Acupuncture for cervical dystonia associated with anxiety and depression: A case report

BACKGROUND Cervical dystonia(CD)is a type of muscle tone disorder that usually occurs in the neck muscles.Due to the intermittent or continuous involuntary contraction of the neck muscles,the head and neck are twisted and skewed and some postural abnormalities occur.Long-term abnormal posture or pain can cause negative emotions in patients,which can affect their quality of life.CASE SUMMARY This case report included a 37-year-old woman who was diagnosed with CD associated with anxiety and depression;the accompanying symptoms were head and neck tilt of approximately 90°to the right and mental abnormality.After two courses of acupuncture treatment,the patient’s head and neck can be maintained in a normal position,and the negative emotions can be relieved.CONCLUSION This case indicates that acupuncture can effectively improve CD and the emotional state and quality of life of patients,making it an effective alternative treatment for the condition.

Analysis of risk factors leading to anxiety and depression in patients with prostate cancer after castration and the construction of a risk prediction model

BACKGROUND Cancer patients often suffer from severe stress reactions psychologically,such as anxiety and depression.Prostate cancer(PC)is one of the common cancer types,with most patients diagnosed at advanced stages that cannot be treated by radical surgery and which are accompanied by complications such as bodily pain and bone metastasis.Therefore,attention should be given to the mental health status of PC patients as well as physical adverse events in the course of clinical treatment.AIM To analyze the risk factors leading to anxiety and depression in PC patients after castration and build a risk prediction model.METHODS A retrospective analysis was performed on the data of 120 PC cases treated in Xi'an People's Hospital between January 2019 and January 2022.The patient cohort was divided into a training group(n=84)and a validation group(n=36)at a ratio of 7:3.The patients’anxiety symptoms and depression levels were assessed 2 wk after surgery with the Self-Rating Anxiety Scale(SAS)and the Selfrating Depression Scale(SDS),respectively.Logistic regression was used to analyze the risk factors affecting negative mood,and a risk prediction model was constructed.RESULTS In the training group,35 patients and 37 patients had an SAS score and an SDS score greater than or equal to 50,respectively.Based on the scores,we further subclassified patients into two groups:a bad mood group(n=35)and an emotional stability group(n=49).Multivariate logistic regression analysis showed that marital status,castration scheme,and postoperative Visual Analogue Scale(VAS)score were independent risk factors affecting a patient's bad mood(P<0.05).In the training and validation groups,patients with adverse emotions exhibited significantly higher risk scores than emotionally stable patients(P<0.0001).The area under the curve(AUC)of the risk prediction model for predicting bad mood in the training group was 0.743,the specificity was 70.96%,and the sensitivity was 66.03%,while in the validation group,the AUC,specificity,and sensitivity were 0.755,66.67%,and 76.19%,respectively.The Hosmer-Lemeshow test showed aχ^(2) of 4.2856,a P value of 0.830,and a C-index of 0.773(0.692-0.854).The calibration curve revealed that the predicted curve was basically consistent with the actual curve,and the calibration curve showed that the prediction model had good discrimination and accuracy.Decision curve analysis showed that the model had a high net profit.CONCLUSION In PC patients,marital status,castration scheme,and postoperative pain(VAS)score are important factors affecting postoperative anxiety and depression.The logistic regression model can be used to successfully predict the risk of adverse psychological emotions.

Effects of the Treatment of Carpal Tunnel Syndrome with Surgery and Injections on the Hospital Anxiety and Depression Scale (HADS)

