Agata Szulc

Effect of antidepressant treatment on peripheral inflammation markers – A meta-analysis

INTRODUCTION Major Depressive Disorder (MDD) in accordance to the inflammatory concept is associated with complex immunological disturbances in the central nervous system (CNS). This is reflected by elevated plasma levels of inflammatory cytokines in depressed subjects. Although numerous studies report significant influence of antidepressants on pro-inflammatory/anti-inflammatory cytokines balance, the available data is often inconsistent regarding specific cytokines and drugs used. We aimed to perform a comprehensive meta-analysis of the effect of antidepressant treatment on a wide array of cytokines. METHODS We performed a systematic search of 6 databases, which yielded 32 studies measuring the levels of selected cytokines before and at a second time-point during antidepressant treatment. For meta-analysis of selected studies with a continuous measure we analysed variables containing the number of cases, mean and standard deviation of the level of IL-1ß, IL-2, IL-5, IL-6, IL-8, IL-10, CRP, TNF-α, IFN-γ levels observed in the different studies, in the intervention groups before and after antidepressant treatment. RESULTS Statistical analysis revealed significant decreases of IL-4, IL-6, and IL-10 in MDD subjects after antidepressant treatment. In case of IL-1ß the decrease was significant exclusively for SSRI drugs. We did not find any significant effect of antidepressant medication on IL-2, TNF-α IFN-γ and CRP. CONCLUSIONS Antidepressant treatment affects the levels of cytokines in depression. The immunological imbalance in MDD is complex and seems to be mediated by other factors yet to be elucidated. The credibility of our results is limited by high heterogeneity among studies and very few studies with a placebo-controlled design. Research with MDD subtypes, response to treatment status and cytokine associations with the kynurenine pathway taken into account pose a promising target for future studies.

Effects of Antipsychotic Administration on Brain Glutamate in Schizophrenia: A Systematic Review of Longitudinal 1H-MRS Studies

Schizophrenia is associated with brain glutamate dysfunction, but it is currently unclear whether antipsychotic administration can reduce the extent of glutamatergic abnormality. We conducted a systematic review of proton magnetic resonance spectroscopy (1H-MRS) studies examining the effects of antipsychotic treatment on brain glutamate levels in schizophrenia. The Medline database was searched to identify relevant articles published until December 2016. Inclusion required that studies examined longitudinal changes in brain glutamate metabolites in patients with schizophrenia before and after initiation of first antipsychotic treatment or a switch in antipsychotic treatment. The searches identified eight eligible articles, with baseline and follow-up measures in a total of 168 patients. The majority of articles reported a numerical reduction in brain glutamate metabolites with antipsychotic treatment, and the estimated overall mean reduction of 6.5% in Glx (the combined signal from glutamate and glutamine) across brain regions. Significant reductions in glutamate metabolites in at least one brain region were reported in four of the eight studies, and none of the studies reported a significant glutamatergic increase after antipsychotic administration. Relationships between the degree of change in glutamate and the degree of improvement in symptoms have been inconsistent but may provide limited evidence that antipsychotic response may be associated with lower glutamate levels before treatment and a greater extent of glutamatergic reduction during treatment. Further longitudinal, prospective studies of glutamate and antipsychotic response are required to confirm these findings.

Cognitive impairment in schizophrenia across age groups: a case–control study

BackgroundThe potential dynamics of cognitive impairment in schizophrenia is discussed in the literature of the field. Recent publications suggest modest changes in level of cognitive impairment after first psychotic episode. Present article attempts to explore cognitive differences between patients and controls across age groups and differences between age groups in clinical group.MethodsOne hundred and twenty-eight hospitalized patients with schizophrenia (64 women and 64 men) and 68 individuals from the control group (32 women and 32 men) aged 18–55 years were examined. The patients were divided into age groups (18–25, 26–35, 36–45, 46–55). Both groups were examined using Wisconsin Card Sorting Test, Rey Auditory Verbal Learning Test, Rey Osterrieth Complex Figure Test, Trail Making Test (A and B), Stroop Test, verbal fluency test and Wechsler digit span.ResultsPatients with schizophrenia obtained significantly lower scores versus the control group in regard to all the measured cognitive functions (Mann–Whitney U; p < 0.05. Most deficits were present in all age groups, however, statistically important impairment in executive functions (WCST) were present only in “older” groups.ConclusionsPatients with schizophrenia obtained less favourable results than the control group in all age groups. Deficits regarding executive functions do not seem to be at a significant level among the youngest group, whereas they are more noticeable in the group of 46–55-year-olds. Executive functions are significantly lowered in the group aged 36–45 in comparison to the “younger” groups. The level of cognitive functions shows a mild exacerbation in connection with age, whereas cognitive rigidity proved to be related to the number of years spent without hospital treatment.

