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Background/Objectives: Major Depressive Disorder (MDD) affects over 280 million people worldwide and is a leading cause of disability. Emotional blunting—characterized by a numbing or flattening of emotions—is a significant yet often underrecognized symptom that impairs daily functioning and interpersonal relationships in patients with MDD. It remains unclear whether emotional blunting results primarily from the disorder itself or from antidepressant treatments, especially selective serotonin reuptake inhibitors (SSRIs) and serotonin–norepinephrine reuptake inhibitors (SNRIs). Vortioxetine, a multimodal antidepressant approved for MDD, may help alleviate emotional blunting by modulating neurotransmitters differently than SSRIs. This study investigates the severity of emotional blunting among Hong Kong MDD patients and explores the changes in this symptom with the use of vortioxetine, while also considering anhedonia as a related dimension of reward processing. Methods: This naturalistic, longitudinal observational study in Hong Kong enrolled adults (aged 18 and above) clinically diagnosed with MDD who were initiating vortioxetine treatment for emotional blunting. Patient inclusion was based on independent prescribing decisions by psychiatrists, with informed consent obtained. Data collection comprised one intake interview and the administration of four self-report questionnaires—ODQ, PHQ-9, PDQ-D, SDS, MFI, and SHAPS—at baseline, week 1, week 4, and week 8. Demographic and clinical history data were also recorded. Questionnaires were completed online or via phone, over a study duration of approximately two months. Results: The prevalence of emotional blunting, estimated by the proportion of patients with an ODQ score at or above the clinical cut-off (≥50), was 91.9% at baseline, decreasing to 85.5% at week 1, 77.7% at week 4, and 73.3% at week 8. Significant improvements were also observed in depressive symptoms, cognitive dysfunction, functional impairment, pleasure experience, and fatigue. Conclusions: In this naturalistic observational cohort of patients with MDD who were prescribed vortioxetine, self-reported emotional blunting, depressive symptoms, cognitive dysfunction, functional impairment, and fatigue decreased over eight weeks. Anhedonia scores (SHAPS) decreased to non-significant levels, and clinician-rated Clinical Global Impression scores confirmed a significant reduction in illness severity.

Background There has been longstanding interesting in cognitive training for older adults with cognitive impairment. In this study, we will investigate the effects of working memory training, and explore augmentation strategies that could possibly consolidate the effects in older adults with mild neurocognitive disorder. Transcranial direct current stimulation (tDCS) has been demonstrated to affect the neuronal excitability and reported to enhance memory performance. As tDCS may also modulate cognitive function through changes in neuroplastic response, it would be adopted as an augmentation strategy for working memory training in the present study. Methods/Design This is a 4-week intervention double-blind randomized controlled trial (RCT) of tDCS. Chinese older adults (aged 60 to 90 years) with mild neurocognitive disorder due to Alzheimer’s disease (DSM-5 criteria) would be randomized into a 4-week intervention of either tDCS-working memory (DCS-WM), tDCS-control cognitive training (DCS-CC), and sham tDCS-working memory (WM-CD) groups. The primary outcome would be working memory test – the n-back task performance and the Chinese version of the Alzheimer’s Disease Assessment Scale – Cognitive Subscale (ADAS-Cog). Secondary outcomes would be test performance of specific cognitive domains and mood. Intention-to-treat analysis would be carried out. Changes of efficacy indicators with time and intervention would be tested with mixed effect models. Discussion This study adopts the theory of neuroplasticity to evaluate the potential cognitive benefits of non-invasive electrical brain stimulation, working memory training and dual stimulation in older adults at risk of cognitive decline. It would also examine the tolerability, program adherence and adverse effects of this novel intervention. Information would be helpful for further research of dementia prevention studies. Trial registration ChiCTR-TRC- 14005036 Date of registration: 31 July 2014.

RationaleHow striatal dopamine synthesis capacity (DSC) contributes to the pathogenesis of negative symptoms in first-episode schizophrenia (SZ) and delusional disorder (DD) has seldom been explored. As negative symptoms during active psychotic episodes can be complicated by secondary influences, such as positive symptoms, longitudinal investigations may help to clarify the relationship between striatal DSC and negative symptoms and differentiate between primary and secondary negative symptoms.ObjectiveA longitudinal study was conducted to examine whether baseline striatal DSC would be related to negative symptoms at 3 months in first-episode SZ and DD patients.MethodsTwenty-three first-episode age- and gender-matched patients (11 DD and 12 SZ) were consecutively recruited through an early intervention service for psychosis in Hong Kong. Among them, 19 (82.6%) patients (9 DD and 10 SZ) were followed up at 3 months. All patients received an 18F-DOPA PET/MR scan at baseline.ResultsBaseline striatal DSC (Kocc;30–60) was inversely associated with negative symptoms at 3 months in first-episode SZ patients (rs =  − 0.80, p = 0.010). This association remained in SZ patients even when controlling for baseline negative, positive, and depressive symptoms, as well as cumulative antipsychotic dosage (β =  − 0.69, p = 0.012). Such associations were not observed in first-episode DD patients. Meanwhile, the severity of negative symptoms at 3 months was associated with more positive symptoms in DD patients (rs = 0.74, p = 0.010) and not in SZ patients.ConclusionsThese findings highlight the role of striatal DSC in negative symptoms upon resolution of active psychotic episodes among first-episode SZ patients. Baseline striatal dopamine activity may inform future symptom expression with important treatment implications.

