Search Results (102)

Axial truncal dystonia can present as either flexion or extension, often with a tendency toward lateral movement. Flexion dystonia is more common and may represent a clinical spectrum associated with parkinsonism. In contrast, extensor trunk dystonia is less frequent and exhibits a diverse range of causes. In this paper, we reviewed the literature on axial extensor trunk dystonia. We identified 11 studies involving 49 patients, of which only 10 had idiopathic trunk dystonia. Treatment with botulinum neurotoxin A (BoNT/A) emerged as the most effective therapy; however, many studies did not provide detailed descriptions of the treatment (4/11) and follow-up periods were not specified or short term (up to one–two years). We present four new, well-documented patients with the idiopathic form of extensor trunk dystonia who were treated with BoNT/A with moderate to significant effect according to Global Clinical Impression scale (GCI) and Burke-Fahn-Marsden (BFM) dystonia scale. These cases include long-term follow-up for three patients, all without any adverse events. While the diagnostic process and treatment can be challenging, we recommend using BoNT/A with adjusted doses tailored to the appropriate muscle groups as a first-line treatment. Full article

Background/Objectives: This study aimed to investigate the association between serum ferritin levels and functional impairment in children with Attention Deficit Hyperactivity Disorder (ADHD). In addition, we investigated whether this relationship remained significant after controlling for core symptom severity and examined the correlations between ferritin levels and ADHD symptom levels. Methods: The sample included 88 children aged 6–13 years: 44 diagnosed with ADHD and 44 healthy controls (HCs) matched for age and sex. ADHD symptom severity was assessed using Turgay’s DSM-IV-Based ADHD and Disruptive Behavior Disorders Screening Scale (T-DSM-IV-S; parent-report) and the Clinical Global Impression—Severity (CGI-S) scale (clinician-rated). Functional impairment was measured using the Weiss Functional Impairment Rating Scale—Parent Report (WFIRS-P). Serum ferritin levels were determined through venous blood samples. Statistical analyses included group comparisons, Spearman correlations, and partial correlations controlling for symptom severity. Results: Children with ADHD had significantly lower serum ferritin levels and higher levels of both symptom severity and functional impairment compared to HCs. Ferritin levels were negatively correlated with ADHD symptom severity and with functional impairment in the Life Skills domain. However, after controlling for ADHD symptom severity, the association with Life Skills was no longer statistically significant. Conclusions: Ferritin levels were found to be associated with both ADHD symptom severity and functional impairment in the Life Skills domain. However, this relationship was not independent of symptom severity, suggesting that core ADHD symptoms may mediate the impact of iron status on daily functioning. Due to the study’s limitations (e.g., cross-sectional design, small sample size, gender imbalance, and lack of inflammatory and dietary data), our findings should be interpreted with caution, as they do not establish causality or resolve the ongoing inconsistencies in the literature. These results underscore the relevance of iron metabolism in the clinical presentation of ADHD and highlight the need for future research to determine whether improving iron status could serve as an adjunctive strategy in the management of functional impairments in this population. Full article

Objective: The aim of the study was to assess the effectiveness and safety of long-acting injectable anti-psychotic treatment (LAIA) amongst children and adolescents. Given the difficulty of performing an randomized controlled trial (RCT), we suggested comparing children and adolescents to young adults who were treated with LAIAs, and extrapolating data regarding efficacy and safety. Method: We compared data from medical files of adult inpatients treated with LAIAs to children and adolescent inpatients treated with LAIAs, between January 2014 and April 2021. Results: clinical global impression (CGI) scale score and rate of side effects (79% vs. 92%, p-value = 0.106) were not different between children and adolescents and young adults treated with LAIAs. There were no significant differences found between the groups in most demographic and clinical parameters such as gender distribution, legal status (voluntary or involuntary hospitalization), first hospitalizations and subsequent hospitalizations. Significant differences were found in duration of hospitalizations (144 days vs.50 days, p-value < 0.001), the indication for recommending LAIA treatment, diagnosis, the distribution of specific LAIAs and the rates of patients treated for side effects of anti-psychotic treatment. Conclusions: Results suggest that LAIA treatment may be as effective amongst children and adolescents as it is for adults. More research should be done to assess safety and efficacy of LAIA treatment in children and adolescents in the short and long term. Full article

