To investigate the effect of cariprazine on cognitive symptom change across bipolar I disorder and schizophrenia.

Post hoc analyses of 3- to 8-week pivotal studies in bipolar I depression and mania were conducted; one schizophrenia trial including the Cognitive Drug Research System attention battery was also analyzed. Outcomes of interest: Montgomery-Åsberg Depression Rating Scale [MADRS], Functioning Assessment Short Test [FAST], Positive and Negative Syndrome Scale [PANSS]). LSMDs in change from baseline to end of study were reported in the overall intent-to-treat population and in patient subsets with specified levels of baseline cognitive symptoms or performance.

In patients with bipolar depression and at least mild cognitive symptoms, LSMDs were statistically significant for cariprazine vs placebo on MADRS item 6 (3 studies; 1.5 mg=−0.5 [P<.001]; 3 mg/d=−0.2 [P<.05]) and on the FAST Cognitive subscale (1 study; 1.5 mg/d=−1.4; P=.0039). In patients with bipolar mania and at least mild cognitive symptoms, the LSMD in PANSS Cognitive subscale score was statistically significant for cariprazine vs placebo (3 studies; −2.1; P=.001). In patients with schizophrenia and high cognitive impairment, improvement in power of attention was observed for cariprazine 3 mg/d vs placebo (P=.0080), but not for cariprazine 6 mg/d; improvement in continuity of attention was observed for cariprazine 3 mg/d (P=.0012) and 6 mg/d (P=.0073).

These post hoc analyses provide preliminary evidence of greater improvements for cariprazine vs placebo across cognitive measures in patients with bipolar I depression and mania, and schizophrenia, suggesting potential benefits for cariprazine in treating cognitive symptoms.

Autism is a neurodevelopmental disorder, and there are certain differences in the brain activation patterns of English language semantic processing among autistic individuals. The research aims to explore the brain activation patterns of autistic groups during English semantic processing thus to enhance their understanding of language development.

The study used functional Magnetic Resonance Imaging (fMRI) technology, combined with the task paradigm of English word meaning processing, to study the brain activation patterns of individuals with autism. By comparing the differences in brain activation patterns between two groups in word meaning processing tasks, researchers attempted to reveal the specific neural mechanisms involved in language processing in autistic groups. At the same time, SPSS23.0 statistical software was used to process the data.

Through comparative experiments, the Hamilton Anxiety Rating Scale (HAMA) score and Generalized Self-Efficacy Scale (GSES) score of the experimental group were 7.53 and 31.24 respectively; The HAMA and GSES scores of the control group were 10.84 and 25.81, respectively. The results indicate that the processing of English language word meanings has a brain activation effect on people with autism.

Research can promote the understanding of the cognitive and neural mechanisms of autism, and contribute to improving daily communication and life quality for autistic groups.

The Education Department of Hainan Province (No. Hnjgzc2022-121); The Education Department of Hainan Province (No. Hnjgw2022-13).

Ocular abnormalities and visual dysfunction have been associated with autism spectrum disorder (ASD). Our study assessed the risks of developing retinal diseases in individuals with ASD.

In all, 18 874 patients with ASD and 188 740 controls were selected from the Taiwan National Health Insurance Research Database between 2001 and 2009. The control group was matched based on demographic characteristics and medical and ophthalmological comorbidities. The hazard ratios (HRs) with 95% confidence intervals were calculated with Cox-regression analyses adjusted for selected confounders.

Individuals with ASD had a higher incidence of developing retinal diseases (1.48‰ vs 0.73‰, P < .001), and the diagnosis of retinal diseases occurred earlier than the controls (3.73 vs 6.28 years, P < .001). When compared to the control group, the HR of developing retinal diseases in the ASD group was 1.75 (95%: 1.04-2.94) and 7.84 (95%: 3.51-17.47) for retinal detachment. There was no association between the cumulative daily dose of atypical antipsychotics and the incidence of retinal diseases in the ASD group.

