Nearly half of older adults with major depression have treatment-resistant late-life depression (TRLLD). A systematic review of randomized controlled trials up to March 2024 found that aripiprazole (based on two studies), venlafaxine, ketamine, and lithium were associated with reduced depressive symptoms after treatment. Among non-pharmacological approaches, repetitive transcranial magnetic stimulation, sequential bilateral theta burst stimulation, and cognitive remediation also showed significant improvements. However, the quality of evidence ranged from very low to medium, and most studies had small sample sizes. Aripiprazole augmentation appears effective with an acceptable side effect profile, but other treatments lack strong evidence. Large-scale trials are needed for firm conclusions.
Fixed, false beliefs called delusions are a core feature of psychotic disorders, but why they remain fixed is not well understood. This review proposes a clearer vocabulary for describing delusion fixity—using the terms conviction, incorrigibility, persistence, and stability—and examines factors from diagnosis, psychopathology, psychodynamics, social context, cognition, metacognition, and cognitive neuroscience that may influence fixity. The authors present a working model of delusion fixity and call for interdisciplinary longitudinal studies to better understand it and to improve therapeutic strategies.
People with Alzheimer's disease show a range of changes in consciousness, including reduced awareness of cognitive deficits, diminished self-awareness, and impaired introspection, which appear early and worsen as the disease progresses. These awareness impairments are linked to brain damage in areas that overlap with proposed neural correlates of consciousness. The authors argue that recognizing Alzheimer's disease as a disorder of consciousness is overdue and important for understanding patients' lived experience and improving care.