Background: The prevalence of carpal tunnel syndrome (CTS) and of anxiety and depression in primary care practice are high. Different studies had shown an increased prevalence of anxiety and depression in CTS patients. Nevertheless, few papers had been published studying the anxiety and depression scales in the treatment of CTS, either with corticosteroid injections (I) or with surgical decompression (S). Objective: To assess whether clinical improvement observed after the treatment of CTS either with I or with S correlates with an improvement in the punctuations of the Hospital Anxiety and Depression scales (HADS), at 3, 6 and 12-month follow-up. Methods: Randomized and open-label clinical trial, comparing I and S. Patients with symptoms suggestive of CTS (nocturnal paraesthesias) of at least 3 months duration and neurophysiological confirmation were included. Patients with clinically apparent motor impairment were excluded. The subjective evaluation of symptoms was carried out using the visual-analogue scale of pain (VAS-p). Clinical reviews were performed 3, 6 and 12 months after treatment. Each patient completed the HADS questionnaire and a VAS-p at 0, 3, 6, and 12 months. Statistical significance was established using the Student’s t test and the Mann-Whitney U test when necessary. A linear regression analysis was used to know the effect of the treatment adjusted for the initial score of both scales. Results: 65 patients were included (30 in group I and 35 in group S). There was no statistical difference between both groups in terms of age, gender distribution, disease duration, VAS-p, neurophysiological testing severity of CTS or the 8 subscales of HADS. Both groups improved significantly in relation to the baseline VAS-p values, in the reviews at 3, 6 and 12 months, with no significant differences between I and S. At 6 months, the reduction in the anxiety scale was around 3 points for both treatments (S = 3.6 and I = 3.2), without reaching significant differences. At 12 months, it was somewhat higher for those treated with I, but always around 3 points and without significant differences. The Depression scale score was slightly reduced at 6 months, and in a similar way for both groups (I = 1 and S = 1.19;p = 0.8). After 12 months, group I doubled the previous reduction, with group S experiencing a very slight change (I = 1.96 and S = 1.03;p = 0.3). When analysing the effect of group S on group I, the result was a reduction of 0.25 points for Anxiety (p = 0.7) and of 0.02 points for Depression (p = 0.9). Conclusions: Treatment of CTS with I or S results in a similar and discrete improvement in Anxiety scores on the HADS scale at 6 and 12 months. For both types of treatment, the Depression scores barely changed at 6 months, being somewhat higher in group I after 12-month follow-up. The independent effect of the S on both scales is small and not significant.

COVID-19-induced anxiety,depression and stress among healthcare professionals in Sri Lanka

Objective:To assess the degree of anxiety,depression and stress due to the COVID-19 epidemic among healthcare professionals in Sri Lanka.Methods:Healthcare professionals from 6 selected government and private hospitals located in Gampaha District were recruited for the study.The socio-demographic factors,knowledge and attitudes of healthcare professionals on COVID-19 was collected through a self-administered questionnaire,while Depression,Anxiety and Stress Scale score was used to assess the psychological wellbeing.Descriptive statistics and binary logistic regression techniques were used for data analysis.Results:Totally 324 healthcare professionals were included and the respondents had a high overall level of knowledge towards COVID-19.Twenty-five percent of the respondents had different levels of anxiety,while 10.8%had mild depression,and 4.6%had moderate depression.Interestingly,40.4%of the respondents had mild stress,and 11.1%had moderate stress.Young people(20-35 years),medical laboratory technologist and nursing officer,being quarantined,having a SARS-CoV-2-infected family member,involvement in COVID-19 patient care,and limited availability of personal protection equipment,were recognized as significant risk factors associated with anxiety,depression and stress.Conclusions:The healthcare professionals are high-risk groups to experience psychological impacts from COVID-19.Continuous monitoring and implementing appropriate intervention activities and provision of counseling support are highly recommended.

