Nevin Manimala

J Psychopathol Clin Sci. 2025 Oct 6. doi: 10.1037/abn0001069. Online ahead of print.

ABSTRACT

This article contends that many of the chief complaints about the Diagnostic and Statistical Manual of Mental Disorders can be obviated by a set-theoretic, combinatorial approach. Arbitrary cutoffs, polythetic criteria, and category heterogeneity can be avoided by using a data-driven approach that assesses whether particular symptom combinations represent sufficient conditions for clinical benchmarks at an acceptable level of conditional probability. Using data from the National Comorbidity Survey-Replication, this study employed generalized anxiety disorder, major depressive disorder, posttraumatic stress disorder, and the union of major depressive disorder and generalized anxiety disorder as exemplars and set a target probability threshold of p ≥ .90 for sufficiency. All possible symptom combinations were generated for each subsample, with sample sizes of N = 1,948, N = 2,285, N = 777, and N = 3,129, respectively. Sufficient sets were identified for diagnosis, clinical distress, and functional impairment. Establishing sufficiency reduced the number of possible symptom combinations by at least 94% (M = 98.7%, SD = 1.79%). Finally, in a large, randomly split-halved subsample (N = 6,656), sufficient sets were identified at p ≥ .90 and tested in the holdout data. Results yielded an average conditional probability of .91 (SD = .03), reinforcing the robustness and generalizability of the current methods. These results suggest that a large amount of the heterogeneity in symptom combinations in internalizing disorders may be nested and reducible. Thus, much of the combinatorial information in the symptom presentations of these disorders may be overlapping and there may be core features of psychopathology that are sufficient to produce fidelity without requiring additional complexity. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

PMID:41051852 | DOI:10.1037/abn0001069

Dev Psychol. 2025 Oct 6. doi: 10.1037/dev0002084. Online ahead of print.

ABSTRACT

Subjective aging predicts various developmental outcomes, including cognitive functioning. However, associations could be bidirectional. We focused on central dimensions of subjective aging (subjective age; self-perceptions of aging related to social losses, physical losses, and ongoing development) and investigated reciprocal longitudinal associations with perceptual-motor speed, both at the between-person level (i.e., Do individuals with more positive subjective aging trajectories exhibit better cognitive performance trajectories?) and within-person level (e.g., Is an individuals’ cognitive performance poorer than their typical trajectory on measurement occasions when their subjective aging is less positive than their typical trajectory?). We used data from the German Ageing Survey (n = 15,898; aged 40-95 years; observation period: 2002-2017, up to five occasions; mean number of observations: 2.1; sample sizes between 2002 and 2017: 4,334; 7,668; 4,800; 9,703; 6,551). Using autoregressive latent trajectory models with structured residuals, we controlled for sociodemographic, social, and health-related factors. At the between-person level, higher levels of perceptions related to ongoing development and lower levels of perceptions related to physical and social loss were associated with higher levels of perceptual-motor speed. Linear decline in perceptual-motor speed was less steep for individuals with lower physical loss intercepts and higher ongoing development levels. While there were significant within-person synchronous associations between perceptual-motor speed and subjective aging, we found no reliable cross-lagged associations. All between-person and within-person associations of subjective age with perceptual-motor speed were not statistically significant. Our results imply that there are meaningful between-person and within-person associations between subjective aging and cognitive abilities. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

PMID:41051819 | DOI:10.1037/dev0002084

Zh Nevrol Psikhiatr Im S S Korsakova. 2025;125(9):131-138. doi: 10.17116/jnevro2025125091131.

ABSTRACT

OBJECTIVE: The aim of this study was to study the complex relationship between markers of oxidative stress and depression in patients diagnosed with Parkinson’s disease, with an emphasis on how various therapeutic interventions affect these biochemical parameters.

MATERIAL AND METHODS: The study included 60 participants (26 women and 34 men, average age 65.13±0.84 years) who received Fluvoxamine 100 mg/day as monotherapy (main group, n=30) or combination therapy (comparison group, n=30), including the antioxidant Cytoflavin and Fluvoxamine 100 mg/day. The control group consisted of 20 practically healthy elderly people. Using clinical, psychometric, and statistical research methods, the dynamics of depression symptoms and markers of oxidative stress in patients diagnosed with Parkinson’s disease were evaluated during a three-month course of treatment with Fluvoxamine and Cytoflavin.

