N-Acetylcysteine in depressive symptoms and functionality: a systematic review and meta-analysis

OBJECTIVE: To assess the utility of N-acetylcysteine administration for depressive symptoms in subjects with psychiatric conditions using a systematic review and meta-analysis. DATA SOURCES: A computerized literature search was conducted in MEDLINE, Embase, the Cochrane Library, SciELO, PsycINFO, Scopus, and Web of Knowledge. No year or country restrictions were used. The Boolean terms used for the electronic database search were (NAC OR N-acetylcysteine OR acetylcysteine) AND (depression OR depressive OR depressed) AND (trial). The last search was performed in November 2014. STUDY SELECTION: The literature was searched for double-blind, randomized, placebo-controlled trials using N-acetylcysteine for depressive symptoms regardless of the main psychiatric condition. Using keywords and cross-referenced bibliographies, 38 studies were identified and examined in depth. Of those, 33 articles were rejected because inclusion criteria were not met. Finally, 5 studies were included. DATA EXTRACTION: Data were extracted independently by 2 investigators. The primary outcome measure was change in depressive symptoms. Functionality, quality of life, and manic and anxiety symptoms were also examined. A full review and meta-analysis were performed. Standardized mean differences (SMDs) and odds ratios (ORs) with 95% CIs were calculated. RESULTS: Five studies fulfilled our inclusion criteria for the meta-analysis, providing data on 574 participants, of whom 291 were randomized to receive N-acetylcysteine and 283 to placebo. The follow-up varied from 12 to 24 weeks. Two studies included subjects with bipolar disorder and current depressive symptoms, 1 included subjects with MDD in a current depressive episode, and 2 included subjects with depressive symptoms in the context of other psychiatric conditions (1 trichotillomania and 1 heavy smoking). Treatment with N-acetylcysteine improved depressive symptoms as assessed by Montgomery-Asberg Depression Rating Scale and Hamilton Depression Rating Scale when compared to placebo (SMD = 0.37; 95% CI = 0.19 to 0.55; P < .001). Subjects receiving N-acetylcysteine had better depressive symptoms scores on the Clinical Global Impressions-Severity of Illness scale at follow-up than subjects on placebo (SMD = 0.22; 95% CI = 0.03 to 0.41; P < .001). In addition, global functionality was better in N-acetylcysteine than in placebo conditions. There were no changes in quality of life. With regard to adverse events, only minor adverse events were associated with N-acetylcysteine (OR = 1.61; 95% CI = 1.01 to 2.59; P = .049). CONCLUSIONS: Administration of N-acetylcysteine ameliorates depressive symptoms, improves functionality, and shows good tolerability.

Factors contributing to depressive mood states in everyday life: A systematic review

BACKGROUND: Although accumulated evidence suggests that fluctuations in depressed mood are common among individuals with depression, and may be associated with onset, duration, and severity of illness, a systematic appraisal of putative predictors of depressed mood is lacking. METHODS: A systematic search for relevant studies in the literature was conducted using PsycInfo and PubMed databases via EbscoHost in February 2016. The search was limited to articles using the experience sampling method, an approach suitable for capturing in situ fluctuations in mood states. RESULTS: Forty-two studies met inclusion criteria for the review, from which three key risk factors (poor sleep, stress, and significant life events) and two protective factors (physical activity and quality of social interactions) were identified. The majority of papers supported concurrent and lagged associations between these putative protective/risk factors and depressed mood. LIMITATIONS: Despite support for each of the proposed protective/risk factors, few studies evaluated multiple factors in the same study. Moreover, the time course for the effects of these predictors on depressed mood remains largely unknown. CONCLUSIONS: The present review identified several putative risk and protective factors for depressed mood. A review of the literature suggests that poor sleep, negative social interactions, and stressful negative events may temporally precede spikes in depressed mood. In contrast, exercise and positive social interactions have been shown to predict subsequent declines in depressed mood. However, the lack of multivariate models in which the unique contributions of various predictors could be evaluated means that the current state of knowledge prevents firm conclusions about which factors are most predictive of depressed mood. More complex modeling of these effects is necessary in order to provide insights useful for clinical treatment in daily life of the depressed mood component of depressive disorders.

Prospective progression from high-prevalence disorders to bipolar disorder: exploring characteristics of pre-illness stages

BACKGROUND: Identification of risk factors within precursor syndromes, such as depression, anxiety or substance use disorders (SUD), might help to pinpoint high-risk stages where preventive interventions for Bipolar Disorder (BD) could be evaluated.