Individuals with ASD have a higher risk of developing retinal detachment and are diagnosed with retinal diseases earlier than controls. Future research is needed to elucidate the mechanisms mediating the progression of retinal diseases in the ASD population.

Vortioxetine has demonstrated dose-dependent efficacy in patients with major depressive disorder (MDD), with the greatest effect observed with vortioxetine 20 mg/day. This analysis further explored the clinical relevance of the more rapid and greater improvement in depressive symptoms observed with vortioxetine 20 mg/day vs 10 mg/day.

Analysis of pooled data from six short-term (8-week), randomized, placebo-controlled, fixed-dose studies of vortioxetine 20 mg/day in patients with MDD (N = 2620). Symptomatic response (≥50% decrease in Montgomery–Åsberg Depression Rating Scale [MADRS] total score), sustained symptomatic response, and remission (MADRS total score ≤10) were assessed by vortioxetine dosage (20 or 10 mg/day).

After 8 weeks, 51.4% of patients receiving vortioxetine 20 mg/day had achieved symptomatic response vs 46.0% of those receiving vortioxetine 10 mg/day (P < .05). Significantly more patients achieved symptomatic response vs placebo from week 2 onwards for vortioxetine 20 mg/day and from week 6 onwards for vortioxetine 10 mg/day (both P ≤ .05). Sustained response was achieved from week 4 for 26.0% of patients receiving vortioxetine 20 mg/day vs 19.1% of those receiving vortioxetine 10 mg/day (P < .01), increasing to 36.0% and 29.8%, respectively, over the 8-week treatment period (P < .05). At week 8, 32.0% of patients receiving vortioxetine 20 mg/day were in remission vs 28.2% of those receiving vortioxetine 10 mg/day (P = .09). Rates of adverse events and treatment withdrawal were not increased during the week following vortioxetine dose up-titration to 20 mg/day.

Vortioxetine 20 mg/day provides more rapid and more sustained symptomatic response than vortioxetine 10 mg/day in patients with MDD, without compromising tolerability.

Autism is also called autism because of its lonely behavior. It is a widespread developmental symptom in children. In the industry, neuropsychological intervention for children with autism spectrum disorders has been widely concerned. Conventional neuropsychological intervention for autistic children is mostly drug therapy, which has a large side effect. As a form of art, art appreciation has been put forward on the neuropsychological cure of children. It is different from the traditional language psychotherapy, which usually takes artistic activities as a medium to help mental and psychological therapy. Therefore, the research will apply art appreciation to the treatment of autistic children’s neuropsychology, and provide basis for their clinical diagnosis and treatment by predicting their behavior.

The study took children aged 3-6 years old before school as the subjects. Each child suffered from autism. Since there were fewer girls with autism spectrum, 30 children were screened in the study, including 21 boys and 9 girls. The study observed the behavioral development level, art appreciation level and emotional communication level of 30 children before and after auxiliary diagnosis and treatment, and compared the scores of the three factors before and after diagnosis and treatment. The experimental results are shown in Figure 1.

The statistics showed the effect of art appreciation and rehabilitation therapy. The three indexes were higher than those before the experiment, and the P values were lower than 0.05. In addition, after the experiment, the behavioral development level of the children increased to 25.43 ± 5.70 points, and their emotional communication score also increased to 15.22 ± 4.06 points. To sum up, art appreciation is effective in the neuropsychological treatment of autistic children, which can effectively improve the cognition of autistic children and alleviate cognitive barriers.

In medical research and clinical diagnosis, the diagnosis of autistic children cannot simply use simple medical diagnosis. Its particularity indicates the need for multidisciplinary treatment. The particularity of art appreciation can not only attract children’s attention, but also alleviate their cognitive barriers. From the experimental results, the special effect of art appreciation has a certain auxiliary effect on the rehabilitation of autistic children. In the future research hypothesis, a diagnosis and evaluation system suitable for domestic autistic children can be constructed through art appreciation, so as to improve the physical and mental health of autistic children more effectively.Figure 1.

