Six Distinct Subtypes of Depression, Anxiety Identified Via Brain Imaging

Medscape | By Megan Brooks

Brain imaging combined with artificial intelligence has identified six distinct "biotypes" of depression and anxiety that may lead to more personalized and effective treatment.

This research has "immediate clinical implications," study investigator Leanne Williams, PhD, director of the Stanford Medicine Center for Precision Mental Health and Wellness, told Medscape Medical News.

"At Stanford, we have started translating the imaging technology into use in a new precision mental health clinic. The technology is being actively developed for wider use in clinical settings, and we hope to make it accessible to more clinicians and patients," Williams said.

No More Trial and Error?

Depression is a highly heterogeneous disease, with individual patients having different symptoms and treatment responses. About 30% of patients with major depression are resistant to treatment, and about half of patients with generalized anxiety disorder do not respond to first-line treatment.

"The dominant 'one-size-fits-all' diagnostic approach in psychiatry leads to cycling through treatment options by trial and error, which is lengthy, expensive, and frustrating, with 30-40% of patients not achieving remission after trying one treatment," the authors noted.

"The goal of our work is figuring out how we can get it right the first time," Williams said in a news release, and that requires a better understanding of the neurobiology of depression.

To that end, 801 adults diagnosed with depression and anxiety underwent functional MRI to measure brain activity at rest and when engaged in tasks designed to test cognitive and emotional functioning.

Researchers probed six brain circuits previously associated with depression: The default mode circuit, salience circuit, attention circuit, negative affect circuit, positive affect circuit, and the cognitive control circuit.

Using a machine learning technique known as cluster analysis to group the patients' brain images, they identified six clinically distinct biotypes of depression and anxiety defined by specific profiles of dysfunction within both task-free and task-evoked brain circuits.

"Importantly for clinical translation, these biotypes predict response to different pharmacological and behavioral interventions," investigators wrote.

For example, patients with a biotype characterized by overactivity in cognitive regions of the brain experienced the best response to the antidepressant venlafaxine compared with patients with other biotypes…

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Establishing a Bond - The Admission Visit

By Barbara Karnes

We who work in end of life situations take care of the patient and the caregiver/ family. As end of life approaches, our attention and interactions revolve around the family/ caregiver as much as the patient. Our work involves creating trust with all involved as quickly as possible.

End of life work is time sensitive. We who serve need to establish a bond and trust by the end of our first visit. Time is the enemy here. Sensitive information, scary information, heart wrenching information will be shared and given.

How do we get beyond the social conventions of strangers meeting and getting to know and trust each other in a very short time? From the time we ring the doorbell for the first time, our bonding efforts begin. I begin with a handshake and introduction. “Hi, my name is Barbara. I’m going to be your hospice nurse” (or admission nurse, or social worker, or home health aide, or chaplain). 

Now sit down and get acquainted before actual work begins. This get-acquainted time is as important as all the other work you will do. You’re beginning to build the trust, the comfort that is necessary for each other part of your work.

“Tell me how you’re doing? How is John doing? Tell me a bit about how everything is going for you right now.” While having this conversation, sit next to the person — not across the room, not across a table. You want to be able to touch, to feel close. Without words, you are creating a kinship with which to build trust. No laptops or tablets in sight. No paperwork. This is get-acquainted time, person-to-person time while mentally gathering information.

Then go see John and do your assessment. Much depends upon where John is in the dying process. Is he responsive? If so, maybe he was with you during this get-acquainted time. This would indicate he is probably months from death. Is he in bed, confused, in and out of awareness? Then he is probably weeks from death. Is he non-responsive? Then you assess he is probably days from death.

Where he is in the dying process will determine how you interact with him and the kind of bond you can make with him. It will also be the determining factor in the amount of visits you will be making. (My recommendation: if months, then once a week. If weeks, then two or three times a week, and if imminent, then every day, sometimes twice a day.)

Our assessment visit finished, we can now explain there is paperwork required. “Let’s sit in the kitchen (or wherever) and get the business part and paperwork signed.”

The visit is now complete. When leaving, and with all future visits, ask these questions. “Have you understood everything we’ve talked about today? Do you have any questions you want to ask me? Is there anything else you want us to talk about?” Remind them of the on call 24/7 availability. 

As I leave the doorway, I again shake hands. Being the hugger that I am, by the end of most visits the caregiver and I will hug. Sometimes simply saying “I’m a hugger. Can I give you a hug?” brings the visit to a satisfying end. A connection has begun.

You're Invited to Join the HHAC Annual Conference Committee 

The HHAC Education/Professional Development Council is currently seeking additional dedicated volunteers to join the 2025 Annual Conference Committee.

This dynamic group of volunteers will play a vital role in shaping the educational agenda and selecting speakers for the 2025 Rocky Mountain Home Care, Health and Hospice Conference that will take place in May 2025.

Benefits to you:

• Free registration to the two-day conference
• Opportunities to build connections with other industry leaders and fellow volunteers
• Opportunities to develop the conference educational agenda 
• Recognition as a volunteer leader within HHAC

Time commitment – only one (1 hour) planning meeting per month. Virtual monthly committee meetings will start in August 2024 on Wednesdays at either 10:30 or 11:30 AM Mountain Time.

If you have questions or would like to volunteer, contact Maria Donovan, Conference Planner at [email protected] by July 26th. Please provide your name, contact information and your meeting day/time preference.

How the Supreme Court’s Chevron Decision Could Help Stop Home Health Cuts

Home Health Care News | By Andrew Donlan

On Friday, the U.S. Supreme Court upended the Chevron doctrine precedent. For home health industry purposes, that means a potentially weakened Centers for Medicare & Medicaid Services (CMS) moving forward.

The news comes just two days after the home health proposed payment rule was released, which included significant cuts for the third straight year.

Broadly, moving away from the Chevron precedent – usually known as the Chevron doctrine – will mean less regulatory power for government agencies. Government agencies often take their own interpretations of certain laws and statutes, and then act upon those interpretations. Moving forward, it’s likely that these agencies will need more explicit direction from Congress to regulate on firm standing.

The reaction to the Supreme Court decision has mostly been centered around issues like the environment and reproductive rights.

But the decision could also be the breakthrough that home health providers needed to stop – and potentially undo – payment cuts. This week, CMS proposed a 1.7%, or $280 million, decrease to aggregate home health payments for 2025. The final rule is expected in late October or early November.

The National Association for Home Care & Hospice (NAHC) already filed a lawsuit against the U.S. Department of Health & Human Services (HHS) and CMS over rate cuts in 2023.

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