A red pomegranate fruit extract-based formula ameliorates anxiety/depression-like behaviors via enhancing serotonin (5-HT) synthesis in C57BL/6 male mice

This study investigated the anti-anxiety/anti-depression potential of a formula containing red pomegranate fruit extract(RPFE;40%,m/m),Lactobacillus rhamnosus(JB-1)(34%,m/m),magnesium gluconate(25%,m/m)and vanillin(1%,m/m).The RPFE formula(dose:2.0,1.5 or 1.0 mg/g·day)reversed behavioral dysfunctions and body weight gain induced by chronic restraint stress combined with corticosterone injection in C57BL/6 male mice.The RPFE formula exhibited the abilities to normalize the levels of serum infl ammatory cytokines(NF-κB,TNF-α,IL-6,IL-1βand IFN-γ)and malondialdehyde(MDA),and activities of superoxide dismutase(SOD),catalase(CAT)and nitric oxide synthase(NOS),as well as relieve the injury of hippocampal neurons.The serotonin(5-HT)levels in hippocampus were increasingly enhanced,which might be mediated by reducing the activity of indoleamine-2,3-dioxygenase(IDO)and increasing the activity of tryptophan hydroxylase(TPH).Thus,the neuroprotective and ameliorating effects on anxiety/depression-like behaviors resulting from the RPFE formula ingestion were possibly related to serotonergic activation,which might be mediated via anti-infl ammatory and anti-oxidant actions.

Comparison of the Improvement Effect of MVD and Gamma Knife on Pain,Anxiety and Depression of Patients after Treatment of Primary Trigeminal Neuralgia

Objective:To explore the effects of microsurgical vascular decompression(MVD)and gamma knife respectively on the treatment of pain,anxiety and depression in patients with primary trigeminal neuralgia.Methods:From February 2011 to June 2017,we treated 108 patients with primary trigeminal neuralgia.According to the treatment plan of the patients,they were divided into an observation group and a control group,54 cases each.The observation group underwent microsurgical vascular decompression(MVD)for the treatment of primary trigeminal neuralgia,while the control group received gamma knife treatment.The effects of pain,improvement of anxiety and depression were compared between two groups at 1 week,3 months,and 6 months after treatment.Results:The pain,anxiety and depression scores of the observation group was significantly lower than that of the control group(P<0.05).Conclusion:MVD can relieve patients'pain,anxiety and depression symptoms,as well as improve quality of life and restore self-confidence in life.

Associations of Time Spent on Study and Sleep with Anxiety and Depressive Symptoms in Junior High School Students:Report from the Large-Scale Monitoring of Basic Education Data in China

In the context of the COVID-19 pandemic and under the pressure of high competitiveness for higher education in China,junior high school students’mental health is facing greater challenges.Understanding the time allocation of study and sleep is necessary for developing effective prevention and treatment programs.Based on a survey of 31,057 junior high school students in 47 junior high schools in Gansu Province,China's Mainland,the study analyzed the associations of time spent on study and sleep with anxiety and depressive symptoms among junior high school students through chi-square test,ANOVA,logistic regression model and threshold regression model.It was found that 18.4%–21.1%of junior high school students had mild and above anxiety and depressive symptoms.Female junior high school students were more likely to have anxiety and depressive symptoms.In addition,time spent on study was significantly and positively associated with anxiety and depressive symptoms and time spent on sleep was significantly and negatively associated with anxiety and depressive symptoms.Late sleepers were more likely to suffer from anxiety and depressive tendencies.Reducing after-school study time appropriately and getting more sleep are beneficial in reducing anxiety and depression,but it is more important to ensure time of sleep.For the reduction of anxiety and depressive symptoms,the maximum time spent on study after school should not exceed 1.92 h,the minimum time spent on sleep at night should be more than 7 h and a 40-min lunch break should be guaranteed at noon.