Behavior level of children before and after the experiment

Few studies have explored the complex relationship of pro- and anti-inflammatory cytokines with cognitive function in adolescents with first-episode schizophrenia, bipolar disorder, or major depressive disorder.

In total, 26, 35, and 29 adolescents with first-episode schizophrenia, bipolar disorder, and major depressive disorder, respectively, and 22 age- and sex-matched controls were included in the current study. Cytokines, namely interleukin (IL)-2, IL-6, tumor necrosis factor (TNF)-α, and C-reactive protein (CRP), were assessed. The Wisconsin Card Sorting Test (WCST) and the working memory task were administered to assess cognitive function.

Using generalized linear models with adjustment for demographic data and clinical symptoms, patients with bipolar disorder were found to exhibit the highest levels of CRP (P = .023), IL-6 (P = .022), and TNF-α (P = .011), and had the lowest IL-2 levels (P = .034) among the four groups. According to the results of the WCST and working memory task, adolescents with schizophrenia exhibited the lowest performance in cognitive function. In addition, among the assessed cytokines, only CRP levels (P = .027) were negatively associated with WCST scores.

Dysregulated pro- and anti-inflammatory cytokines and impaired cognitive functioning were observed in first-episode adolescent-onset schizophrenia, bipolar disorder, and major depressive disorder. The altered cytokine profiles may play important roles in the pathophysiology of schizophrenia, bipolar disorder, and major depressive disorder.

Behaviors typical of body-focused repetitive behavior disorders such as trichotillomania (TTM) and skin-picking disorder (SPD) are often associated with pleasure or relief, and with little or no physical pain, suggesting aberrant pain perception. Conclusive evidence about pain perception and correlates in these conditions is, however, lacking.

A multisite international study examined pain perception and its physiological correlates in adults with TTM (n = 31), SPD (n = 24), and healthy controls (HCs; n = 26). The cold pressor test was administered, and measurements of pain perception and cardiovascular parameters were taken every 15 seconds. Pain perception, latency to pain tolerance, cardiovascular parameters and associations with illness severity, and comorbid depression, as well as interaction effects (group × time interval), were investigated across groups.

There were no group differences in pain ratings over time (P = .8) or latency to pain tolerance (P = .8). Illness severity was not associated with pain ratings (all P > .05). In terms of diastolic blood pressure (DBP), the main effect of group was statistically significant (P = .01), with post hoc analyses indicating higher mean DBP in TTM (95% confidence intervals [CI], 84.0-93.5) compared to SPD (95% CI, 73.5-84.2; P = .01), and HCs (95% CI, 75.6-86.0; P = .03). Pain perception did not differ between those with and those without depression (TTM: P = .2, SPD: P = .4).

The study findings were mostly negative suggesting that general pain perception aberration is not involved in TTM and SPD. Other underlying drivers of hair-pulling and skin-picking behavior (eg, abnormal reward processing) should be investigated.

Social phobia is a common psychological disorder, particularly common among college students. College English, as a compulsory course, provides an opportunity for implementing an interactive teaching model. By implementing an interactive teaching model, students can more actively participate in classroom discussions, group activities, and role-playing, thereby enhancing their social skills and confidence.

This study selected English teachers and 86 students from a university as the research subjects. By comparing the differences in students’ social fear levels between traditional and interactive teaching modes, the traditional teaching group usually adopts traditional face-to-face teaching methods for learning. The interactive teaching group adopts a more interactive and participatory teaching approach, using methods such as classroom discussions, group activities, experiments, and applications. This study used SPSS23.0 statistical software to analyze the data.

In the experiment, the scores of social phobia patients in the traditional teaching group showed a decreasing trend on the Self Rating Anxiety Scale, from 58.64 points to 34.16 points; The score of the interactive teaching changed from 60.24 points to 52.77 points. By comparing the scores of the interactive teaching group and the traditional teaching group, the interactive teaching mode of college English can improve communication skills of patients with social phobia.