RESULTS: During 3 months of therapy, the average score on the Hamilton depression scale in the main group decreased from 26.63±0.33 to7.22±0.5 points (p<0.01), in the comparison group from 26.51±0.29 to 12.18±1.1 points. According to the HADS scale, the average score in the main group decreased from 15.46±0.8 to 7.1±0.1 points (p<0.05), and in the comparison group from 15.14±0.8 to 9.7±1.2 points. After the therapy, all patients showed a significant slowdown in lipid peroxidation processes, an increase in the concentration of antioxidant enzymes, and a statistically significant (p<0.01) increase in the concentration of reduced glutathione, with a more significant improvement in the main group.

CONCLUSION: The results of a comparative analysis of the effectiveness of treatment of depression in patients with Parkinson’s disease showed that the use of a combination of Fluvoxamine and Cytoflavin provides a more pronounced therapeutic effect compared with Fluvoxamine monotherapy. These findings emphasize the need to integrate combined approaches into the development of new treatment strategies for depressive states based on a personalized assessment of the clinical picture of depressive disorder and biomarkers of oxidative stress.

PMID:41051815 | DOI:10.17116/jnevro2025125091131

Zh Nevrol Psikhiatr Im S S Korsakova. 2025;125(9):99-102. doi: 10.17116/jnevro202512509199.

ABSTRACT

OBJECTIVE: To analyze the efficacy of eperison in combination with botulinum toxin injections for the treatment of pain syndrome in patients with spastic torticollis (ST).

MATERIAL AND METHODS: A retrospective study was conducted to evaluate the effectiveness of eperison administration alongside botulinum therapy in 29 patients diagnosed with ST. The study employed a cross-sectional retrospective analysis of medical data. Patients receiving botulinum toxin injections at three-month intervals (a total of 6 cycles), with assessments at 2 months (4-6 cycles after each injection), were administered eperison at a dose of 150 mg/day. The efficacy of the treatments was evaluated using a validated scale: the 85-point TWSTRS (Toronto Western Spasmodic Torticollis Rating Scale), assessed three times-before each botulinum injection (on day 1), at day 14, and and at day 60 later.

RESULTS: For cycles 1-3 (botulinum toxin, without eperisone), the average TWSTRS scale score on the on day 1 of each cycle was 40.72 – 41.66; cycles 4-6 with the addition of Eperisone – 26.6-30.4 points. When comparing the average values of the TWSTRS scale for cycles 1-3 and cycles 4-6 on the «Pain» scale, t-test value was: 15.85 (p=0.000546).

CONCLUSION: The intake of the centrally acting muscle relaxant eperison resulted in a statistically significant improvement in patients with ST by the time of the next injection (paired Student’s t-test 2.77-2.92, p=0.05), including improvements in the «Pain» scale, compared to botulinum therapy without eperison in the same patients.

PMID:41051811 | DOI:10.17116/jnevro202512509199

Zh Nevrol Psikhiatr Im S S Korsakova. 2025;125(9):90-98. doi: 10.17116/jnevro202512509190.

ABSTRACT

OBJECTIVE: To study the antidepressant efficacy and the tolerability of agomelatine (Valdoxan) in daily clinical practice in patients with a depressive episode that occurred after COVID-19.

MATERIAL AND METHODS: The final analysis included 103 patients (70.9% women, average age 45 years). Of these, 78.6% have had mild COVID-19 in the last 3 months, and 21.4% have had moderate COVID-19. The average time from the onset of infection to inclusion in the study was 2.1±0.7 months. At the start of the study, 53.4% of patients had a mild depressive episode, and 46.6% had a moderate depressive episode. Clinical and psychopathological, psychometric (HAMD-17, CGI, SF-36), and statistical methods of investigation were used.

RESULTS: A significant decrease in the severity of depression was revealed. The average overall score on the HAMD-17 scale decreased compared to baseline by 2.6±3.3, 6.7±5.3, and 10.9±4.9 at weeks 2, 4, and 8 of agomelatin administration, respectively (p<0.0001). Mental and physical indicators on the SF-36 scale also significantly improved compared to baseline (p<0.0001). By the end of the study, 81.4% of patients had responded to therapy, 71.6% had achieved remission according to the criteria established in the study. It was found that the initial value of the total HAMD-17 score has a statistically significant effect (p<0.0001) on the outcome of depression therapy after COVID-19, an additional contribution is made by the prescription of COVID-19 disease. Agomelatin was well tolerated during the 8 weeks of follow-up.