Correlation Analysis of Neuropathic Headache and Depression and Anxiety

Objective:To explore the relationship between neuropathic headache,and depression and anxiety,as well as to adopt reasonable methods to reduce patients'depression and anxiety.Methods:From June 2019 to May 2021,a total of 89 neuropathic headache patients were treated in our hospital,which is Yidu Central Hospital of Weifang and they were recorded as the observation group.During the same period,healthy individuals were randomly selected using a random number table method and 91 cases were randomly selected and recorded as the control group.Through the questionnaire survey and the use of SAS and SDS scores,the anxiety and depression of healthy people were evaluated,and the correlation between neurological headache,and anxiety and depression were analyzed.Results:In the control group,the number of people with mild,moderate,and severe anxiety were three,two,and zero,accounting for 3.30%,2.20%,and 0.00%,respectively.The total anxiety was 5.50%,and the SAS score was 31.23±3.22;In the observation group,the number of people with mild,moderate,and severe anxiety were fourteen,eleven,and six,accounting for 15.73%,12.36%,and 6.74%,respectively.The total anxiety was 34.83%,and the SAS score was 49.56±4.98,which was measured.The data shows that the control group is significantly lower than the observation group in terms of the number of people or the anxiety score,and both P<0.05 are statistically significant;the number of mild,moderate,and severe depression in the control group is four,two,and zero,respectively.They were 4.40%,2.20%,0.00%,the total depression was 6.60%,and the SAS score was 33.23±3.24;the number of people with mild,moderate,and severe depression in the observation group were sixteen,eleven,and five,respectively.17.98%,12.36%,5.62%,total depression degree was 35.96%,SAS score was 46.56±4.68.The measurement data showed that the control group was significantly lower than the observation group in terms of the number of people or the depression score,and both were P<0.05,which was statistically significant.Conclusion:Patients with neuropathic pain are usually accompanied by anxiety and depression.Anxiety and depression are also important factors that affect patients with neuropathic pain.Psychotherapy intervention for patients is very necessary to relieve patients'anxiety and depression.Thereby reducing the pain of the patient.

Effects of strengthening prospective nursing practice on sleep quality,anxiety,and depression of awake patients in intensive care unit

BACKGROUND The intensive care unit(ICU)is a specialized hospital department.Awake patients in the ICU frequently encounter adverse psychological states,such as anxiety and fear,often accompanied by poor sleep quality.This situation has garnered significant attention within the medical community.AIM To investigate the impact of prospective nursing intervention strategies on the sleep quality and negative emotional state of conscious ICU patients.METHODS One hundred and twenty ICU awake patients admitted to our hospital were selected and randomly divided into control(n=60)and observation(n=60)groups.Patients in the control group were cared for using the conventional nursing model,while patients in the observation group were cared for using the prospective nursing model.Sleep improvement was assessed using the International Standardized Sleep Efficiency Formula and Pittsburgh Sleep Quality Index(PSQI).The PSQI,Generalized Anxiety Disorder 7-item(GAD-7)scale,Self-Depression Scale(SDS),and satisfaction before and after treatment were used to assess the negative emotional states of patients under the two care models.RESULTS Patient satisfaction in the observation group was significantly higher than in the control group.The GAD-7 and SDS scores in the observation group were significantly lower than those in the control group,and the total effective rate of sleep improvement in the observation group was significantly higher than in the control group.After treatment,the PSQI scores of the two groups significantly decreased(P<0.05).The decrease in the observation group was more significan than that in the control group,and the difference between the two groups was statistically significant.CONCLUSION Prospective nursing interventions can improve sleep quality and psychological levels and significantly affect conscious patients in the ICU,which is worthy of clinical application.

Guanxin Danshen Dripping Pills Improve Quality of Life and Cardiovascular Prognoses of CHD Patients after PCI with Anxiety or Depression(GLAD Study):A Randomized Double-Blind Placebo-Controlled Study