Introduction: The introduction of the transdiagnostic approach in psychiatry shifts the focus from discrete diagnoses to shared symptoms across various disorders. The Transdiagnostic Global Impression—Psychopathology (TGI-P) scale is a newly developed tool designed to assess psychiatric symptoms across diagnostic boundaries. It evaluates ten core symptom domains—positive, negative, cognitive, manic, depressive, addiction, anxiety, sleep, hostility, and self-harm—regardless of specific diagnoses. Objective: This study aims to evaluate the efficacy of cariprazine across these ten transdiagnostic symptom domains. Methods: A systematic literature review and meta-analysis were conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Searches were performed on EMBASE and clinicaltrials.gov. Efficacy measures such as the Positive and Negative Syndrome Scale (PANSS), Montgomery–Åsberg Depression Rating Scale (MADRS), Young Mania Rating Scale (YMRS), Hamilton Anxiety Rating Scale (HAM-A), and Columbia-Suicide Severity Rating Scale (C-SSRS) were used to assess cariprazine’s effect on the ten transdiagnostic symptoms. Multilevel random-effects meta-analyses were conducted to evaluate the efficacy of cariprazine versus placebo in alleviating depressive and anxiety symptoms across clinical trials. Results: A total of 30 studies were included in the review. Cariprazine showed therapeutic benefits on positive, negative, manic, and depressive symptoms in specifically designed trials. Preliminary positive effects were seen on anxiety, hostility, and cognitive symptoms across disorders. However, specific trials have not been conducted for anxiety disorders or cognitive impairment. Meta-analyses demonstrated that cariprazine significantly reduces both depressive and anxiety symptoms compared to placebo. Cariprazine significantly improved sleep-related symptoms in both mania and depression trials. Suicidality was evaluated in non-suicidal populations, and no increase was observed. Addiction symptoms were part of the exclusion criteria in the RCTs, so they could not be assessed. Previous reports of cariprazine’s anti-craving and anti-abuse effects come from real-world evidence rather than RCT data. Conclusions: Cariprazine appears to be promising in addressing a broad range of symptom domains across psychiatric conditions. Full article

Background/Objectives: The joint presence of chronic pain (CP) and depression is frequent, exacerbating symptoms of both conditions. Although tricyclic antidepressants and serotonin noradrenaline reuptake inhibitors are effective treatments, they are frequently not well tolerated, and selective serotonin reuptake inhibitors are not useful for controlling CP. This study investigated vortioxetine’s effectiveness in relieving CP in patients with any degree of depression. Methods: Patient data with any degree of depression and with CP (Visual Analog Scale [VAS] score ≥ 4) were collected and analyzed. Included patients (n = 142) were initially treated with vortioxetine 10 mg/day for 3 months. Improvement of patients’ pain and condition was measured with the VAS, Patient Global Impression (PGI), and Clinical Global Impression (CGI) scales at 1 and 3 months. Brief Pain Inventory (BPI) was measured at baseline and 3 months. Additionally, at baseline and after 3 months of treatment, the Satisfaction with Medicines Questionnaire (SATMED-Q) and 9-item Patient Health Questionnaire (PHQ-9) were evaluated. Adverse Events (AEs) were recorded. Results: Patients showed significant improvement (p < 0.001) in VAS from baseline to 1 and 3 months (mean [SD]: 7.19 [0.62], 6.23 [0.80], and 5.41 [1.15], respectively). BPI and PHQ-9 scores also showed a significant decrease from baseline (mean [SD] of 6.05 [0.75] and 11.73 [4.89], respectively) to 3 months (5.11 [1.04] and 6.95 [2.52], respectively). Clinical improvement with the CGI and PGI scales were reported. According to the SATMED-Q, patients were satisfied with the treatment. Only a few mild EAs were recorded. Conclusions: Vortioxetine can improve both the severity and intensity of CP in patients with any degree of depression. Full article