CONCLUSION: The results indicate a high antidepressant and anxiolytic effectiveness and safety of agomelatine after 8 week of treatment of patients with depression after COVID-19 infection. The results of the study add to the knowledge about the antidepressant effectiveness of agomelatine and suggest that it may become a drug for the treatment of MDE in patients who have suffered COVID-19 infection.

PMID:41051810 | DOI:10.17116/jnevro202512509190

Zh Nevrol Psikhiatr Im S S Korsakova. 2025;125(9):79-89. doi: 10.17116/jnevro202512509179.

ABSTRACT

OBJECTIVE: To study the effect of magnetic resonance imaging-guided focused ultrasound (MR-FUS) on the motor and non-motor symptoms of essential tremor (ET) (cognitive functions, anxiety, depression, apathy, sleep disorders), as well as to establish association between adverse events (AEs) and the technical parameters of the surgery, postablation neuroimaging changes in the brain matter, and clinical and demographic factors.

MATERIAL AND METHODS: Twenty-two patients with disabling drug-resistant ET were prospectively evaluated prior to unilateral ventral intermediate nucleus (Vim) FUS thalamotomy, and at 24 hours, 3, 6, and 12 months postoperatively.

The change of tremor was assessed using the Clinical Rating Scale for Tremor (CRST). Non-motor symptoms were assessed using the Montreal Cognitive Assessment (MoCA), the Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI), the Apathy Scale, and the Epworth Sleepiness Scale. The Tinetti test was used to assess balance and gait. The quality of life for patients with ET was assessed using the Quality of Life in Essential Tremor Questionnaire (QUEST). MRI with a magnetic field strength of 3.0 T was performed immediately after surgery, as well as at 24 hours, 3, 6, and 12 months post-surgery.

RESULTS: MR-FUS led to a significant reduction in tremor in the extremities of the contralateral thalamotomy site; the mean total CRST and hemi-CRST scores decreased by 78% and 80% (p<0.0001), respectively, with a significant persistence of the improvement at 12 months after surgery by 63% and 64% (p=0.012), respectively. The quality of life of patients with ET significantly improved at 6 and 12 months after surgery by 38% (p=0.017) and 45% (p=0.012), respectively. MR-FUS had no statistically significant impact on cognitive function, severity of apathy, anxiety, depression, or daytime sleepiness (p>0.05). Mild adverse events occurred in 45% of patients immediately after surgery, and most of the AEs regressed by Month 3 of follow-up. The lesion volume and postoperative edema were significantly correlated with a decrease in the total CRST score at 6 and 12 months postoperatively (r=-1, p=0.01). The results of the correlation analysis showed that patients with AEs after FUS-thalamotomy had larger foci of necrosis and postoperative edema, and also had a significantly shorter duration of surgery (p=0.042). However, the number of sonications (both verification and therapeutic), the power of ultrasound waves, and the maximum exposure temperatures in the patients of the compared groups did not differ significantly.

CONCLUSION: The results of an open prospective study confirmed the effectiveness of unilateral FUS thalamotomy of the Vim nucleus of the thalamus for the treatment of ET. There was no significant effect on the non-motor manifestations of ET. All reported AEs were mild and transient. The risk of AEs was determined by the volume of the lesion and postoperative edema, as well as the duration of surgery.

PMID:41051809 | DOI:10.17116/jnevro202512509179

J Phys Chem Lett. 2025 Oct 6:10639-10646. doi: 10.1021/acs.jpclett.5c02193. Online ahead of print.

ABSTRACT

We present a methodology for accelerating the estimation of the free energy from path integral Monte Carlo simulations by considering an intermediate artificial reference system where interactions are inexpensive to evaluate numerically. Using the spherically averaged Ewald interaction as this intermediate reference system for the uniform electron gas, the interaction contribution for the free energy was evaluated up to 18 times faster than the Ewald-only method. Furthermore, an extrapolation technique with respect to the quantum statistics was tested and applied to alleviate the Fermion sign problem. Combining these two techniques enabled the evaluation of the free energy for a system of 1000 electrons, where both finite-size and statistical errors are below chemical accuracy. The general procedure can be applied to systems relevant for planetary and inertial confinement fusion modeling with low to moderate levels of quantum degeneracy.