The study adopted an interactive teaching model in college English teaching, and found that the symptoms of social phobia among college students were alleviated to some extent, which had a positive impact on their mental health.

Chongqing Federation of Social Sciences (No. 2022WYZX32).

“Subsyndromal” obsessive-compulsive disorder symptoms (OCDSs) are common and cause impaired psychosocial functioning. OCDSs are better captured by dimensional models of psychopathology, as opposed to categorical diagnoses. However, such dimensional approaches require a deep understanding of the underlying neurocognitive drivers and impulsive and compulsive traits (ie, neurocognitive phenotypes) across symptoms. This study investigated inhibitory control and self-monitoring across impulsivity, compulsivity, and their interaction in individuals (n = 40) experiencing mild–moderate OCDSs.

EEG recording concurrent with the stop-signal task was used to elicit event-related potentials (ERPs) indexing inhibitory control (ie, N2 and P3) and self-monitoring (ie, error-related negativity and correct-related negativity (CRN): negativity following erroneous or correct responses, respectively).

During unsuccessful stopping, individuals high in both impulsivity and compulsivity displayed enhanced N2 amplitude, indicative of conflict between the urge to respond and need to stop (F(3, 33) = 1.48, P < .05, 95% Cl [−0.01, 0.001]). Individuals high in compulsivity and low in impulsivity showed reduced P3 amplitude, consistent with impairments in monitoring failed inhibitory control (F(3, 24) = 2.033, P < .05, 95% CI [−0.002, 0.045]). Following successful stopping, high compulsivity (independent of impulsivity) was associated with lower CRN amplitude, reflecting hypo-monitoring of correct responses (F(4, 32) = 4.76, P < .05, 95% CI [0.01, 0.02]), and with greater OCDS severity (F(3, 36) = 3.32, P < .05, 95% CI [0.03, 0.19]).

The current findings provide evidence for differential, ERP-indexed inhibitory control and self-monitoring profiles across impulsive and compulsive phenotypes in OCDSs.

The clinical value of the identification of mood disorders in patients with acute coronary syndrome (ACS) is well established. However, assessment based on DSM criteria presents some limitations. This study aimed to provide an innovative strategy for evaluating the spectrum of mood disturbances in ACS.

A total of 288 patients with a first episode of ACS underwent interviews based on DSM-IV-TR criteria (major depressive disorder, minor depression, and dysthymia), Diagnostic Criteria for Psychosomatic Research-DCPR (demoralization and type A behavior), and the Clinical Interview for Depression-CID. Additional self-report inventories (psychological well-being and distress) were administered. A total of 100 consecutive patients who satisfied criteria for DSM-IV-TR depression or DCPR demoralization were enrolled in a randomized controlled trial on a sequential combination of cognitive-behavioral and well-being therapy (CBT/WBT) vs clinical management (CM) and reassessed up to 30-month post-intervention.

A total of 29.9% of patients showed a DSM-IV-TR depressive syndrome. Inclusion of demoralization and type A identified psychological distress in 58% of the sample. According to CID, reactivity to social environment, fatigue, depressed mood, and somatic anxiety were the most common symptoms. Somatic symptoms were significantly associated with DSM-IV-TR depression (fatigue and changes of appetite), whereas environmental reactivity with demoralization. Both depression and demoralization were associated with higher distress and lower well-being. Unlike CM, CBT/WBT was significantly associated with decrease of guilt, pessimism, fatigue, and early insomnia (CID).

The findings indicate that standard psychiatric approach identifies only a narrow part of mood disturbances affecting ACS patients. A more articulated assessment unravels specific clinical configurations that may entail prognostic and therapeutic implications.

Insomnia was associated with cerebral structural changes and Alzheimer’s disease. However, associations among cerebral perfusion, insomnia with cerebral small vessel disease (CSVD), and cognitive performance were little investigated.

