Sheppard Pratt Health System

Background/Purpose: Psychological resilience plays an important role in improving physical function among people living with fibromyalgia (FM). The Connor-Davidson Resilience 10-Item Scale (CD-RISC-10) was created to measure psychological resilience in clinical populations. The purpose of this article is to assess the reliability and validity of the CD-RISC-10 in adults with FM. Method: A descriptive online survey was conducted on 200 participants with FM registered in a national registry. Resilience was measured using the CD-RISC-10. The CD-RISC-10 was assessed for reliability and validity utilizing a Rasch analysis using the Winsteps statistical program. Results: There was evidence of item reliability for the CD-RISC-10, with an item separation of 5.09 and item reliability of .96. All items on the CD-RISC-10 fit with the concept of psychological resilience, evidenced by acceptable inlier-sensitive or information-weighted fit and outlier-sensitive fit statistics. When controlling for age, sex, and comorbidities, there was a significant relationship between resilience and physical function (R 2 = .35, F = 22.43, p < 0.001) and resilience and pain intensity (R 2 = .27, F = 16.83, p < 0.001). Conclusion: This study found the CD-RISC-10 to be a reliable and valid scale for assessing resilience in adults with FM.

The RECOVER trial randomized 493 patients with markedly treatment-resistant major depressive disorder to treatment-as-usual with or without active vagus nerve stimulation (VNS Therapy). While the primary outcome measure did not statistically separate the treatment conditions, the field may lack optimal metrics for quantifying symptom improvement in markedly treatment-resistant patients. This study examined the impact of three factors on sensitivity to clinical improvement across the total RECOVER sample and to differences in the effectiveness of the randomized conditions, systematically varying outcome classification (remission, response, and partial response), observation period (3-12months, 6-12months, 10-12months and last observation), and depression rating scale. Effect sizes for detecting therapeutic change across the total sample and the difference in effectiveness between the randomized groups were markedly higher for partial response than response or remission classifications. Longer observation periods produced larger therapeutic effects across the sample, but the effect sizes for the randomized treatment differences were substantially higher in the final 10-12month period. The MADRS showed the least sensitivity to change across the sample and between the treatment groups. Using the partial response classification and the 10-12month observation period, a significant difference between the groups was obtained for 3 of 4 depression scales. The findings derive from a retrospective assessment of alternative outcome metrics. In a large randomized controlled trial of VNS for markedly treatment-resistant depression, the magnitude of therapeutic effects and separation of treatment groups differed as a function of outcome classification, measurement period, and rating scale.

Few treatments are available for individuals with marked treatment-resistant depression (TRD). Evaluate the safety and effectiveness of FDA-approved adjunctive vagus nerve stimulation (VNS) in patients with marked TRD. This 12-month, multicenter, double-blind, sham-controlled trial included 493 adults with marked treatment-resistant major depression who were randomized to active or no-stimulation sham VNS for 12 months. The primary outcome was percent time in response across months 3-12, with response defined as a ≥50% change from baseline on the Montgomery-Åsberg Depression Rating Scale (MADRS). Several secondary endpoints were evaluated. Overall, 88.4% of participants completed the trial. Percent time in MADRS response did not distinguish active from sham VNS. However, ratings from on-site clinicians (Clinical Global Inventory-Impression [CGI-I]), patients (Quick Inventory of Depressive Symptomology-Self Report [QIDS-SR]), and offsite masked raters (Quick Inventory of Depressive Symptomology-Clinician [QIDS-C]) revealed antidepressant benefits significantly favoring active VNS. Active VNS demonstrated significantly more percent time in response on the CGI-I (P=0.004) and QIDS-SR (P=0.049), and significantly more percent time in partial response (PR; symptom improvement ≥30%) on the CGI-I (P<0.001) and QIDS-C (P=0.006) versus sham VNS. Active VNS exceeded sham VNS in rate of dyspnea (P=0.035), a known side effect of VNS. No new adverse events were identified. Percent time in MADRS response did not distinguish the treatment groups, but on multiple instruments time in response and PR showed a positive treatment effect. VNS was found safe and effective in participants with marked TRD.

Given the recent expansion of the U.S. Immigration and Customs Enforcement's (ICE's) jurisdiction to include previously protected areas, including hospitals, physicians are now more likely to encounter ICE officers. However, guidance from lawmakers, institutions, and professional societies on how to navigate these encounters is limited and, at times, contradictory. This column focuses on an interaction between ICE and psychiatry in an emergency setting to explore some challenges that individual physicians, particularly psychiatrists, may face when attempting to practice within legal constraints and ethical guidelines, highlighting the need for more robust guidance.

<b><i>Conclusions:</i></b> Routine TMS delivered in diverse clinical settings results in marked anxiolytic and antidepressant effects in patients with anxious depression. The extent of improvement in anxiety and depression symptoms strongly covaries.