PMID:41051799 | DOI:10.1021/acs.jpclett.5c02193

JAMA Netw Open. 2025 Oct 1;8(10):e2535573. doi: 10.1001/jamanetworkopen.2025.35573.

ABSTRACT

IMPORTANCE: Associations of midlife cardiovascular health (CVH), measured once, with incident cardiovascular disease (CVD) are well described. Less is known about patterns of young adulthood CVH, including its changes and associations with later-life CVD outcomes.

OBJECTIVE: To model patterns of change in population-level and individual-level CVH through young adulthood and to assess whether they are associated with incident CVD in later life.

DESIGN, SETTING, AND PARTICIPANTS: The Coronary Artery Risk Development in Young Adults (CARDIA) study is a prospective longitudinal cohort study that enrolled Black and White participants at ages 18 to 30 years in 1985 and 1986 with subsequent follow-up examinations during the next 35 years at 4 urban US centers. Participants with at least 3 CVH measurements in young adulthood and subsequent follow-up with assessment of incident CVD events were included. Analyses were conducted from October 26, 2023, to May 15, 2024.

EXPOSURES: CVH was measured using the American Heart Association Life’s Essential 8 score. Patterns of CVH change in young adulthood (from examinations at years 0 to 20) were modeled with population-level trajectories and assessed by individual-level CVH status changes.

MAIN OUTCOMES AND MEASURES: Incident CVD (myocardial infarction, heart failure, stroke, coronary revascularization, and CVD death) after year 20.

RESULTS: There were 4241 participants in young adulthood (2354 [55.5%] female, 2042 [48.1%] self-identified as Black and 2199 [51.9%] self-identified as White) with a mean (SD) baseline age of 24.9 (3.6) years. In the trajectory analysis, 4 distinct CVH trajectory patterns were identified. Compared with the persistently high CVH trajectory, the moderate-to-low declining and moderate declining CVH trajectories had substantially higher risk for incident CVD. AHRs for incident CVD events ranged from 2.15 (95% CI, 1.04-4.47) in the persistently moderate pattern to 9.96 (95% CI, 4.75-20.86) in the moderate-to-low declining pattern. In the CVH status change analysis (n = 2857), compared with stable moderate CVH in young adulthood, stable high CVH had a lower risk (adjusted hazard ratio [AHR], 0.25 [95% CI, 0.09-0.69]), and stable low CVH had a higher risk (AHR, 5.91 [95% CI, 2.38-14.66]) for incident CVD. Each 10-point decrease in Life’s Essential 8 score between years 0 and 20 was associated with a 53% increase in CVD risk (AHR, 1.53 [95% CI, 1.31-1.78]).

CONCLUSIONS AND RELEVANCE: In this prospective cohort study of young adults, unfavorable patterns of CVH change through young adulthood were associated with marked elevations in risk for incident CVD. These data suggest that achieving and maintaining high CVH throughout young adulthood through strategies of primordial prevention are important for prevention of later-life CVD.

PMID:41051778 | DOI:10.1001/jamanetworkopen.2025.35573

JAMA Netw Open. 2025 Oct 1;8(10):e2535580. doi: 10.1001/jamanetworkopen.2025.35580.

ABSTRACT

IMPORTANCE: A national shortage of blood culture bottles affected approximately half of US hospitals, necessitating changes in blood culture practices.

OBJECTIVE: To determine the association between restrictive blood culture stewardship measures and patient outcomes at a pediatric hospital.

DESIGN, SETTING, AND PARTICIPANTS: A retrospective cohort study was performed to determine the association between new restrictive stewardship measures and blood culture practices in a quaternary care pediatric medical center from July 1, 2023, to January 31, 2025. All children with blood cultures collected were included.

EXPOSURES: The following restrictive measures were enacted: (1) a 48-hour restriction on all aerobic blood cultures, (2) a 7-day restriction on all anaerobic blood cultures, (3) authorization to order an additional aerobic blood culture every 7 days, and (4) pooling of all central vein catheter lumens in 1 blood culture bottle.

MAIN OUTCOMES AND MEASURES: The primary outcome was the monthly blood culture positivity rate, stratified and normalized per 100 emergency department (ED) visits and per 100 patient-days.