Background and Objectives: There have been a limited number of randomized controlled trials (RCTs) comparing pharmacopuncture therapy (PPT) and physical therapy (PT) for chronic knee pain. In this study, we assess the feasibility, safety, and preliminary effectiveness of PPT compared to PT in patients with chronic knee pain. Materials and Methods: This pilot study was designed as a two-arm, parallel RCT. Patients were recruited through in-hospital advertisements. Forty patients aged 19 to 70 with knee pain with a numeric rating scale (NRS) score of 5, persisting for >3 months, were randomized into the PPT or PT group. The type of PT solution or PT method was not determined in advance, leaving it to the clinician’s judgment. Treatment was administered twice weekly for 3 weeks with a 6-week follow-up. The primary outcome was the NRS score for knee pain, whereas the secondary outcomes were the visual analog scale (VAS), knee range of motion, Korean Western Ontario and McMaster (K-WOMAC), Patient Global Impression of Change, and five-level EuroQol five-dimension scores. Additionally, adherence, acceptability, dropout rate, and adverse events were measured to assess the feasibility of a follow-up main study. The protocol was registered at ClinicalTrials.gov (NCT06505681). Results: The PPT group showed significantly superior improvement compared with the PT group in the NRS (difference = −2.05, 95% confidence interval [CI]: −2.76 to −1.34), VAS (difference = −21.58, 95% CI: −29.42 to −13.74), and K-WOMAC scores (difference = −13.17, 95% CI: −21.67 to −4.67). Of the 55 patients who initially expressed interest in participation, 8 declined after receiving detailed information about this study. Among the forty enrolled participants, one patient in the PPT group dropped out, and one missed a single treatment session. Apart from these cases, all participants completed the assigned treatments and follow-up assessments, demonstrating high adherence. No serious adverse events were reported. Conclusions: PPT demonstrated excellent effectiveness in pain relief and functional improvement in these patients. Full article

Background: Feeding and Eating Disorders (FEDs) are severe mental health conditions often emerging during childhood or adolescence, with rising prevalence. They are frequently associated with psychiatric and organic comorbidities, including anxiety symptoms and insomnia. Phytotherapy, particularly Passiflora incarnata L. Herba, has been suggested as a potential treatment option for anxiety and insomnia in youth. Methods: this is an observational and retrospective study that includes patients assessed in a third-level Italian Regional Centre for Feeding and Eating Disorders in Children and Adolescents between 1 January 2020 and 31 December 2023. Eligible patients had a confirmed diagnosis of a FED, along with either an anxiety or a sleep disorder. During follow-up, the clinical efficacy of Passiflora incarnata L. Herba was assessed using the Clinical Global Impression–Improvement scale (CGI-I). Comparative analyses were conducted by stratifying the sample based on the target symptoms (sleep disorders/insomnia and anxiety), FED subtype, and whether polytherapy was used. Results: this study includes 94 patients, with most diagnosed with anorexia nervosa (71.3%). Passiflora incarnata L. Herba was administered at a dosage of 200 mg (1–2 tablets for day). It was often combined with selective serotonin reuptake inhibitors (SSRIs) (56.5%), atypical antipsychotics (27.7%), or benzodiazepines (7.4%). Treatment was initiated for anxiety symptoms (75.5%) or insomnia (28.7%). No side effects were reported. Among patients with specific outcome data, 53.3% reported improvements in anxiety symptoms, and 45.4% reported improvements in insomnia. Conclusions: this is the first study to evaluate the use of Passiflora incarnata L. Herba for anxiety and insomnia in children and adolescents with FEDs. Our findings suggest that Passiflora incarnata L. Herba may serve as a well-tolerated adjunctive treatment, showing symptomatic improvement in up to 53% of the patients with data on treatment outcomes. Notably, 53.3% and 45.4% of participants, with specific outcome data, reported reduced anxiety and insomnia symptoms, respectively. Given its excellent safety profile and preliminary efficacy, Passiflora incarnata L. Herba may represent a promising alternative for patients with mild symptoms or for caregivers hesitant about conventional pharmacotherapy. Full article

