other hand, may ruin this effect.
HubMed – depression

Silent brain infarcts: A cause of depression in the elderly?

Filed under: Depression Treatment

Psychiatry Res. 2012 Nov 12;
Saavedra Perez HC, Direk N, Hofman A, Vernooij MW, Tiemeier H, Ikram MA

The present study included 1047 elderly participants. At baseline, brain magnetic resonance imaging (MRI) was performed to detect infarcts and white matter lesions; further, depressive disorders were assessed. Participants were followed up during 3.6 years to determine incident and recurrent depression. We found an increased risk of recurrent depression associated with silent brain infarcts.
HubMed – depression

Abnormal neural activity in partially remitted late-onset depression: An fMRI study of one-back working memory task.

Filed under: Depression Treatment

Psychiatry Res. 2012 Nov 12;
Lee TW, Liu HL, Wai YY, Ko HJ, Lee SH

Only half of the geriatric patients with major depressive disorder (MDD) can reach full remission after treatment of half a year. This study was designed to examine the neural responses in the partial responders of late-onset MDD. We used 3-Tesla functional magnetic resonance imaging to assess the patterns of cerebral activation/deactivation in the performance of a one-back version of the n-back working memory task. We recruited 14 major depressive patients who reached partial remission after at least half a year of pharmacological intervention, compared with 14 non-depressive controls. There were no significant between-group differences in the demographical profiles and working memory performance, which was true for both accuracy and reaction time. Brain masks encompassing the neural responses of activation/deactivation were constructed from the non-depressive controls. The depressive group shows enhanced activities at left middle frontal and left parietal regions, and reduced deactivation at several temporal regions and left amygdala within the masks. Besides, the depressive group activates extra neural nodes at middle frontal and middle temporal regions outside the masks. The neural responses at left amygdala are significantly correlated with the severity of depression and comorbid anxiety. The loss of deactivation in left amygdala and temporal areas in cognitive endeavor may be related to the refractoriness to treatment.
HubMed – depression

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