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Decision making (DM) is a component of executive functioning, essential for choosing appropriate decisions. Executive dysfunctioning is particularly common in late-life depression, however the literature is scarce on DM. This case-control study aimed to evaluate the DM profile and performance in participants with and without unipolar major depression. The DM profile and performance were assessed by the Melbourne Decision Making Questionnaire and the Iowa Gambling Task (IGT), respectively, in three groups of older adults from a university-based geriatric psychiatry clinic, i.e. current depression (n = 30), remitted depression (n = 43) and healthy controls (n = 59). The Hamilton Depression scale (HAM-D) 21 items, the Hamilton Anxiety scale, and the Mini-Mental State Examination were used to access depressive symptoms, anxiety symptoms, and cognitive impairment, respectively. Multinomial, nominal and binary logistic regression was used to evaluate the associations between depression, depressive symptomatology and DM. In comparison to the control group, patients with current depression presented higher scores in buck-passing and proscratination DM profiles. In the hypervigilance profile, there was a significant difference between current and remitted depression groups. A higher value ​in the HAM-D scale increased the probability of disadvantageous DM profiles. Depressive patients showed a tendency of a higher mean score in both disadvantageous decks (A and B) of IGT. Patients with current depression showed a worse performance compared to the remitted depression group in the IGT netscore. Older adults with current depression showed DM profiles considered maladaptive or disadvantageous compared to both remitted depression and healthy controls groups. [ABSTRACT FROM AUTHOR]

Cocaine intoxication presents a significant public health concern globally, with its use widespread in various regions. This case report outlines the challenging management of a 30-year-old male who presented with acute cocaine intoxication, leading to multiple organ failure and eventual death. The patient exhibited classic symptoms of cocaine intoxication preceding a fall, resulting in severe injuries. Despite aggressive resuscitative measures, the patient deteriorated rapidly, developing rhabdomyolysis, disseminated intravascular coagulation, acute kidney injury, and acute myocardial infarction. Differential diagnoses were considered, ruling out other possible causes. The patient's condition continued to worsen despite treatment, ultimately culminating in cardiac arrest and demise. This case underscores the complexity of managing acute cocaine intoxication and assessing many differential diagnoses, highlighting the importance of early recognition and aggressive intervention to mitigate adverse outcomes. In patients with altered mental status and hemodynamic instability, particularly in areas where drug use is common, cocaine intoxication should be considered as a possible cause., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Rodrigues Alessi et al.)

Major Depressive Disorder (MDD) can occur in parallel with cognitive impairment. The search for a neuropsychological profile of depression has been pursued in the last two decades. However, scant research has been done on executive functions and decision-making ability (DM)., Objective: To perform a systematic review of the evidence of DM performance evaluated using the Iowa Gambling Task (IGT) in adults with MDD., Methods: A systematic search according to the PRISMA statement was performed on MEDLINE for studies in English using the following keywords: 'depression', 'depressive', 'depressive symptoms' AND 'decision making' OR 'game task'., Results: Five articles that met the inclusion and exclusion criteria were identified. Three reported significant differences between depressed and non-depressed individuals. The results indicated that young adults with MDD exhibited lower performance on all or almost all stages of the IGT. One study that evaluated DM in older adults with MDD showed that depressed non-apathetic participants failed to adopt any advantageous strategy and continued to make risky decisions during the task., Conclusion: Results suggest that performance on the DM task by young and old adults with MDD differed in comparison to non-depressed participants. Given the small number of articles, further studies should be performed., Competing Interests: Disclosure: The authors report no conflicts of interest.