METHODS: We examined baseline demographic, clinical, quality of life, and temperament measures along with risk clusters among 52 young people seeking help for depression, anxiety or SUDs without psychosis or BD. The risk clusters included Bipolar At-Risk (BAR) and the Bipolarity Index as measures of bipolarity and the Ultra-High Risk assessment for psychosis. The participants were followed up for 12 months to identify conversion to BD. Those who converted and did not convert to BD were compared using Chi-Square and Mann Whitney U tests.

RESULTS: The sample was predominantly female (85%) and a majority had prior treatment (64%). Four participants converted to BD over the 1-year follow up period. Having an alcohol use disorder at baseline (75% vs 8%, χ(2)=14.1, p<0.001) or a family history of SUD (67% vs 12.5%, χ(2)=6.0, p=0.01) were associated with development of BD. The sub-threshold mania subgroup of BAR criteria was also associated with 12-month BD outcomes. The severity of depressive symptoms and cannabis use had high effects sizes of association with BD outcomes, without statistical significance.

CONCLUSIONS AND LIMITATIONS: The small number of conversions limited the power of the study to identify associations with risk factors that have previously been reported to predict BD. However, subthreshold affective symptoms and SUDs might predict the onset of BD among help-seeking young people with high-prevalence disorders.

The impact of chronic illness on relationships in early adulthood: a comparison study between healthy and arthritic young adults

While engaging in romantic relationships is regarded as a normative task during young adulthood, non-normative life events such as the emergence of chronic illness can mitigate against the successful negotiation of such tasks. Chronic illness brings with it a series of additional challenges and stressors to the realm of personal relationships that are thought to interrupt the development of normative interpersonal and intra-individual processes. However, few studies have examined how young adults faced with a chronic illness such as arthritis navigate romantic relationships and the consequences of illness and relationships on psychological adjustment. The aim of the study was to compare the relationship experiences of healthy young adults with those faced with arthritis. One hundred and nine young adults (M 23.01 years, SD 2.43) took part in the study. Of these participants 41 had been diagnosed with arthritis. A univariate MANOVA revealed arthritic young adults reported significantly more insecure attachment, lower levels of readiness for intimacy, and poorer relationship satisfaction compared to healthy young adults. Further correlational and regression analyses on the arthritic sample revealed psychological adjustment was related to arthritis severity, attachment and components of coping. Findings will be discussed in relation to attachment theory and coping processes.

Increased positive thought disorder with illness duration in patients with schizophrenia

It is unclear whether the severity of positive formal thought disorder, a core clinical feature of schizophrenia, is stable or worsening through the chronic course of the illness. The neurocognitive basis for positive thought disorder also remains unclear. The aim of the present paper was to examine the relationship between thought disorder as measured by the Thought Disorder Index (TDI) and duration of illness and neuropsychological indices in 79 patients with schizophrenia. TDI scores increased in proportion to illness duration. TDI scores were not associated with verbal memory or executive functioning. These results indicate an ongoing worsening of positive thought disorder through the course of illness in schizophrenia.

A longitudinal study of quality of life among people living with a progressive neurological illness

This study investigated predictors of quality of life (QOL) of people with progressive neurological illnesses. Participants were 257 people with motor neurone disease (MND), Huntington’s disease (HD), multiple sclerosis (MS), or Parkinson’s. Participants completed questionnaires on two occasions, 12 months apart. There was an increase in severity of symptoms for people withMND, negative mood for people with HD and Parkinson’s, and social support satisfaction for people with MS. Regression analyses were conducted to determine predictors of QOL for each group. Predictor variables were length of illness, symptoms (physical symptoms, control over body, cognitive symptoms and psychological symptoms), mood, relationship satisfaction and social support. Predictors of QOL were severity of symptoms for people withMND, HD and MS; negative mood for people withMNDand Parkinson’s; and social support satisfaction for people with MS. These results demonstrate the importance of illness severity and mood in predicting QOL, but also indicate differences between illness groups. The limited role played by social support and relationship is a surprising finding from the current study.

Application of a quantitative histological health index for Antarctic rock cod (Trematomus bernacchii) from Davis Station, East Antarctica

A quantitative Histological Health Index (HHI) was applied to Antarctic rock cod (Trematomus bernacchii) using gill, liver, spleen, kidney and gonad to assess the impact of wastewater effluent from Davis Station, East Antarctica. A total of 120 fish were collected from 6 sites in the Prydz Bay region of East Antarctica at varying distances from the wastewater outfall. The HHI revealed a greater severity of alteration in fish at the wastewater outfall, which decreased stepwise with distance. Gill and liver displayed the greatest severity of alteration in fish occurring in close proximity to the wastewater outfall, showing severe and pronounced alteration respectively. Findings of the HHI add to a growing weight of evidence indicating that the current level of wastewater treatment at Davis Station is insufficient to prevent impact to the surrounding environment. The HHI for T. bernacchii developed in this study is recommended as a useful risk assessment tool for assessing in situ, sub-lethal impacts from station-derived contamination in coastal regions throughout Antarctica.