RESULTS: During the study period, a total of 18 132 blood cultures from 5063 patient visits (median [IQR] age, 5.6 [1.1-12.4] years; 2744 [54.2%] male; 358 [7.15%] Black, 3013 [58.5%] Latino/a/x/Hispanic, and 720 [14.2%] White patients) were collected from August 1, 2023, to July 31, 2024 (preintervention period), and 6449 blood cultures from 2495 patient visits (1391 [55.8%] male, median [IQR] age; 5.5 [1.1-12.5] years; 191 [7.7%] Black, 1452 [58.2%] Latino/a/x/Hispanic, and 375 [15.0%] White patients) were collected from August 1, 2024, to January 31, 2025 (postintervention period). Restrictive stewardship measures were associated with a significant decrease in the blood culture collection rate per 100 ED visits (cumulative change, -24.1%; 95% CI, -38.4% to -8.9%; P = .01) and per 100 patient-days (cumulative change, -45.8%; 95% CI, -64.7% to -26.9%; P < .001). In the ED and inpatient units, the blood culture positivity rate remained stable, with a 14.4% (95% CI, -23.1% to 52.0%) and 27.8% (95% CI, -13.7% to 69.3%) cumulative increase, respectively. There was no significant change in hospital mortality due to septic shock (0.13% vs 0.15%) or mean length of stay (5.4 days vs 6.4 days), but there was a significant decrease in readmissions (3.3 vs 2.7; cumulative change, -27.5%; 95% CI, -7.6% to -47.6%; P = .02).

CONCLUSIONS AND RELEVANCE: The implementation of restrictive blood culture measures, including pooling lumens and decreasing testing cadence, successfully reduced blood cultures collected without decreasing blood culture positivity rates and without an increase in mortality secondary to septic shock, readmission rates, or length of stay.

PMID:41051777 | DOI:10.1001/jamanetworkopen.2025.35580

JAMA Netw Open. 2025 Oct 1;8(10):e2535707. doi: 10.1001/jamanetworkopen.2025.35707.

ABSTRACT

IMPORTANCE: Antiemetics have level 1 evidence supporting their role in improving quality of life and treatment tolerability for patients with cancer; they are an essential part of quality care. Utilization management (prior authorization, step therapy, and quantity limits) is implemented by insurance companies to improve effectiveness and efficiency and to control costs.

OBJECTIVE: To characterize utilization management policies for antiemetics for Patient Protection and Affordable Care Act (ACA) Marketplace and Medicaid plans.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used a national sample of all available Medicaid and ACA drug formularies in 2024 linked to the US Food and Drug Administration’s National Drug Codes. Formulations of the 13 most common self-administered (oral, sublingual, transdermal) antiemetics were identified.

EXPOSURE: Plans’ prior authorization, quantity limit, and step therapy policies.

MAIN OUTCOMES AND MEASURES: The share of antiemetics subject to utilization management by coverage type (ACA, Medicaid, Medicaid managed care, state Medicaid), generic vs brand, and geographically by state was calculated.

RESULTS: A total of 561 formularies (301 [53.7%] ACA; 260 [46.3%] Medicaid) were included, amounting to 348 215 unique drug-plan formulations (173 607 [49.9%] ACA; 174 608 [50.1%] Medicaid). Overall, utilization management affected 66 981 covered antiemetic medications in ACA plans (39.7%) and 75 727 in Medicaid plans (43.4%). In ACA plans, a greater proportion of generic formulations faced restrictions than brand-name drugs (40.5% of generic [67 931 of 167 587] vs 17.4% of brand [1050 of 6020]). In Medicaid, this was the opposite: 82.5% of brand drugs (4357 of 5280) vs 42.2% of generic drugs (71 370 of 169 328) faced restrictions. Utilization management policies varied greatly by plan and state; some plans imposed at least 1 coverage restriction on 100% of antiemetic formulations, and others none. Quantity limits were the most prevalent utilization management tool, applying to more than one-third of covered antiemetic formulations in ACA (64 198 [37.0%]) and Medicaid plans (55 585 [38.1%]).

CONCLUSIONS AND RELEVANCE: In this cross-sectional study of Medicaid and ACA formularies, there was substantial variation in utilization management requirements for antiemetics across insurance type and state as well as drug type, use, and class. Efforts to increase standardization of utilization management policies may alleviate administrative burden for patients.

PMID:41051776 | DOI:10.1001/jamanetworkopen.2025.35707