The Montreal Cognitive Assessment as a preliminary assessment tool in general psychiatry: Validity of MoCA in psychiatric patients.

OBJECTIVE The aim of the presented research was to obtain the initial data regarding the validity of Montreal Cognitive Assessment (MoCA) in diagnosing cognitive impairment in psychiatrically hospitalized patients. METHOD The results in MoCA obtained from 221 patients were analyzed in terms of proportional participation of patients with particular diagnosis in three result ranges. In 67 patients, additional version of the scale was also used. Comparative analysis of average results in particular diagnostic groups (organically based disorders, disorders due to psychoactive substance use, psychotic disorders, neurotic disorders and personality disorders) was also carried out, as well as an analysis of the scales accuracy as a diagnostic test in detecting organic disorders. RESULTS The reliability of the test measured with between tests correlation coefficient rho=0.92 (P=.000). Significant differences between particular diagnoses groups were detected (J-T=13736; P=.000). The cutoff points of 23 turned out to have a satisfactory sensitivity and specificity (0.82 and 0.70, respectively) in diagnosing organically based disorders. The area below the receiver operating characteristic curve (AUC=0.854; P=.000) suggests that MoCA has a satisfactory value as a classifier. CONCLUSION The initial data suggest MoCAs high value in prediction of future diagnosis of organically based disorders. The initial results obtained in particular group of diagnoses support construct validity of the method.

Long-term changes of salivary exoglycosidases and their applicability as chronic alcohol-drinking and dependence markers

Abstract Objectives: Investigation of long-term dynamic changes of salivary activity/output of exoglycosidases, deglycosylation processes and their applicability as alcohol markers. Methods: Exoglycosidase (α-fucosidase (FUC), β-galactosidase (GAL), β-glucuronidase (GLU), β-hexosaminidase (HEX, HEX A and HEX B isoenzymes) and α-mannosidase (MAN)) activities were measured in the saliva of healthy social drinking controls (C), alcohol-dependent non-smokers (ANS) and alcohol-dependent smokers (AS) at the 1st, 15th, 30th and 50th day of abstinence after chronic alcohol drinking. Results: The activity of exoglycosidases was 2–3-fold (MAN), 2–6 fold (FUC), 8–25-fold (HEX A) and 19–40-fold (GLU) higher in the ANS and AS groups than in controls, and had good/excellent sensitivity, specificity and accuracy. The higher outputs of exoglycosidases were in the AS and ANS groups than in controls at the 1st day (GLU, HEX A) and at the 50th day (GLU, FUC, MAN) of abstinence. We found numerous correlations between alcohol-drinking days with GLU and HEX A, alcohol amounts with HEX A and duration of alcohol dependence with FUC and MAN activity/output. Conclusions: Salivary exoglycosidases/deglycosylation processes were still very high up to 50 days after the end of alcohol consumption. We found markers of chronic alcohol consumption (HEX A), alcohol dependence (FUC and MAN) and chronic alcohol consumption and dependence (GLU).

Differences in Assessment of Suicidal Tendencies in Men and Women: A Pilot Study

Suicidal behaviors in psychiatric patients are one of the main challenges in current clinical practice. The aim of this study was to investigate the gender differences in suicide risk for psychiatric patients in Poland and the influence of life satisfaction in different stages of life on suicidal tendencies. A descriptive-exploratory approach to inquiry was used for this study. Sixty patients aged 16-67 (45% males and 55% females) answered the demographic-descriptive questionnaire, the Suicide Behaviors Questionnaire-Revised (SBQ-R) and the Cantril Self-Anchoring Striving Scale (CSASS). The results suggest that women turned out to show higher risk of suicidal behavior than men (p<0.001). Moreover, women displayed strong negative correlation between suicide risk and the anticipated life satisfaction in the future (rho=-0.542), while men displayed negative correlation between suicide risk and the pre-illness level of functioning (rho=-0.638). The findings suggest that different therapeutic approaches for each gender should be applied in suicide prevention process.

“Immune Gate” of Psychopathology—The Role of Gut Derived Immune Activation in Major Psychiatric Disorders

Interaction between the gastrointestinal tract (GI) and brain functions has recently become a topic of growing interest in psychiatric research. These multidirectional interactions take place in the so-called gut-brain axis or more precisely, the microbiota-gut-brain axis. The GI tract is the largest immune organ in the human body and is also the largest surface of contact with the external environment. Its functions and permeability are highly influenced by psychological stress, which are often a precipitating factor in the first episode, reoccurrence and/or deterioration of symptoms of psychiatric disorders. In recent literature there is growing evidence that increased intestinal permeability with subsequent immune activation has a major role in the pathophysiology of various psychiatric disorders. Numerous parameters measured in this context seem to be aftermaths of those mechanisms, yet at the same time they may be contributing factors for immune mediated psychopathology. For example, immune activation related to gut-derived bacterial lipopolysaccharides (LPS) or various food antigens and exorphins were reported in major depression, schizophrenia, bipolar disorder, alcoholism and autism. In this review the authors will summarize the evidence and roles of such parameters and their assessment in major psychiatric disorders.