Objective:To assess the efficacy and safety of Guanxin Danshen Dripping Pills(GXDS)in the treatment of depression or anxiety in patients with coronary heart disease(CHD)after percutaneous coronary intervention(PCI).Methods:From September 2017 to June 2019,200 CHD patients after PCI with depression and anxiety were included and randomly divided into GXDS(100 cases)and placebo control groups(100 cases)by block randomization and a random number table.Patients in the GXDS and control groups were given GXDS and placebo,respectively,0.4 g each time,3 times daily for 12 weeks.The primary outcomes were scores of Patient Health Questionnaire-9(PHQ-9),Generalized Anxiety Scale(GAD-7)and the Seattle Angina Pectoris Scale(SAQ).The secondary outcomes included 12 Health Survey Summary Form(SF-12)scores and the first onset time and incidence of major adverse cardiovascular events(MACEs).Other indices including blood pressure,blood lipids,microcirculation and inflammatory-related indices,etc.were monitored at baseline,week 4,and week 12.Results:In the full analysis set(200 cases),after treatment,the PHQ-9 and GAD-7 scores in the GXDS group were considerably lower than those in the control group(P<0.05).Compared with the baseline,the total PHQ-9 scores of the experimental and control groups decreased by 3.97 and 1.18,respectively.The corrected mean difference between the two groups was–2.78(95%CI:–3.47,–2.10;P<0.001).The total GAD-7 score in the GXDS group decreased by 3.48%compared with the baseline level,while that of the placebo group decreased by 1.13%.The corrected mean difference between the two groups was–2.35(95%CI:–2.95,–1.76;P<0.001).The degree of improvement in SAQ score,SF-12 score,endothelin and high-sensitive C-reactive protein levels in the GXDS group were substantially superior than those in the placebo group,and the differences between the two groups were statistically significant(P<0.05).Similar results were obtained in the per protocol population analysis of 177 patients.Three cases of MACES were reported in this study(1 in the GXDS group and 2 in the placebo group),and no serious adverse events occurred.Conclusions:GXDS can significantly alleviate depression and anxiety,relieve symptoms of angina,and improve quality of life in patients with CHD after PCI.(Registration No.ChiCTR1800014291)

One-year outcomes of resveratrol supplement with aflibercept versus aflibercept monotherapy in wet agerelated macular degeneration

AIM:To determine the one-year outcomes of resveratrol oral supplement in patients suffering from wet age-related macular degeneration(AMD).METHODS:Fifty naïve and previously untreated patients suffering from wet AMD,were randomly assigned in two subgroups of 25 patients each.All the participants were treated with 3 monthly intravitreal injections of 2.0 mg aflibercept(IAIs)followed by injections“according to need”,while in one group the patients also received daily two tablets of resveratrol oral supplement.Prior to treatment initiation,a complete ophthalmological examination,including best corrected visual acuity(BCVA)and contrast sensitivity evaluation,optical coherence tomography(OCT)scans,fundus autofluorescence(FAF),fluorescein angiography,indocyanine green angiography,and OCT angiography(OCTA),was performed to every participant,while all of them completed the Hospital Anxiety and Depression Scale(HADS)questionnaire,in order to assess their quality of life(QoL)status.The patients were assessed monthly for 1y with FAF,and OCT or OCTA;the main endpoints were the number IAIs,the changes in BCVA,in contrast sensitivity,and in patients’QoL status.RESULTS:No significant differences were present between the groups regarding the baseline demographic and clinical data.Over the 12-month period,a similar number of IAIs was applied in both groups(4.52±1.00 vs 4.28±0.90,P=0.38),while the rest of the clinical data also did not differ significantly after the completion of the study period.However,for HADS Depression(11.88±2.51 vs 8.28±1.54,P<0.001)and HADS Anxiety(11.92±2.52 vs 7.76±1.51,P<0.001)questionnaires values,the score was significantly better in patients who received resveratrol supplements.Moreover,a statistically significant difference was detected in the mean change from baseline values of contrast sensitivity(0.17±0.19 vs 0.35±0.24,P=0.005),HADS Depression(0.08±1.38 vs-3.88±1.48,P<0.001),and HADS Anxiety(0.36±1.98 vs-5.12±2.70,P<0.001)scores,in favour of the patients treated with resveratrol supplements.CONCLUSION:The resveratrol oral supplement is a complementary treatment in cases of wet AMD,highlighting its effectiveness in improving patients’QoL status.