Background and Objectives: Most genetic studies have focused on catecholamine system genes to identify etiology in attention-deficit/hyperactivity disorder (ADHD), and there is growing evidence that the interaction of several genes may synergistically or antagonistically affect disease outcomes. We investigated the interaction between the alpha-2 adrenergic receptor (ADRA2A) and its transporter (SLC6A2) to determine the etiology and treatment outcomes for ADHD. Materials and Methods: Children with ADHD (age 8.3 ± 2.0 y, 72 boys and 11 girls) were assessed using the Kiddie Schedule for Affective Disorders-Present and Lifetime (K-SASD-PL), ADHD rating scale-IV (ARS), Clinical Global Impressions-Improvement (CGI-I), and Clinical Global Impressions-Severity (CGI-S) scales. Neuropsychological assessments were performed using a continuous performance test (CPT). Methylphenidate was titrated based on the CGI-I and CGI-S scales for 8 weeks. We assessed two polymorphisms, ADRA2A rs553668 and SLC6A2 rs998424, for their association with disease outcomes. Results: The ADRA2A polymorphism had a significant effect on visual/auditory commission errors in the CPT. The CC genotype for ADRA2A combined with the GG genotype for SLC6A2 showed more commission errors than the other combinations of genotypes. Treatment outcome assessment using the CGI-S showed that the SLC6A2 GG genotype had more favorable treatment outcome (p < 0.05) and significant gene × dose interaction on ARS score across 8 weeks (p < 0.01). Conclusions: Our findings provide preliminary evidence for the effect of ADR2A and SLC6A2 gene–gene interactions on the attention system and treatment response in children with ADHD. Although these findings require future replication, our study contributes to the understanding of the genetic basis of ADHD. Full article

Objective: We aimed to analyze the real-world use of COMT inhibitors associated with levodopa in patients with Parkinson’s disease (PD) who present early fluctuations and to explore whether early COMT inhibition optimizes treatment outcomes. Methods: REONPARK is an ongoing 2-year prospective observational study. We included patients diagnosed with PD who presented signs of end-of-dose motor fluctuations for <2 years and started COMT inhibitors according to clinical practice. Outcomes included the clinician and patient global impression of change (CGI-C, PGI-C), the Movement Disorder Society-sponsored revision of the Unified Parkinson’s Disease Rating Scale (MDS-UPDRS), the Parkinson’s Disease Questionnaire-8 (PDQ-8), Non-Motor Symptoms Scale (NMSS), 19-Symptom Wearing-off Questionnaire (WOQ-19), and safety. We present a pre-planned interim analysis (cut-off date 3 July 2023) of patients who completed the first 3 months of follow-up. Results: Seventy patients were analyzed (mean levodopa dose at inclusion 484.8 mg; duration of motor fluctuations 0.6 years). In all cases, COMT inhibition was initiated with opicapone, and 81% maintained a stable levodopa dose at 3 months. After 3 months of treatment with opicapone, 73.5% and 62.8% of patients improved on CGI-C and PGI-C, respectively. MDS-UPDRS scores improved significantly with a mean change from baseline of −3.3 ± 7.7 (p < 0.001) for Part III and −1.3 ± 1.7 (p < 0.001) for Part IV. The mean OFF time decreased from 3.7 ± 2.6 h at baseline to 2.2 ± 2.3 h, and 20.6% of patients no longer experienced OFF periods. Patients experiencing no impact of fluctuations increased from 10% to 45.6%. Conclusions: In PD patients with early fluctuations, three months of opicapone reduced the OFF time and improved functional outcomes, suggesting potential benefits in the early stages. Full article

Background: Mixed urinary incontinence (MUI), particularly the urge-predominant subtype, involves both stress urinary incontinence (SUI) and urge urinary incontinence (UUI), posing a therapeutic challenge. Duloxetine, a serotonin–norepinephrine reuptake inhibitor (SNRI), enhances urethral tone, while tolterodine, an antimuscarinic agent, reduces detrusor overactivity. Their combination may offer synergistic benefits. Aim: The aim of this study was to evaluate the efficacy of duloxetine and tolterodine combination therapy in urge-predominant MUI and identify factors influencing treatment success. Method: A retrospective study was conducted on 106 patients (mean age: 56.45 years) with urge-predominant MUI treated with duloxetine (40 mg twice daily) and tolterodine (4 mg once daily) for 12 weeks. Treatment outcomes were evaluated using the overactive bladder symptom score (OABSS), International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF), 24 h pad test, and Clinical Global Impression Scale (CGI). Univariate and multivariate regression analyses were performed to determine predictors of success. Results: Significant improvements were observed: OABSS decreased from 11.08 to 6.95, ICIQ-SF decreased from 15.69 to 8.84, and pad use decreased from 3.58 to 0.73/day (all p 0.0001). Bladder capacity increased from 315.09 mL to 436.32 mL. Baseline ICIQ-SF scores were independent predictors of success (odds ratio [OR] = 2.919, p = 0.001). Patient satisfaction reached 77.4%, with mild side effects (constipation and dizziness) in 14 patients. Conclusions: Duloxetine and tolterodine combination therapy significantly improved symptoms and quality of life in urge-predominant MUI. Baseline ICIQ-SF scores may predict treatment success. Further prospective studies are needed. Full article