Background: Rumination and overgeneral autobiographical memory are dysfunctional cognitions commonly found in older adults with depression. The theoretical underpinnings of mindfulnessbased cognitive therapy (MBCT) address the ruminative tendencies and the non-specific retrieval of autobiographical memories. This study aims to examine the efficacy and cognitive mechanisms of MBCT in older adults with active depressive symptoms. Methods: 57 older adults (mean age, 70 years) with normal cognition and mild to moderate depressive symptoms were randomly allocated to either the MBCT group or the active control group for 8 weeks. The MBCT group consisted of eight 2-hour weekly sessions and a 7-hour full-day retreat, with different themes for each class, guided mindfulness exercises, feedback and discussion, homework review, and psychoeducation. The active control group comprised a 1-hour physical exercise and a standardised health education of the specific theme with group discussion (eg fall prevention, chronic pain). Participants were assessed before and after the 8-week intervention for four outcome measures: the Hamilton Depression Rating Scale (HAMD), the Ruminative Response Scale (RRS), the Autobiographical Memory Test (AMT), and the Mindful Attention Awareness Scale (MAAS). Results: There was a significant reduction in severity of depressive symptoms (HAMD score) in both the MBCT group (F(1, 27) = 35.9, p < 0.001, η2 = 0.57) and the active control group (F(1, 28) = 9.29, p < 0.01, η2 = 0.24), but only the MBCT group showed substantial improvements in autobiographical memory specificity (AMT score), rumination (RRS score), and mindfulness (MAAS score). Conclusion: Although both MBCT and active control programme decrease the severity of depressive symptoms in older adults, only MBCT improves AMS, rumination, and mindfulness. Our findings provide empirical support for the theoretical underpinnings of MBCT. Older adults with more severe depression and more severe dysfunctional cognition may benefit more from the specific therapeutic effects of MBCT.

Objectives: To compare older adults with late-life depression (LLD) and healthy controls in terms of suicidal ideation during the COVID-19 pandemic, and to determine predictors of suicidal ideation. Methods: Between March and April 2020, old adults diagnosed with major depressive disorder (single or recurrent episode) as defined by the DSM-5 were recruited from psychiatric clinics or inpatient wards, whereas 31 healthy older adults without a history of depression or other psychiatric illnesses were recruited from voluntary organisations or elderly community centres. Their depressive symptoms, perceived severity of the pandemic, perceived time spent on receiving related information, perceived health, levels of loneliness, perceived coping efficacy, suicidal ideation, and the level of symptomatic responses to a specific traumatic stressor in the past week were assessed. Results: In total, 21 men and 43 women aged 61 to 89 years were interviewed through telephone by trained research assistants. Of them, 33 were older adults with LLD (cases) and 31 were healthy older adults (controls). Older people with LLD had a higher level of suicidal ideation than healthy controls, after controlling for the level of depression and medical comorbidity (F (1, 59) = 5.72, p = 0.020). Regression analyses showed that coping efficacy and loneliness accounted for a significant portion of the variance in suicidal ideation, and loneliness significantly predicted the level of stress. Mediation analyses reveal an indirect effect between group and suicidal ideation through coping efficacy (Z = 2.43, p = 0.015). Conclusions: Older people with LLD are at increased suicidal risk and require timely mental health support. Coping efficacy and loneliness are important predictors for suicidal ideation and stress.

Background Cost‐of‐illness studies are essential for care planning and policy making. It is increasing recognized that care for people living with neurocognitive disorders (NCDs) is costly. This study estimated the service utilisation and economic cost of mild and major NCDs among older adults in Hong Kong. Method Based on a population‐based prevalence survey of NCDs in Hong Kong, a total of 461 community‐dwelling older adults aged 60 and over (major NCD: 68, mild NCD: 264, normal cognition: 129) completed the COI survey and were included in analysis. Service utilisation of participants, including medical, social, and informal care, was measured by the adapted version of Resource Utilisation of Dementia questionnaire. Per person cost was estimated from a societal perspective and expressed in 2022 US dollars. Associated factors of service utilisation and economic cost were examined by two‐part models fitting for mixed discrete‐continuous outcomes. Result Annual cost per community‐living adult with major and mild NCD was US $9,542 (95%CI: 7,728‐11,356) and US$ 4,218 (3,670‐4,766) in Hong Kong, respectively, significantly higher than that of normal cognition. The territory‐wide cost of major and mild NCD in community was estimated at US $2.0 (1.7‐2.2) and US$ 1.5 (1.2‐1.8) billion, accordingly. The majority of cost of major NCD (76%) and mild NCD (50%) was attributable to social care and informal care. Costs of major NCDs even doubled from moderate to severe stages, and diagnosed cases incurred half and more costs than hidden cases. Conclusion Economic burden of NCDs in Hong Kong is great, reflecting a striking social and care needs particularly in moderate and severe stages. Care planning should prepare for the blowout needs being revealed by hidden cases of NCDs, as well as the diversified needs by patients in different stages and their caregivers.