Focus on Effects of Chinese Medicine on Improving Anxiety-Depression and Quality of Life of Patients with Primary Sjogren’s Syndrome

Primary Sjogren’s syndrome(pSS)is a chronic autoimmune disease with a long duration of illness,for which there is no cure.Patients often suffer from anxiety and depression due to various reasons,exhibiting a decline in their quality of life.Chinese medicine(CM)has certain advantages in the treatment of pSS,which not only helps relieve clinical symptoms and improve treatment outcomes,but also reduces anxiety and depression and improves the quality of life.Therefore,CM should be considered as early as possible given its effectiveness and synergistic effects in treating p SS.

Association between gastrointestinal symptoms and affectivity in patients with bipolar disorder

AIM To study if anxiety, depression and experience of stress are associated with gastrointestinal(GI) symptoms in patients with bipolar disorder.METHODS A total of 136 patients with bipolar disorder(mean age 49.9 years; 61% women) and 136 controls from the general population(mean age 51.0 years; 60% women) were included in the study. GI symptoms were assessed with The Gastrointestinal Symptom Rating Scale-irritable bowel syndrome(GSRS-IBS), level of anxiety and depression with The Hospital Anxiety and Depression Scale(HADS) and stress-proneness with Perceived Stress Questionnaire. Over a ten year period, all visits in primary care were retrospectively recorded in order to identify functional GI disorders.RESULTS In subjects with low total HADS-score, there were no significant differences in GI-symptoms between patients and controls(GSRS-IBS 7.0 vs 6.5, P = 0.513). In the patients with bipolar disorder there were significant correlations between all GSRS and HADS subscores for all symptom clusters except for "constipation" and "reflux". Factors associated to GI symptoms in the patient group were female sex(adjusted OR = 2.37, 95%CI: 1.07-5.24) and high HADS-Depression score(adjusted OR = 3.64, 95%CI: 1.07-12.4). These patients had also significantly more visits for IBS than patients with low HADS-Depression scores(29% vs 8%, P = 0.008). However, there was no significant differences in consulting behaviour for functional GI disorders between patients and controls(25% vs 17%, P = 0.108).CONCLUSION Female patients and patients with high HADS depression score reported significantly more GI symptoms, whereas patients with low HADS scores did not differ from control subjects.

Effects of progressive muscle relaxation therapy on Maintenance hemodialysis patients:a systematic review and meta-analysis

Objective:This study aimed to evaluate the effects of progressive relaxation therapy on patients with maintenance hemodialysis.Methods:A literature search was performed using PubMed,Embase,Cochrane Library,China National Knowledge Infrastructure,and Wanfang Data from inception to July 2020.Randomized controlled trials on the use of progressive muscle relaxation therapy in maintenance hemodialysis patients were selected.The primary outcomes were the depression and anxiety.Secondary outcomes included fatigue and sleep.Two reviewers proceeded study selection and quality assessment of included trials and performed heterogeneity of included studies before meta-analysis.Results:A total of 8 studies,which comprised a total of 668 participants were included in the final meta-analysis.The results showed that progressive muscle relaxation therapy could reduce the depression of patients(MD=-5.11,95%CI:-6.74 to-3.48,P<0.001),reduce the anxiety(SMD=-1.27,95%CI:-1.73 to-0.82,P<0.001),relieve fatigue symptoms(MD=-0.87,95%CI:-1.20 to-0.53,P<0.001),improve the sleep quality(MD=-1.69,95%CI:-1.95 to-1.42,P<0.001).Conclusion:Progressive muscle relaxation therapy has positive effects on depression,anxiety,fatigue and sleep quality in patients with maintenance hemodialysis.While concurrent evidence is insufficient,and further studies of high quality are needed to strengthen the conclusion.

