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i psihosocijalnih intervencija i metoda kao vid holističkog pristupa u onkološkoj populaciji, a neovisno o stadiju karcinoma ili trenutnoj vrsti postupaka liječenja. Vidljiva potreba za navedenim pokazala se i u kliničkoj praksi Klinike za tumore Kliničkog bolničkog centra Sestre milosrdnice u Zagrebu, pri čemu je kreiran program vježbi dubokog disanja, tehnika relaksacije i vođene imaginacije uz glazbu za hospitalizirane onkološke pacijente u predoperativnom razdoblju abdominalnih kirurških zahvata ili operacija karcinoma dojke te tijekom primjene radioterapije. Osim postizanja relaksacije i usvajanja metoda stress managementa, cilj je bio utjecati na što povoljniji tijek postoperativnog razdoblja. U trajanju od 8 mjeseci program je obuhvatio 315 pacijenata, a zbog mogućnosti opetovanih dolazaka -ukupno 478 sudjelovanja. Subjektivni dojam sudionika polaznika navedenih programa pokazao se pozitivnim, s tendencijama ka primjenjivanju usvojenih tehnika i nakon hospitalizacije. KLJUČNE RIJEČI: vježbe dubokog disanja, tehnike relaksacije, vođena imaginacija uz glazbu, karcinom, kirurški zahvat, radioterapija, psihosocijalna onkologija

AimTo evaluate the relationship between the dynamics of proton magnetic resonance spectroscopy (1H-MRS) brain metabolite levels at the beginning of the recovery phase of the index depressive episode and the time to the recurrence of depression.MethodsThis retrospective cohort study analyzed the changes in N-acetyl aspartate (NAA), choline (Cho), and glutamate-glutamine in 48 patients with recurrent depression treated with maintenance antidepressant monotherapy at a stable dose. 1H-MRS was performed at the start of the recovery phase and 6 months later. 1H-MRS parameters, index episode descriptors, and depressive disorder course were analyzed by Cox proportional hazards model.ResultsNAA and Cho decrease six months after the beginning of the recovery period were time-independent risk factors for depressive episode recurrence. Hazard ratio associated with NAA decrease was 2.02 (95% confidence interval 1.06-3.84) and that associated with Cho decrease was 2.06 (95% confidence interval 1.02-4.17). These changes were not related to symptoms severity, as Montgomery-Asberg Depression Scale score remained generally unchanged (mean -0.01; standard deviation 1.6) over the first 6 months of recovery.ConclusionPatients receiving maintenance antidepressant therapy after recovery who experience a decrease in NAA or Cho levels early in the recovery phase have a double risk of depressive episode recurrence. Sustained NAA and Cho levels at the beginning of the recovery phase may indicate increased brain resilience conferred by antidepressant therapy, while NAA and Cho decrease may indicate only the trait-related temporal effect of therapy in another stratum of patients.

Rationale Depression, with variable longitudinal patterns, recurs in one third of patients. We lack useful predictors of its course/ outcome, and proton magnetic resonance spectroscopy (1H-MRS) of brain metabolites is an underused research modality in finding outcome correlates. Objectives To determine if brain metabolite levels/changes in the amygdala region observed early in the recovery phase indicate depression recurrence risk in patients receiving maintenance therapy. Methods Forty-eight patients on stable-dose antidepressant (AD) maintenance therapy were analyzed from recovery onset until (i) recurrence of depression or (ii) start of AD discontinuation. Two 1H-MRS scans (6 months apart) were performed with a focus on amygdala at the beginning of recovery. N-acetylaspartate (NAA), choline-containing metabolites (Cho), and Glx (glutamine/ glutamate and GABA) were evaluated with regard to time without recurrence, and risks were assessed by Cox proportional hazard modeling. Results Twenty patients had depression recurrence, and 23 patients reached AD discontinuation. General linear model repeated measures analysis displayed three-way interaction of measurement time, metabolite level, and recurrence on maintenance therapy, in a multivariate test, Wilks' lambda = 0.857, F(2,40) = 3.348, p = 0.045. Cho levels at the beginning of recovery and subsequent changes convey the highest risk for earlier recurrence. Patients experiencing higher amygdala Cho after recovery are at a significantly lower risk for depression recurrence (hazard ratio = 0.32; 95% confidence interval 0.13-0.77). Conclusion Cho levels/changes in the amygdala early in the recovery phase correlate with clinical outcome. In the absence of major NAA fluctuations, changes in Cho and Glx may suggest a shift towards reduction in (previously increased) glutamatergic neurotransmission. Investigation of a larger sample with greater sampling frequency is needed to confirm the possible predictive role of metabolite changes in the amygdala region early in the recovery phase.