Objective Hyponatremia is a common electrolyte disturbance in psychiatric patients related to psychogenic polydipsia, psychotropic medications, and medical comorbidities. Data on the prevalence of admission hyponatremia and its independent clinical correlates in psychiatric inpatients remain limited. Method This retrospective study included 322 consecutive male psychiatric inpatients hospitalized between June and December 2022. Hyponatremia was defined as serum sodium <135 mEq/L within 24 h of admission. Sociodemographic, clinical, and laboratory data were extracted from electronic medical records. Age and disease duration were entered into a Firth penalized logistic regression model. Sensitivity analyses used alternative sodium cut-offs (<134 and <136 mEq/L), glucose-corrected sodium, and continuous sodium. Results Hyponatremia was identified in 15 patients (4.7%, 95% CI 2.8-7.5%). Older age, longer disease duration, and a greater number of psychiatric hospitalizations were associated with hyponatremia in univariable analyses. After adjustment for age, disease duration remained associated with hyponatremia (OR = 1.07 per year, 95% CI = 1.02-1.14, P = .006), with similar estimates across alternative sodium cut-off values, but was not associated with continuous sodium. Diabetes mellitus was also associated with hyponatremia univariably, though this should be interpreted with caution given the small number of affected patients and its attenuation after glucose correction. Conclusions Admission hyponatremia was identified in 4.7% of male psychiatric inpatients. Disease duration was associated with hyponatremia after adjustment for age, although its contribution cannot be fully separated from that of age. These findings support careful evaluation of abnormal admission serum sodium values. Prospective multicenter studies are needed to confirm these findings and clarify underlying mechanisms.
ObjectiveDepression and anxiety are common among patients with chronic illnesses and can substantially affect quality of life. Patients with otorhinolaryngology (ENT) conditions may be particularly vulnerable. This study assessed the prevalence of depressive and anxiety symptoms among adults attending ENT clinics in Saudi Arabia and identified associated factors.MethodsA cross-sectional study was conducted among a convenience sample of adults aged ≥18 years attending ENT clinics in Saudi Arabia using a self-administered electronic questionnaire. Depressive and anxiety symptoms were assessed using validated Arabic versions of the PHQ-9 and GAD-7. Factors associated with scores ≥10 were examined using multivariable logistic regression.ResultsAmong 1020 participants, 38.1% (95% CI 35.2-41.2) had moderate-to-severe depressive symptoms and 31.0% (95% CI 28.2-33.9) had moderate-to-severe anxiety symptoms. Depression was associated with younger age (aOR 0.96), Western-region residence (aOR 1.49), widowhood (aOR 7.17; n = 7), smoking (aOR 1.85), and psychiatric follow-up (aOR 2.53), while monthly household income of 10 000-20,000 Saudi riyals was associated with lower odds (aOR 0.68). Anxiety was associated with younger age (aOR 0.96), smoking (aOR 1.95), psychiatric follow-up (aOR 2.80), family history of psychiatric illness (aOR 1.41), and tinnitus (aOR 1.75; false discovery rate q = 0.034). No other ENT condition or comorbidity remained associated after adjustment and false discovery rate correction.ConclusionModerate-to-severe depressive and anxiety symptoms were common among adults attending ENT clinics in this Saudi convenience sample. These findings support consideration of routine mental health screening in ENT settings.
Background Depression and neurotoxic complications are frequently observed in patients with hematologic malignancies (HM). Serotonergic antidepressants, mainly selective serotonin reuptake inhibitors (SSRIs) and serotonine-norepinephrine reuptake inhibitors (SNRIs) are commonly prescribed as the first line-treatment of depression because they are safer and have fewer side effects than other medications antid. Among SNRIs, duloxetine has shown promise, with multiple experimental studies demonstrating its ability to prevent or alleviate chemotherapy-induced peripheral neuropathy (CIPN). However, SSRI/SNRIs use raise several biological and pharmacological considerations due to clinically relevant drug–drug interactions. Despite the widespread use of antidepressants in this population, robust clinical evidence supporting their efficacy and safety specifically in HM patients remains limited. Objective The aim of this review is to evaluate the effects of SSRIs/SNRIs in HM, their impact on CIPN, drug interactions relevant to HM therapy, and clinical outcomes of antidepressant use in this population. Methods Following PRISMA guidelines, a systematic search of several databases (PubMed, Scopus and Web Of Science) covering the period from January 1, 2000, to January 31, 2025, was conducted. Results A total of 251 articles were initially identified. Ultimately, 24 articles were eligible for analysis. The data relies solely from in vitro studies indicate that SSRIs and SNRIs may enhance the effectiveness of chemotherapy. Only one clinical study evaluated antidepressant efficacy in HM patients, showing improvement in depressive symptoms with paroxetine. Moreover, duloxetine has an established clinical role in the treatment of painful CIPN. However, the evidence supporting its use for CIPN prevention remains limited to preclinical models and lacks definitive clinical validation. The safety issues include serotonin toxicity, a risk of bleeding related to SSRIs and SNRIs impact on platelet functions and other potential drug-drug interactions. Conclusions Based on available data, it is not possible to clearly recommend SSRIs and SNRIs for HM patients beyond the registered indications. Clinical studies are needed to confirm anticancer and chemosensitizing effects of SSRIs and SNRIs demonstrated in experimental models of leukemia and lymphoma. Nevertheless, the potential broader therapeutic benefits of duloxetine and related serotonergic agents in CIPN warrant further investigation. Due to the high prevalence of depression in HM patients, more data on safety in this population is warranted.