This cross-sectional study included 89 patients with CSVDs and white matter hyperintensities (WMHs). They were dichotomized into the normal sleep and poor sleep group, according to Pittsburgh sleep quality index (PSQI). Baseline characteristics, cognitive performance, and cerebral blood flow (CBF) were measured and compared between the two groups. The association or correlation between cerebral perfusion, cognition, and insomnia was analyzed using binary logistic regression.

Our study found that declined MoCA score (P = .0317) was more prevalent in those with poor sleep. There was a statistical difference in the recall (P = .0342) of MMSE, the delayed recall (P = .0289) of MoCA between the two groups. Logistic regression analysis showed educational background (P < .001) and insomnia severity index (ISI) score (P = .039) were independently correlated with MoCA scores. Arterial spin labeling demonstrated that left hippocampal gray matter perfusion was significantly reduced (P = .0384) in the group with poor sleep. And, negative correlation was found between left hippocampal perfusion and PSQI scores.

In the patients with CSVDs, insomnia severity was associated with cognitive decline. Left hippocampal gray matter perfusion was correlated with PSQI scores in CSVDs.

Emotional dysregulation (ED) is a common characteristic of both attention deficit hyperactivity disorder (ADHD) and major depressive disorder (MDD), especially in adolescents. However, whether ADHD and MDD may share the specific ED-related neural networks remains unknown.

In total, 43 adolescents with clinical ED (22 adolescents with ADHD and 21 with MDD) were recruited; in addition, 29 sex- and age-matched healthy controls (HCs) were included. Resting-state functional connectivity (RSFC) analysis, voxel-based morphometry, and diffusion tensor imaging analysis were performed for each patient. In addition, we determined the significant regions of interest in patients with ED due to ADHD and MDD as compared with HCs and tested their correlations with clinical rating scale scores.

Compared with HCs, patients with ED had greater RSFC in the cerebellum and supramarginal gyrus (SMG), especially between vermis VI and the SMG in the attention networks, and lower RSFC between the right supplementary motor area and right lateral parietal area. Lower gray matter (GM) volume in the SMG was also found. RSFC was significantly correlated with clinical rating scale scores for all patients with ED due to ADHD or MDD. GM change was correlated with ED and MDD rating scale scores.

The cerebellum and attention networks might play major roles in ED pathophysiology in adolescents with ADHD and MDD. Increased connectivity of the vermis to the SMG serves as a possible underlying neural network.

Bipolar affective disorder is a type of mood disorder. According to the characteristics of the attack, its clinical manifestations can be divided into depressive attack, manic attack, and mixed attack. Bipolar disorder patients may have irritability, increased sleep, inattention, more suicidal ideas, and other symptoms, which seriously affect the life quality of patients. The medical model of medical service rehabilitation training combined with family hospitalization focuses on using medical services to improve the effect of patients’ rehabilitation training, and advocates family hospitalization for patients. The study will explore the relieving effect of the medical service model of medical service rehabilitation training combined with family hospitalization on bipolar disorder, in order to provide scientific basis for the clinical treatment of the medical service model of medical service rehabilitation training combined with family hospitalization.

120 patients with bipolar disorder diagnosed in a hospital were selected as research objects, and were divided into control group and experimental group, with 60 people in each group. Both groups received routine drug treatment according to their conditions. The experimental group treated patients on this basis with the medical service rehabilitation training combined with family hospitalization. Before and after the experiment, Hamilton Depression Scale (HAMD) and Bech-Rafaelsdn Mania Rating Scale (BRMS) were used to evaluate the two groups of patients, and the evaluation results were statistically analyzed.

The clinical effects of the control group and the experimental group after treatment were compared with those of the patients with bipolar disorder before the experiment (P < 0.05). The HAMD and BRMS scores of the experimental group after the experiment were significantly higher than those of the control group, and the clinical effects of the experimental group were more significant than those of the control group, with a statistically significant difference (P < 0.05). Table 1 shows the comparison of HAMD and BRMS scores of patients before and after the experiment.

