Mechanisms Underlying Treatment-Resistant Depression: Exploring Sex-Based Biological Differences

Treatment-resistant depression (TRD) represents a severe and complex subtype of major depressive disorder (MDD), affecting approximately 30% of patients who fail to respond adequately to multiple standard antidepressant therapies. While the pathophysiology of TRD remains incompletely understood, emerging evidence suggests that sex-based biological differences might influence its onset, progression, and treatment response. Women are disproportionately affected by depression and are more likely to experience residual symptoms and treatment resistance, potentially due to hormonal fluctuations, immune system differences, and variations in brain circuitry and neuroplasticity. This narrative explores the current literature on the mechanisms underlying TRD, with a particular emphasis on sex-specific biological factors. Key focus areas include dysregulation in neurotransmitters and neurotrophic pathways, inflammation, HPA axis alterations, mitochondrial dysfunction, as well as the influence of sex hormones such as estrogen and progesterone. By highlighting these differences, this review underscores the importance of personalized, sex-informed approaches in the prevention and treatment of TRD and calls for further research to elucidate the biological underpinnings that contribute to sex disparities in treatment outcomes

Fog cloud in front of the Lewy bodies dementia: delirium

Lewy body dementia (LBD) is the second most common form of dementia after Alzheimer disease. Clinical symptoms include acute onset of cognitive fluctuations accompanied by dementia, visual hallucinations, disorientation and sleep disorders that suggest initially the diagnosis of delirium. Antipsychotic medication for the treatment of delirium worsens the symptoms due to neuroleptic sensitivity associated with increased morbidity and mortality patients with LBD. In literature, there are rare case reports with overlooked LBD that presented like delirium symptoms. Additionally, it was declared that quetiapine and cholinesterase inhibitors have individually efficacy on treatment of LBD. In this case, we present a woman who had difficulty for diagnosis due to misdiagnosis of LCD and treatment with quetiapine and rivastigmine

A weighted additive fuzzy programming approach for multi-criteria supplier selection

In supply chain management, to build strategic and strong relationships, firms should select best suppliers by applying appropriate method and selection criteria. In this paper, to handle ambiguity and fuzziness in supplier selection problem effectively, a new weighted additive fuzzy programming approach is developed. Firstly, linguistic values expressed as trapezoidal fuzzy numbers are used to assess the weights of the factors. By applying the distances of each factor between Fuzzy Positive Ideal Rating and Fuzzy Negative Ideal Rating, weights are obtained. Then applying suppliers' constraints, goals and weights of the factors, a fuzzy multi-objective linear model is developed to overcome the selection problem and assign optimum order quantities to each supplier. The proposed model is explained by a numerical example. (c) 2010 Elsevier Ltd. All rights reserved

Visual Hallucinations in an Old Patient after Cataract Surgery and Treatment

Sensory visual pathologies, accompanying simple or complex visual hallucinations that occur in visually-impaired individuals due to ophthalmologic or brain pathologies related to visual pathways in patients without mental disorders, are defined as Charles Bonnet syndrome. Between 10% and 60% of the patients having age-related eye diseases involving retina, cornea and the lens, commonly with macular degeneration experience complex visual hallucinations depending on the severity of visual problems. The neurophysiology of the visual hallucinations in Charles Bonnet Syndrome is not clearly known, and they may differ in content and severity over time. In differential diagnoses of Charles Bonnet Syndrome, many aetiologies (drugs, uraemia, exposure to toxic materials, neurodegenerative and psychiatric conditions) need to be ruled out. In the treatment of Charles Bonnet syndrome, first the management of the reason of visual loss should be clarified if possible. If needed, neuroleptics, anticonvulsants, antidepressants, benzodiazepines, cognitive enhancer agents such as cholinesterase inhibitors can be used also. In this case, an 83-year-old female patient experiencing visual hallucinations as burning candles in both eyes’ visual field after left eye cataract surgery, treated with 0.5 milligram/day risperidone will be presented

An integrated fuzzy-lp approach for a supplier selection problem in supply chain management

In supply chain management process, the firm select best supplier takes the competitive advantage to other companies. Thus, supplier selection is an important issue and with the multiple criteria decision-making approach, the supplier selection problem includes both tangible and intangible factors. This paper is aimed to present an integrated fuzzy and linear programming approach to the problem. Firstly, linguistic values expressed in trapezoidal fuzzy numbers are applied to assess weights and ratings of supplier selection criteria. Then a hierarchy multiple model based on fuzzy set theory is expressed and fuzzy positive and negative ideal solutions are used to find each supplier's closeness coefficient. Finally, a linear programming model based on the coefficients of suppliers, buyer's budgeting, suppliers' quality and capacity constraints is developed and order quantities assigned to each supplier according to the linear programming model. The integrated model is illustrated by an example in a textile firm. (C) 2008 Elsevier Ltd. All rights reserved

Short-term and temporary smoking associated with manic episode: case report

The high rate of smoking in psychiatric patients is a common condition. In patients with bipolar disorder high rates of smoking have been frequently reported. High rates of smoking habit are believed to be associated with many factors in patients with bipolar affective disorder. In this case report, an inpatient male patient who started smoking a few days before existence of manic episode, and decreasing of the numbers of smoked cigarettes day by day with the alleviation of manic symptoms, and quitted to smoke with disappearance of manic symptoms, and some suggested treatment strategies will be discussed over the relationship between the use of nicotine and bipolar disorder