Salivary immune proteins monitoring can help detection of binge and chronic alcohol drinkers: Preliminary findings

BACKGROUND We compared effects of binge and chronic alcohol drinking on oral health and salivary immunity proteins. METHODS The study involved males: 13 healthy social-drinking (C), 10 alcohol-dependent after chronic alcohol-intoxication (A), and 8 binge-drinkers after a single binge-drinking session (B). We compared periodontal/dental state and salivary immune proteins (lactoferrin -Lf, lysozyme -Lz, oral peroxidase -OPO, immunoglobulin A -IgA) in all groups. RESULTS Group A had worse dental and periodontal states than group C and B. Group B had a lower OPO activity and Lz concentration, and a higher IgA concentration in comparison to group C. Group A had a higher OPO activity than group C. Group B had a lower Lz and a higher LF and IgA outputs than C. Group A had a lower IgA output and a strong tendency of Lf and Lz outputs to be lower than in group C. Positive correlations were found between alcohol amounts and OPO and Lf output in group A, with no such correlations in group B. Only IgA concentration in group B and OPO activity in group A have potential to be markers that help to differentiate binge from chronic alcohol drinking, and OPO activity had better accuracy than IgA. CONCLUSION Binge alcohol consumption resulted in specific disturbances in salivary innate immunity (Lz), whereas chronic drinking led to disturbances in both adaptive and innate immunity (IgA, Lz and Lf). There is potential applicability of raised salivary IgA concentration and especially OPO activity in binge and chronic drinking detection and differential-diagnosis.

An Introduction to the Model of Crisis Intervention Procedure for Borderline Patients (CIP-BP): A Case Study

ABSTRACT Borderline personality disorder is highly associated with suicidal behaviors. The authors of the current case study present the introduction model of original Crisis Intervention Procedure for Borderline Patients (CIP‐BP) which is a method focused on restoring emotional balance, reducing the severity of symptoms and the risk of suicidal behavior, as well as developing optimum solutions for further action. Its aim is to enable the patient to regain control of their emotional memory, increase autonomy and restore important interpersonal relations by using the original resources of this person. The procedure aims at providing nursing personnel with a practical tool to effectively avert the crisis and prevent further decompensation of BPD patients. Further pre‐post study is required to determine the effectiveness of the procedure. HIGHLIGHTSPatients with borderline personality disorder are at high risk of suicide death due to severe experiencing of crises.Preventing suicidal behaviors in borderline personality disorder patients is a difficult challenge for nursing personnel.A practical tool for nurses is required to effectively avert the crises of borderline personality patients.

The differences in level of trait anxiety among girls and boys aged 13–17 years with myopia and emmetropia

BackgroundA significant increase in myopia among children and teenagers can be observed all over the world. Yet at the same time, there is still an insignificant number of studies concerning this health problem.The aim of this study was to assess the level of trait anxiety among myopic group of teenagers in comparison to teenagers with emmetropia, and to confirm whether the level of trait anxiety relates to age and gender.MethodsTwo hundred thirty-nine students aged 13–17 years were included in the study. The study group comprised 114 persons with myopia (81 girls and 33 boys), while the control group comprised 125 persons without refractive error (79 girls and 46 boys). Volunteers completed a set of questionnaires including: personal data, State-Trait Anxiety Inventory for Children (STAIC) (13–14 year-olds), or State-Trait Anxiety Inventory (STAI) (15–17 year-olds). The trait anxiety subscales were thus analyzed.ResultsAmong younger adolescents (13–14 years of age) with myopia there was a significantly higher incidence of pathological intensification of anxiety as a constant trait. After taking into account the distribution of gender, there was a higher level of trait anxiety in the group of boys with myopia than in the control group aged 13–17 years and 13–14 years. There was also a higher level of trait anxiety detected in males than in females.ConclusionsMyopia may affect the level of trait anxiety among 13–14-year-olds. In both age groups of girls, a higher percentage of patients with high level of anxiety was discovered (≥7 sten), as compared to their peers without vision defects. Our results can contribute to a more accurate analysis of young teenagers’ psychological problems, especially among boys diagnosed with myopia.