Background Psychological distress is common in family carers of persons with neurocognitive disorders (NCDs). This study evaluated suicidal ideation in family caregivers of persons with NCDs, and the roles of positive experience of caregiving in moderating these severe psychological difficulties. Method 445 older adults (NCDs: 322, normal cognition: 123) and their family caregivers were recruited from the population‐based Hong Kong Mental Morbidity Survey for Older Persons. Carers’ suicidal ideation was screened by positive response from Patient Health Questionnaire‐9 (PHQ‐9): thoughts being better off dead or hurting yourself in the past two weeks. Positive aspects of caregiver (PAC) were measured. A conceptual model was constructed to test the mediation and moderation effects among PAC, carer burden, psychological distress and suicidal ideation. Result Nearly one in eleven (9%) dementia caregivers reported thoughts of death or suicidal ideation in the past two weeks. Higher rates were found in female carers comorbid with mood disorders and carers of high comorbidity or dependence persons. The association between carer burden and suicidal ideation was mediated by psychological distress (80.5%, p = 0.023). Higher levels of PAC were associated with lower rates of suicidal ideation in carers with moderate‐to‐high caring burden (moderation effects of PAC, p <0.05). Conclusion Suicidal ideation in carers was associated with caring burden and affected by psychological distress. PAC attenuates the impact of burden and distress on suicidal ideation. Carer psychological intervention should focus on strengthening PAC, especially in carers experiencing high psychological distress.

There are sparse data on whether non-pharmaceutical interventions can reduce the spread of influenza. We implemented a study of the feasibility and efficacy of face masks and hand hygiene to reduce influenza transmission among Hong Kong household members. We conducted a cluster randomized controlled trial of households (composed of at least 3 members) where an index subject presented with influenza-like-illness of <48 hours duration. After influenza was confirmed in an index case by the QuickVue Influenza A+B rapid test, the household of the index subject was randomized to 1) control or 2) surgical face masks or 3) hand hygiene. Households were visited within 36 hours, and 3, 6 and 9 days later. Nose and throat swabs were collected from index subjects and all household contacts at each home visit and tested by viral culture. The primary outcome measure was laboratory culture confirmed influenza in a household contact; the secondary outcome was clinically diagnosed influenza (by self-reported symptoms). We randomized 198 households and completed follow up home visits in 128; the index cases in 122 of those households had laboratory-confirmed influenza. There were 21 household contacts with laboratory confirmed influenza corresponding to a secondary attack ratio of 6%. Clinical secondary attack ratios varied from 5% to 18% depending on case definitions. The laboratory-based or clinical secondary attack ratios did not significantly differ across the intervention arms. Adherence to interventions was variable. The secondary attack ratios were lower than anticipated, and lower than reported in other countries, perhaps due to differing patterns of susceptibility, lack of significant antigenic drift in circulating influenza virus strains recently, and/or issues related to the symptomatic recruitment design. Lessons learnt from this pilot have informed changes for the main study in 2008. ClinicalTrials.gov NCT00425893 HKClinicalTrials.com HKCTR-365.

Background. The relationship between seasonal influenza vaccine and susceptibility to 2009 pandemic A/H1N1 virus infection is not fully understood. Methods. One child 6–15 years of age from each of 119 households was randomized to receive 1 dose of inactivated trivalent seasonal influenza vaccine (TIV) or saline placebo in November 2008. Serum samples were collected from study subjects and their household contacts before and 1 month after vaccination (December 2008), after winter (April 2009) and summer influenza (September–October 2009) seasons. Seasonal and pandemic influenza were confirmed by serum hemagglutinination inhibition, viral neutralization titers, and reverse-transcription polymerase chain reaction performed on nasal and throat swab samples collected during illness episodes. Results. TIV recipients had lower rates of serologically confirmed seasonal A/H1N1 infection (TIV group, 8%; placebo group, 21%; P = .10) and A/H3N2 infection (7% vs 12%; P = .49), but higher rates of pandemic A/H1N1 infection (32% vs 17%; P = .09). In multivariable analysis, those infected with seasonal influenza A during the study had a lower risk of laboratory-confirmed pandemic A/H1N1 infection (adjusted odds ratio [OR], 0.35; 95% confidence interval [CI], 0.14–0.87), and receipt of seasonal TIV was unassociated with risk of pandemic A/H1N1 infection (adjusted OR, 1.11; 95% CI, 0.54–2.26). Conclusions. TIV protected against strain-matched infection in children. Seasonal influenza infection appeared to confer cross-protection against pandemic influenza. Whether prior seasonal influenza vaccination affects the risk of infection with the pandemic strain requires additional study. Clinical trials registration. ClinicalTrials.gov number NCT00792051.