The medical service model of medical service rehabilitation training combined with family hospitalization can effectively relieve the symptoms of patients with bipolar disorder, and it is more effective than conventional treatment methods.Table 1.

Comparison of HAMD and BRMS scores of patients before and after the experiment

Tourette syndrome (TS) is a neurodevelopmental disorder characterized by the presence of motor and phonic tics. It is at least three times more common in males compared with females; however, the clinical phenomenology between sexes has not been fully examined. We aimed to contrast the clinical features between males and females with TS and chronic tic disorder.

We studied 201 consecutive patients fulfilling the diagnostic criteria for TS, persistent (or chronic) motor and vocal tic disorder and provisional tic disorder that were considered within the TS spectrum disorder. We performed blinded evaluations of video-recordings and retrospectively reviewed the clinical charts of all patients.

Age ranges between 4 and 65 years. Males represented 77.6% of patients in the cohort. Overall, no differences were observed in the frequency, distribution and complexity of tics between sexes, except for a higher frequency of attention-deficit/hyperactivity disorder (ADHD) (P = .003) among males. Patients younger than 18-years old, in addition to a higher frequency of ADHD (P = .026), males had a statistically higher frequency of complex motor tics (P = .049) and earlier age at onset (P = .072) than females in the multivariate regression analysis. However, these differences were lost in patients older than 18 years, due to increased complexity of tics in females with aging.

A sexual dimorphism was observed between patients with TS mainly before age of 18 years, suggesting an earlier onset of some types of tics and ADHD in males compared to females.

Aripiprazole has high binding affinity for the dopamine D2 receptor, which is thought to be responsible for the antipsychotic effect, though aripiprazole is not the most potent of the second-generation antipsychotics. Theoretically, aripiprazole could displace or outcompete more potent antipsychotics, prompting decreased antipsychotic effect. We describe a case of aripiprazole potentially worsening psychiatric symptoms by blocking paliperidone.

Ms. A is a 43-year-old woman with schizophrenia, multiple inpatient hospitalizations, and a history of court-ordered treatment. She historically has had good response to oral and long-acting formulations of risperidone and paliperidone. Ms. A requested a medication change and was transitioned to aripiprazole lauroxil injection with plan for bimonthly administration. Approximately 1 month after receiving her aripiprazole lauroxil injection, Ms. A presented to our CPEP due to symptoms of psychosis and was admitted to our inpatient unit. She was restarted on oral paliperidone, titrated up to her previously effective dose, and was transitioned to paliperidone palmitate LAI. In contrast to prior admissions, she did not respond well to paliperidone and displayed continued and worsened psychosis.

Prior studies have examined how adding aripiprazole to another, more potent D2 antagonist can cause a relapse in psychotic symptoms; however, few studies have investigated the inverse relationship or mechanism. Those that have proposed mechanisms typically refer to aripiprazole’s partial agonist activity as the causative factor, rather than an impediment to antipsychotic binding which we have described. Prescribers should be aware of this potential interaction and carefully consider initiating long-acting injectable forms of aripiprazole to avoid this phenomenon.

No Funding

Compulsive buying behavior or pathological buying is increasingly being recognized as a psychiatric disorder, and various psychosocial factors have been proposed to contribute to this problem. This study aimed to identify the association between compulsive buying behavior, stress, anxiety, depression, and impulsivity.

This cross-sectional, online survey used Google Forms to collect sociodemographic and clinical details of the participants between June 2021 and August 2021. In addition, they were evaluated on Pathological Buying Screener, Depression, Anxiety and Stress Scale – 21 (DASS-21), and Barratt Impulsiveness Scale – Brief (BIS-Brief).