SA HealthPlus : a controlled trial of a statewide application of a generic model of chronic illness care

SA HealthPlus, one of nine national Australian coordinated care trials, addressed chronic illness care by testing whether coordinated care would improve health outcomes at the cost of usual care. SA HealthPlus compared a generic model of coordinated care for 3,115 intervention patients with the usual care for 1,488 controls. Service coordinators and the behavioral and care-planning approach were new. The health status (SF-36) in six of eight projects improved, and those patients who had been hospitalized in the year immediately preceding the trial were the most likely to save on costs. A mid-trial review found that health benefits from coordinated care depended more on patients' self-management than the severity of their illness, a factor leading to the Flinders Model of Self-Management Support.

Using the personal wellbeing index in Lao PDR : issues of equivalence

Lao PDR is one of the 50 countries included in the International Wellbeing Group study which uses Cummin's (2001) Personal Wellbeing Index (PWI) to draw cross-national comparisons of subjective wellbeing. Lau, Cummins & McPherson (2005) found a statistically significant difference in PWI scores between Australian & Hong Kong. They ask whether this is a real reflection of lower quality of life in Hong Kong or whether there exists a cultural response bias which predisposes the Hong Kong population to be less willing to admit to high levels of satisfaction in the seven domains of the index. If the difference reflects cultural response bias, what factors contribute to that bias & how common is this phenomenon in the countries of South-east Asia & IndoChina? The paper addresses these questions with particular attention to Lao PDR where responses to the PWI from both urban & rural populations suggest a similar reticence about expressing high levels of satisfaction. The paper explores the sources of resistance to reporting positive subjective wellbeing & what adaptations may be needed to the Index to allow for such bias.

An index of diet and eating patterns is a valid measure of diet quality in an Australian population

Diet indices represent an integrated approach to assessing eating patterns and behaviors. The aim of this study was to develop a comprehensive food-based dietary index to reflect adherence to healthy eating recommendations, evaluate the construct validity of the index using nutrient intakes, and evaluate this index in relation to sociodemographic factors, health behaviors, risk factors, and self-assessed health status. Data were analyzed from adult participants of the Australian National Nutrition Survey who completed a 108-item FFQ and a food habits questionnaire (n = 8220). The dietary guideline index (DGI) consisted of 15 items reflecting the dietary guidelines, including dietary indicators of vegetables and legumes, fruit, total cereals, meat and alternatives, total dairy, beverages, sodium, saturated fat, alcoholic beverages, and added sugars. Diet quality was incorporated using indicators relating to whole-grain cereals, lean meat, reduced/low fat dairy, and dietary variety. We investigated associations between the DGI score, sociodemographic factors, health behaviors, chronic disease risk factors, and nutrient intakes. We found associations between the DGI scores and sex, age, income, area-level socioeconomic disadvantage, smoking, physical activity, waist:hip ratio, systolic blood pressure (males only), and self-assessed health status (females only) (all P < 0.05). Higher DGI scores were associated with lower intakes of energy, total fat, and saturated fat and higher intakes of fiber, β-carotene, vitamin C, folate, calcium, and iron (P < 0.05). This food-based dietary index is able to discriminate across a variety of sociodemographic factors, health behaviors, and self-assessed health and reflects intakes of key nutrients.

A longitudinal study of economic pressure among people living with a progressive neurological illness

Objectives: Previous research has examined costs associated with progressive neurological illnesses, but has not examined predictors of economic pressure, or quality of life (QOL). The aim of the current study was to examine the predictors of both economic pressure and QOL among people with a range of progressive neurological illness.

Method: Participants were 257 people with motor neurone disease, Huntington’s disease, multiple sclerosis and Parkinson’s.

Results: High levels of cut backs in spending predicted economic pressure for all groups. Economic pressure predicted QOL at 12-month follow-up for all groups except Parkinson’s. For Parkinson’s, predictors of QOL were long duration of illness, illness-related expenses and cut backs in spending. Cut backs in spending, and not income or expenses, were the most important predictor of economic pressure. QOL was predicted by high levels of economic pressure for most of the illness groups.

Discussion: The implications of these findings are discussed. They suggest that cut backs in spending, as opposed to income and expenses, are important factors to focus on assisting people to adjust to the changes to their financial situation that frequently occurs after developing one of these progressive neurological illnesses.