Research on the prognostic value of adjusting intraperitoneal threedimensional quality evaluation mode in laparoscopic cholecystectomy patients

BACKGROUND Benign gallbladder diseases have become a high-prevalence condition not only in China but also worldwide.The main types of benign gallbladder diseases include gallbladder polyps,acute and chronic cholecystitis,and gallstones,with gallstones being the most common,accounting for over 70%of cases.Although the mortality rate of benign gallbladder diseases is low,they carry obvious potential risks.Studies have shown that an increased incidence of benign gallbladder diseases can increase the risk of cardiovascular diseases and gallbladder cancer,resulting in a substantial disease burden on patients and their families.AIM To assess the medical utility of the Configuration-Procedure-Consequence(CPC)three-dimensional quality evaluation model in modulating the prognosis of laparoscopic cholecystectomy patients.METHODS A total of 98 patients who underwent laparoscopic cholecystectomy in our hospital from February 2020 to January 2022 were selected as the subjects.According to the random number table method,they were divided into a study group and a control group,with 49 patients in each group.The control group received routine perioperative care,while the study group had the addition of the CPC three-dimensional quality evaluation.The postoperative recovery-related indicators(time to first flatus,time to oral intake,time to ambulation,hospital stay),stress indicators(cortisol and adrenaline levels),distinctions in anxiety and RESULTS The time to first flatus,time to oral intake,time to ambulation,and hospital stay of the study group patients were obviously lower than those of the control group patients,with statistical significance(P<0.05).On the 1st day after admission,there were no obvious distinctions in cortisol and adrenaline levels in blood samples,as well as in the Self-Rating Anxiety Scale(SAS)and Self-Rating Depression Scale(SDS)scores between the study group and the control group(P>0.05).However,on the 3rd day after surgery,the cortisol and adrenaline levels,as well as SAS and SDS scores of the study group patients,were obviously lower than those of the control group patients(P<0.05).The study group had 2 cases of incisional infection and 1 case of pulmonary infection,with a total incidence of complications of 6.12%(3/49),which was obviously lower than the 20.41%(10/49)in the control group(P<0.05).CONCLUSION Implementing the CPC three-dimensional quality evaluation model for patients undergoing laparoscopic cholecystectomy can help accelerate their perioperative recovery process,alleviate perioperative stress symptoms,mitigate anxiety,depression,and other adverse emotions,and to some extent,reduce the incidence of perioperative complications.

Impact of Adverse Events Associated With Acitretin Treatment of Moderate-to-Severe Plaque Psoriasis:Based on an Observational,Single-Center Study in Shanghai,China

Objective:Acitretin is a widely used systemic retinoid that is to treat psoriasis but has significant variations in efficacy and adverse events(AEs)among individuals.This study aimed to determine the impact of AEs associated with acitretin treatment of moderate-to-severe plaque psoriasis on the Dermatology Life Quality Index(DLQI)and Hospital Anxiety and Depression Scale(HADS)scores.Methods:This prospective,observational,single-center study was conducted from March 2021 to June 2022 and analyzed 116 patients with moderate-to-severe plaque psoriasis treated with acitretin who were followed up for 12 weeks.The primary outcome was the incidence of AEs related to acitretin,and the secondary objective was to investigate the effect of AEs on the DLQI and HADS scores.The generalized linear models were used to assess the association between AEs related to acitretin and DLQI scores or HADS scores,and the association between the involved system/tissue and DLQI scores or HADS scores.Results:A final total of 45 patients were included in the analysis,and a total of 157 treatment-related AEs involving nine organs or systems were reported in 41 patients.The most common AE was skin-or mucosa-related,with 72 cumulative events in 31 patients.AEs also commonly affected the endocrine,digestive,and genitourinary systems.Compared with the group with 0-2 AEs,the group with 3-5 AEs had a significantly increased DLQI score by 5.49 points(95%CI,1.47-9.51)(P=0.0089).Compared with AEs involving 0 to 1 system,AEs affecting 2 to 3 systems resulted in a significant increase in the DLQI score by 5.75 points(95%CI,1.67-9.83)(P=0.0071).Generalized linear models showed no statistically significant associations between AEs and the HADS scores.Conclusion:Our study demonstrates a high incidence of acitretin-related AEs.These AEs may affect quality of life but rarely cause psychological problems such as anxiety and depression.