Out of 426 participants with valid responses, 169 (39.7%) qualified for pathological buying. The participant groups “with” and “without” pathological buying were comparable on sociodemographic characteristics, the preferred mode of shopping, and daily Internet use duration. Those “with” pathological buying scored significantly higher on DASS-21 and BIS-Brief. Both DASS-21 and BIS-Brief scores were predictors of pathological buying scores.

There is a significant association between pathological buying, psychological distress, and impulsivity.

With the increasing social employment pressure, the psychological pressure of college students in their daily study and life is also increasing. Because students’ physical and mental growth is not sound, it is difficult for them to carry out targeted self-intervention and adjustment against psychological pressure, which leads to long-term accumulation of negative psychology and eventually forms depressive symptoms. In recent years, the number of depression patients in colleges and universities has been increasing. It is necessary to form a daily treatment strategy system that is in line with students’ psychological characteristics.

90 students diagnosed with depression were selected and divided into three groups. The first group was a single drug intervention group, which only used the common form of depression drug intervention. The second group was a single art design appreciation intervention, which used professional art design and appreciation psychological intervention strategies to intervene students’ depression. The third group is the design appreciation and drug combined intervention group. The students in this group participated in professional art design and appreciation psychological intervention while taking antidepressant drug treatment. The study collected the depression psychological status of the three groups of patients before and after treatment, and used the collected data for quantitative analysis.

The research results showed that before the start of treatment, the Self-Rating Depression (SDS) scores of the three groups of students with depression were 63.21 points in the single drug intervention group, 64.32 points in the single art design appreciation intervention group and 63.54 points in the art design appreciation and drug combined intervention group. It showed that the levels of depression symptoms of the three groups of students before the intervention were similar. After intervention, the SDS score of the single drug intervention group decreased to 45.22 points, the SDS score of the single art design appreciation intervention group decreased to 46.51 points, and the SDS score of art design appreciation and drug combined intervention decreased to 40.13 points. It can be seen that the intervention effect of art design appreciation and drug intervention is the most obvious. Compared with the other two methods, this method is more conducive to the depression intervention for students.

From the comparison of the patients’ condition in the single drug intervention group, the single art design appreciation intervention group, and the art design appreciation and drug combination intervention group before and after the intervention, it can be seen that the art design appreciation and drug combination intervention strategy designed by the research is more conducive to forming a better intervention effect in the student group, helping them to establish a psychological reaction mechanism in life with antidepressant drugs and reduce the severity of self-depression.Table 1.

Group intervention effect

Analysis of efficacy and tolerability of vortioxetine 20 mg/day, and optimal timing of dose adjustment, in patients with major depressive disorder (MDD).

Pooled analysis of six randomized, fixed-dose studies of vortioxetine 5 to 20 mg/day. Mean change from baseline in Montgomery–Åsberg Depression Rating Scale (MADRS) total score was analyzed by vortioxetine dose using a mixed model for repeated measures. Tolerability was assessed over the 8-week treatment period and from day 8 (ie, following dose increase to 20 mg/day). Data from three randomized, flexible-dose studies were examined for frequency and timing of dose adjustment.

A clear dose–response relationship for vortioxetine was confirmed in terms of improvement in MADRS total score. Significant differences vs placebo were seen for vortioxetine 20 mg/day from week 2 onwards; vortioxetine 10 mg did not separate from placebo until week 4. At week 8, mean change in MADRS total score from baseline was significantly greater for vortioxetine 20 mg/day vs 10 mg/day (difference, −1.03 points; P < .05). Incidence of adverse events was not increased in patients who received vortioxetine 20 mg/day vs 10 mg/day. In flexible-dose studies, dosage was increased to 20 mg/day after 1 week in 48.0% of patients; final dosage was 20 mg/day in 64.3% of patients.

Vortioxetine 20 mg is significantly more effective than vortioxetine 10 mg in patients with MDD, with a similar tolerability profile. In flexible-dose studies, almost half of all patients received 20 mg/day after 1 week and two-thirds received 20 mg/day as their final dosage.