Background/Objectives: Schizophrenia is a severe psychiatric disorder, with onset typically occurring in late adolescence or early adulthood. Early identification of psychotic symptoms, especially those occurring before age 12, has been linked to better long-term outcomes. This study aims to assess the presence of psychotic spectrum symptoms before the age of 12 in adult schizophrenia patients and explore their clinical implications for early detection and intervention. Methods: This retrospective, observational study included 170 adult patients diagnosed with schizophrenia, confirmed by the SCID-5. Patients were recruited from the University of Siena Medical Center and completed the modified lifetime version of the Psychotic Spectrum Self-Report (PSY-SR) questionnaire, which assessed the onset of specific psychotic symptoms before and after age 12. Symptom severity was evaluated using the Brief Psychiatric Rating Scale (BPRS) and the Clinical Global Impression Scale (CGI). This study also examined the impact of the duration of untreated psychosis (DUP) on symptom severity. Results: In our cohort, 21% of patients exhibited prodromal symptoms before age 12 (95% CI: 15–27%). Prodromal symptoms were linked to a 9.53-point increase in the BPRS scores (p = 0.0478) and a 0.50-point increase in the CGI scores (p = 0.0347). The age of symptom onset negatively correlated with the BPRS scores (p < 0.0001), with each year of delay resulting in a 1.33-point decrease. The DUP correlated significantly with both the BPRS (ρ = 0.97) and CGI scores (ρ = 0.94). The multivariate analysis revealed that a longer DUP was associated with significant increases in both scores: a 27.16-point increase in the BPRS (p < 0.0001) for a moderate DUP and a 67.51-point increase (p < 0.0001) for a severe DUP. The CGI scores increased by 1.11 points with a moderate DUP and 3.17 points with a severe DUP (p < 0.0001). However, the interaction between the DUP and prodromal symptoms at age 12 was not significant, indicating similar impacts of the DUP regardless of early symptom onset. Conclusions: The results support the critical importance of early detection and intervention in schizophrenia. Early psychotic spectrum symptoms, particularly those occurring before age 12, are significant predictors of later severity and functional impairment. This study underscores the value of screening tools like the PSY-SR for identifying prodromal symptoms and facilitating timely intervention. Our findings highlight the need for the early identification of psychotic symptoms, particularly in at-risk populations, to improve long-term outcomes. Intervening before the onset of full-blown psychosis may reduce the severity of schizophrenia and promote better clinical outcomes. Full article

Background. Sleep disturbances are frequent in patients with substance use disorders (SUDs) and are associated with craving and addiction relapses, leading to increased clinical severity and detrimental outcomes. Daridorexant, a selective dual orexin receptor antagonist, has been approved for persistent insomnia disorder (ID), but specific insights on patients with SUDs are lacking. Methods. This observational, retrospective study investigated the effects of a three-month treatment with daridorexant (50 mg/day) in 41 outpatients with comorbid IDs and SUDs. Improvement in subjective sleep measures, assessed with the Insomnia Severity Index (ISI) and subjective total sleep time, was the primary outcome measure. Changes in anxiety and depression symptoms, quality of life, clinical global severity, and craving were also investigated through the following: Hamilton Anxiety and Depression Rating Scale; Five-item World Health Organization Well-Being Index; Clinical Global Impression Severity Scale; Visual Analog Scale for Craving. Results. All sleep outcomes significantly improved throughout treatment, which was generally safe and well tolerated, with mild and transient drowsiness and sluggishness reported in 21.1% of patients. Similar improvements were observed in psychopathology, quality of life, and craving, and positive correlations were found among ISI scores and anxiety/depression symptoms and craving. An abstinence rate (i.e., absence of any substance use, regardless of the amount, throughout treatment) of 65.8% was also detected at the endpoint. Conclusions. These preliminary findings suggest that daridorexant might represent a promising tool for treating insomnia in patients with SUDs. Identifying interventions effectively targeting insomnia with a good safety/tolerability profile in SUDs is crucial to achieve remission and full functional recovery. Full article