Frequency, severity and effect of life of physical symptoms experienced during pregnancy

This study aimed to: 1) describe the number, frequency, severity of discomfort and effect of symptoms on life of 29 physical symptoms women experienced at 15 to 25 weeks of gestation; 2) explore whether experiencing this group of physical symptoms more frequently and intensely was associated with a higher score of depressive symptoms and lower self-esteem; (3) examine whether discomfort and effect ratings aided prediction of well being over and above symptom frequency; and (4) investigate which individual physical symptoms contributed most to predicting depressive symptoms and self-esteem. Pregnant women (n = 215) completed the Beck Depression Inventory, Rosenberg Self-Esteem Scale, and a physical symptoms questionnaire. Frequency, discomfort, and the effect of physical symptoms all consistently correlated with higher scores for depressive symptoms, but less consistently with lower self-esteem. Discomfort and the effect of symptoms predicted variance in depressive symptoms after accounting for symptom frequency. Higher frequency, more discomfort, and the effect of fatigue and effect of flatulence were related to depressive symptoms. Relationships between pregnancy-related physical symptoms, depressive symptoms, and low self-esteem suggest that when women report any of these constellation of factors, further screening is indicated. A comprehensive assessment of physical symptoms includes frequency, discomfort, and effect on life.

A boarding school outbreak of pertussis in adolescents : value of laboratory diagnostic methods

Culture for Bordetella pertussis (B. pertussis) is the traditional gold standard for laboratory diagnosis of pertussis but is insensitive, especially later in the course of illness and in vaccinated persons. Interpretation of serology is limited by the lack of an appropriate reference standard. An outbreak of pertussis in a crowded boarding-school dormitory allowed evaluation of laboratory correlates of infection. Questionnaires, serum samples and throat swabs were collected from members of the exposed group. Serum samples from unexposed controls of a similar age group were used for comparison. B. pertussis PCR was performed on throat swabs, and sera were tested for IgA antibodies against whole-cell (WC) B. pertussis antigen and IgG antibodies to pertussis toxin (PT). The Centers for Disease Control and Prevention definition for pertussis was used to define clinical cases. We evaluated the use of a previously published cut-off for PT IgG of 125 EIA units (EU)/ml. Completed questionnaires were obtained from 115 students, of whom 85 (74%) reported coughing symptoms, including 32 (28%) who met the clinical case definition for pertussis. B. pertussis was detected by PCR in 17 (15%) and WC IgA in 22 (19%) students; neither correlated with symptoms, but dormitory of residence strongly predicted PCR status. The mean PT IgG geometric mean concentration, in this situation of high pertussis exposure, correlated with severity of symptoms and was significantly higher in both symptomatic and asymptomatic children exposed during the outbreak (P<0·001) than in control children. A cut-off for PT IgG of 125 EU/ml was too high in an outbreak situation to be sensitive enough to identify pertussis cases. A case of pertussis in a crowded boarding-school dormitory resulted rapidly in an outbreak. Serology and PCR were useful in identifying the outbreak and commencing disease control measures. The use of serology has mostly been evaluated in community serosurveys, where it is not possible to determine if immunity reflects vaccination, asymptomatic disease or symptomatic disease. This outbreak gave us the opportunity to evaluate the value of serology and PCR in the presence of confirmed exposure to pertussis.

When the whole 'bloke' thing starts to crumble : men's access to chronic illness (arthritis) self management programs

This thesis explores the issue of men's access to chronic illness self management programs from a social constructionist perspective. A combination of research methodologies was used; a quantitative analysis to confirm gender differences in levels and patterns of service use; a qualitative analysis to gain an increased understanding of the factors affecting men's access; and a trial to test the application of the research findings. The clients and services of Arthritis Victoria were chosen as the setting for this research. The quantitative analyses were conducted on contingency tables and odds ratios and confirmed that men were under-represented as service users. The analyses also identified gender differences in patterns of service use. The qualitative analysis was based on a series of in-depth, semi-structured interviews. It was undertaken from a grounded theory approach to allow for the development of theoretical explanations grounded in the data. It was found that men's decisions to access chronic illness self management programs were strongly influenced by dominant social constructions of masculinity which constrained help-seeking and health management behaviour. However, the restrictive influence of hegemonic masculinity was progressively undermined by the increasing severity of the chronic condition until a crisis point was reached in terms of the severity of the condition or its impact on lifestyle. This resulted in a reformulation or rejection of hegemonic masculinity. The described conceptual framework was consistent for men from diverse social groupings, although it appeared less prominent in both younger and older men, suggesting that dominant social constructions of masculinity have the greatest influence on health decisions during the middle stage of adulthood when work and family obligations are greatest. The thesis findings informed the development of some guiding principles for reviewing the structure and delivery of chronic illness self management services for men. The guiding principles will have direct application in the planning of Arthritis Victoria programs, and implications for other chronic illness self management programs in Australia, and also in Western countries with a similar health and sociocultural setting to Australia.