ObjectiveTo estimate reported mental health-related diagnosis and treatment frequencies among middle-aged and older adults in China with elevated depressive symptoms, including those with recent general medical contact.MethodRespondent-wave observations were pooled from four Harmonized China Health and Retirement Longitudinal Study (CHARLS) waves (2011-2018) among adults aged 45 or older. Elevated symptoms were defined as a 10-item Center for Epidemiologic Studies Depression Scale score ≥10. Proportions used wave-specific respondent weights; 95% confidence intervals used community-cluster bootstrap resampling. Pooled logistic regression used community-clustered robust standard errors; sensitivity analyses used respondent-clustered and normalized-weight models.ResultsAmong 67,472 observations from 23,619 individuals, weighted symptom prevalence was 32.4% (95% CI = 31.1%-33.6%). Among symptom-positive observations with outcome data, a doctor diagnosis of emotional, nervous, or psychiatric problems was reported in 3.3% (95% CI = 2.9%-3.7%), and related treatment in 1.3% (95% CI = 1.1%-1.6%). Among 719 symptom-positive observations with reported diagnosis and positive weights, 557 had treatment data; 37.7% (95% CI = 32.1%-43.9%) of these reported treatment. Among symptom-positive observations with recent outpatient or inpatient contact, 4.3% included a reported diagnosis and 1.8% included treatment. Of 5013 respondents with elevated symptoms but no reported diagnosis or treatment in 2011, 76.3% reported elevated symptoms during follow-up; 3.9% later reported diagnosis and 1.3% reported treatment.ConclusionsReported mental health-related diagnosis and treatment were uncommon among symptom-positive observations, even after recent medical contact. Questionnaire routing and missing treatment data limit interpretation of the apparent gap. Because symptoms and care were self-reported, these estimates should not be interpreted as clinical treatment rates for depressive disorders.
Objective Postoperative delirium (POD) is a frequent complication after surgery in older adults and is associated with increased morbidity and prolonged recovery. The impact of perioperative management of angiotensin receptor blockers (ARBs) on POD remains uncertain. This randomized exploratory trial investigated the association between perioperative ARB continuation or withholding and POD outcomes in elderly patients undergoing elective surgery. Methods Elderly patients (≥65 years) receiving chronic ARB therapy and undergoing elective surgery were randomly assigned to either perioperative ARB continuation or temporary ARB withholding. The allocated ARB management strategy was applied during the perioperative period, and POD was assessed daily for 5 postoperative days using the Confusion Assessment Method (CAM). Delirium severity was evaluated using the Delirium Rating Scale-Revised-98 (DRS-R-98). Plasma levels of neurofilament light chain (NfL), glial fibrillary acidic protein (GFAP), interleukin-6 (IL-6), interleukin-8 (IL-8), and C-reactive protein (CRP) were evaluated as exploratory biomarkers. Results Among 44 randomized participants, 42 were included in the final analysis (21 per group). POD occurred in 4/21 participants (19.1%) in the ARB continuation group and 12/21 participants (57.1%) in the ARB withholding group, corresponding to an absolute risk difference of −38.1 percentage points (95% confidence interval, −59.7 to −8.7; P = 0.025). Surgical category was markedly imbalanced between groups, with orthopedic procedures accounting for 57.1% of the ARB continuation group and 95.2% of the ARB withholding group ( P = 0.009). Lower DRS-R-98 scores were observed in the ARB continuation group compared with the ARB withholding group: median (interquartile range, IQR), 0 (0-7) vs 18 (5-26), P = 0.025, accompanied by shorter delirium duration (median (IQR), 0 (0-40) vs 40 (12-100) hours, P = 0.030). Exploratory biomarker analyses showed smaller postoperative relative increases in NfL, GFAP, and IL-8 in the ARB continuation group, whereas IL-6 and CRP did not differ significantly between groups after false discovery rate (FDR) correction. These biomarker findings are exploratory and should not be interpreted as evidence of causal or mechanistic effects. Conclusions In this small randomized exploratory trial, perioperative ARB continuation was associated with lower observed POD incidence and severity compared with temporary ARB withholding. However, the marked imbalance in surgical category and the limited sample size preclude independent attribution of these differences to ARB management. These findings are hypothesis-generating and require confirmation in larger, adequately powered randomized studies with better balance of surgical procedures.