Effects of Biologics on Mental Health and Health-Related Quality of Life in Patients With Psoriasis:A Repeated Cross-Sectional Survey in Chinese Population

Objective:Psoriasis is a chronic inflammatory systemic disease that severely impacts patients’ quality of life (QoL) and psychological health.While biologics have been shown to be effective in treating psoriatic lesions,thus improving QoL,real-life data regarding such effects remain scant.We administered a repeated cross-sectional survey to assess the effects of 8 weeks of biologics treatment on the QoL and mental health status of patients with moderate-to-severe plaque psoriasis.Methods:From March to May 2022,patients with moderate-to-severe plaque psoriasis were enrolled and treated with biologics in the outpatient clinic at the Dermatology Hospital of Southern Medical University.Assessments were performed before treatment and after 4 and 8 weeks of treatment with biologics.Psoriasis severity,QoL,and mental health status were evaluated using the Psoriasis Area and Severity Index (PASI),Dermatology Life Quality Index (DLQI),36-Item Short-form Health Survey (SF-36),and Hospital Anxiety and Depression Scale (HADS).A multivariate generalized estimating equations (GEE) analysis was used to account for repeated measures and to determine the effects of treatment duration and type of biological agent on relevant indicators.Results:Among the 78 enrolled patients,the ranges of pretreatment scores were 4.6 to 46.8 for the PASI,1 to 30 for the DLQI,31.5 to 100.0 for the physical component score (PCS) of the SF-36,16.6 to 100.0 for the mental component score (MCS) of the SF-36,0 to 15 for the HADS-A,and 0 to 17 for the HADS-D.After 8 weeks of biologics treatment,98.7% (77/78) of patients had obtained PASI 75.All assessed scores changed over time (GEE,P < 0.001).Moreover,there were group-by-time interaction effects for the DLQI score (GEE,P = 0.023) and PCS (GEE,P = 0.029).The HADS-A and HADS-D scores were both decreased at week 8 compared with pretreatment values.Correlation analyses revealed that higher DLQI scores were associated with lower levels of QoL and higher levels of anxiety or depression.Conclusion:Biologics are not only effective in the treatment of skin lesions but also exert beneficial effects upon the QoL and mental health of patients with psoriasis as determined in the short-term assessments conducted in this study.

The trade-off between COVID-19 and mental diseases burden during a lockdown: Mathematical modeling of control measures

Background:During the COVID-19 pandemic,many countries used lockdowns as a containment measure.While lockdowns successfully contributed to slowing down the contagion,the related mobility restrictions were reportedly associated with an increased risk of major depressive and anxiety disorders.We aimed to quantify the trade-off between the quality-adjusted life years(QALY)gain due to lower COVID-19 incidence as a result of a lockdown and QALY loss due to lockdown-induced mental disorders.Methods:We developed an agent-based model of COVID-19 epidemic and coupled mental disorder development in the population of a large city.We used data sources on the places of living,studying and working,public health and census surveys.Modeling of mental disorders was based on diathesis-stress concept.We quantified mental and physical health burden in terms of QALY taking into account major depressive and anxiety disorder episodes,lethal and non-lethal cases of COVID-19,and immunization.Findings:We evaluated the dynamics of new major depressive disorder(MDD)and anxiety disorder(AD)cases during the period between September 2020 and December 2021 in Moscow,Russia.We found that lockdown imposition increases the daily chances of getting MDD or ADD by a vulnerable person by 16.79%(95%CI[12.36%,21.23%]).The QALY loss associated with COVID-19-induced and lockdown-induced mental disorders was estimated to be 18.93%(95%CI[16.94%,19.73%])of the total QALY loss caused by COVID-19,immunization,and all kinds of mental disorders.For a synthetic“strong”lockdown,it had been shown that QALY loss is minimized when about 70%of the population are isolated.Interpretation:The burden associated with mental disorders amounts to a considerable part of COVID-19-related losses.Our findings demonstrate that cost-benefit analysis of mobility restriction should include a forecast of mental disorder development in the population.