The Relationship Between Depression and Dementia in the Context of the Impact on Mortality Rates

The aim of the study was to summarize research data on depressive disorders in dementia and to clarify the presence of their impact on mortality rates in dementia. Materials and methods: To compile a literature review on the keywords “dementia”, “mortality” and “depression”, papers were selected and analyzed in the MEDLINE/PubMed and eLibrary databases from 2000 to 2020, as well as relevant references of the analyzed papers. Of the 245 Russian-language and 142 English-language papers, 64 publications were selected for further analysis. Results: the relationship between depression and dementia in late life is complex and is still under debate. Depression can be both a risk factor for the development of dementia and prodromal syndrome, or accompany the development of dementia. Depression is common in all types of dementia and in all stages of the disease, including mild cognitive impairment. Depression and vascular dementia may have a synergistic effect on mortality. Conclusion: the results obtained in the course of the study are important for integral understanding of the peculiarities of managing patients with various types of dementia.

Management of Mild Cognitive Impairment

Mild cognitive impairment (MCI) is a prodromal syndrome often linked to the eventual emergence of dementia syndromes such as Alzheimer’s disease (AD) and vascular dementia (VaD). Research regarding the potential treatment of MCI is reviewed. Current research suggests that neurocognitive decline associated with MCI that may evolve into a dementia syndrome is potentially managed by treating cardiovascular risk factors, appropriate diet and physical exercise, challenging mental activity, intervention for any neuropsychiatric issues, and encouraging meaningful psychosocial relationships. Recent research also suggests potentially better effect on neuropsychological functioning when medication such as donepezil is used to manage both dementia and MCI.

Emotion regulation across the psychosis continuum

Emotion regulation dysfunction is characteristic of psychotic disorders, but little is known about how the use of specific types of emotion regulation strategies differs across phases of psychotic illness. This information is vital for understanding factors contributing to psychosis vulnerability states and developing targeted treatments. Three studies were conducted to examine emotion regulation across phases of psychosis, which included (a) adolescent community members with psychotic-like experiences (PLEs; n = 262) and adolescents without PLEs (n = 1,226); (b) adolescents who met clinical high-risk criteria for a prodromal syndrome (n = 29) and healthy controls (n = 29); and (c) outpatients diagnosed with schizophrenia or schizoaffective disorder (SZ; n = 61) and healthy controls (n = 67). In each study, participants completed the Emotion Regulation Questionnaire and measures of psychiatric symptoms and functional outcome. The three psychosis groups did not differ from each other in reported use of suppression; however, there was evidence for a vulnerability-related, dose-dependent decrease in reappraisal. Across each sample, a lower use of reappraisal was associated with poorer clinical outcomes. Findings indicate that emotion regulation abnormalities occur across a continuum of psychosis vulnerability and represent important targets for intervention.

The Neurobiology and Treatment of Bipolar Disorder

Bipolar disorder (BPD) is a severe mood disorder that often has psychotic features. Its most severe forms are more common and significantly more likely to cause disability than originally thought. Studies of high-risk children have found them to be at increased risk for a variety of symptoms and neurobiological abnormalities. In contrast to schizophrenia, there is no formal prodromal syndrome that has been identified, and cognitive abnormalities do not precede the onset of the disorder. Abnormal sleep and circadian rhythms are prominent and have led to intriguing biological models. Neurobiological experiments have primarily focused on candidate pathways and include circadian abnormalities, epigenetic processes including histone modification, WNT/GSK3 signaling, other modulators of neuroplasticity, and mitochondrial dysfunction. Recent data suggest that BPD is a highly polygenic disease and that integration of prior modeling and data with the wide variety of new genetic risk loci will be productive in the future.

The Neurobiology of Bipolar Disorder

The focus of this chapter is squarely on bipolar disorder. Bipolar disorder is a severe mood disorder that often has psychotic features. Its most severe forms are more common than thought and significantly more likely to cause disability than originally thought. Studies of high-risk children have found them to be at increased risk for a variety of symptoms and neurobiological abnormalities. In contrast to schizophrenia, there is no formal prodromal syndrome that has been identified and cognitive abnormalities do not precede the onset of the disorder. Abnormal sleep and circadian rhythms are prominent and have led to intriguing biological models. Neurobiological experiments have primarily focused on candidate pathways and include circadian abnormalities, epigenetic processes including histone modification, Wnt/GSK3 signaling, other modulators of neuroplasticity, and mitochondrial dysfunction. Recent data suggest that bipolar disorder is a highly polygenic disease and that integration of prior modeling and data with the wide variety of new genetic risk loci will be productive in the future.

Disturbances of basic self and prodromal symptoms among non-psychotic help-seeking adolescents

BackgroundThe goal of this study was to explore the notion that anomalies of self-experience (ASE) are a core, ‘not-yet-psychotic’ clinical phenotype of emerging schizophrenia and its spectrum.MethodTo accomplish this goal, we examined the relationship between ASE and commonly accepted risk markers in a sample of 87 help-seeking, non-psychotic adolescents (aged 14–18 years). ASE were assessed with the Examination of Anomalous Self-Experience (EASE), subclinical psychotic symptoms were assessed with the Prodromal Questionnaire and the Structured Interview for Prodromal Syndromes, deterioration in psychosocial functioning was assessed with the Social and Role Functioning Scales, and level of distress with the Mood and Anxiety Symptoms Questionnaire.ResultsAbout 82 participants completed the entire EASE interview. The number of participants who reported ASE at a clinically meaningful level (n = 18, 22%) was smaller than that who met diagnostic criteria for a prodromal syndrome (n = 28, 34%). The degree of overlap between the two conditions was moderate but statistically significant (χ2(1) = 7.01, p = 0.008). An exploratory factor analysis revealed that ASE load on a different factor than prodromal symptoms and deterioration in functioning, but that there is a moderate correlation between the three factors.ConclusionsThese results suggest that ASE are prevalent among non-psychotic help-seeking adolescents, yet at a considerably lower rate than prodromal symptoms. In addition, they suggest that ASE and prodromal symptoms constitute distinct but moderately related dimensions of potential risk. Taken together, they provide preliminary support for the clinical usefulness of supplementing and refining the methods of early detection of risk with assessment of ASE.