Background/Objectives: Tendinopathy is the preferred term to describe various tendon pathologies, including paratendinitis, tendinitis, and tendinosis, in the absence of histopathological evidence in biopsy specimens. The management of tendinopathies is challenging; rest, physiotherapy (such as eccentric training), injections, shock waves, orthotics, medical therapy, and surgery are the main therapeutic options offered to the patient. The conservative treatment of tendinopathies is still difficult, but several options have been proposed, including the use of anti-inflammatory molecules. In this retrospective study, we aimed to assess the efficacy of a conservative approach in improving pain and functional improvement in hip bursitis (HB) and biceps tendinitis (BT) patients. Methods: A series of data concerning the application of Polynucleotides High Purification Technology (PN HPT^TM) in 47 patients with BT and HB was analyzed. All patients received three bi-weekly injections of PN HPT^TM (T0–T2). Follow-up visits were performed at T3 (8 weeks from T2) and T4 (24 weeks from T2). Both the visual analog scale (VAS) for pain assessment and functional impairment (FI) scores were processed in the form of anonymized series for clinical improvement evaluations. Results: Statistically significant differences (p < 0.001) in pain reduction (−85%) and functional improvement (+86%) were found at the end of treatment. The levels of patient satisfaction (PS) and Clinical Global Improvement—Impression (CGI-I) were equal to 93% and 98%, respectively. According to the analyses, other patient data (e.g., gender, age, and BMI) did not appear to influence the positive treatment outcomes. Conclusions: The application of High Purification Technology (PN HPT^TM) was shown to improve both pain and functional deterioration in patients with tendonitis in a similar manner to other conservative treatments. These retrospective analyses may open up new avenues for the implementation of conservative approaches in patients with tendinitis. Full article

Advances in non-invasive neuromodulation (NM) have enabled practitioners to modulate neural activity safely, offering a promising approach to treating neuropsychiatric and neurological conditions. This study aimed to analyze the training profiles of NM practitioners and assess their perceptions of NM’s clinical efficacy, safety, and patient satisfaction. An online survey was conducted among 117 practitioners in various healthcare fields, using the Clinical Global Impression (CGI) scale to gauge outcomes. The findings indicate that 99.13% of practitioners perceive NM as effective, with high rates of patient improvement in quality of life and symptom management. The study underscores the importance of standardized NM training protocols to enhance therapeutic outcomes. Full article

Background and Objectives: Growing evidence suggested that abnormal lipid metabolism (ALM) was associated with an increased severity of depressive symptoms, but no previous studies have examined the differences in comorbid ALM in major depressive disorder (MDD) patients of different ages of onset. We aim to compare the differences in the prevalence and clinical correlates of ALM between early-onset and late-onset patients with first-episode and drug-naive (FEDN) MDD patients. Methods: Using a cross-sectional design, we recruited a total of 1718 FEDN MDD outpatients in this study. We used the 17-item Hamilton Rating Scale for Depression (HAMD-17), The Hamilton Anxiety Rating Scale (HAMA), the Positive and Negative Syndrome Scale (PANSS) positive subscale, and Clinical Global Impression-Severity Scale (CGI-S) to assess their depression, anxiety, and psychotic symptoms and clinical severity, respectively. Results: There were 349 patients (20.3%) in the early-onset subgroup and 1369 (79.7%) in the late-onset subgroup. In this study, 65.1% (1188/1718) of patients were diagnosed with ALM. The prevalence of ALM in the late-onset group (81.5%, 1116/1369) was significantly higher than that in the early-onset group (20.6%, 72/349) (p = 0.36, OR = 1.147, 95%CI = 0.855–1.537). The HAMD total score (OR = 1.34, 95% CI = 1.18–1.53, p < 0.001) was the only risk factor for ALM in early-onset MDD patients. In late-onset MDD patients, the HAMD total score (OR = 1.19, 95% CI = 1.11–1.28, p < 0.001), TSH (OR = 1.25, 95% CI = 1.16–1.36, p < 0.001), CGI (OR = 1.7, 95% CI = 1.31–2.19, p < 0.001), and anxiety (OR = 2.22, 95% CI = 1.23–4.02, p = 0.008) were risk factors for ALM. Conclusion and Scientific Significance: Our results suggest that there are significant differences in the prevalence and clinical factors of comorbid ALM between early-onset and late-onset FEND MDD patients. Full article