Gerhard Heinze

Th2 cytokine response in Major Depressive Disorder patients before treatment

In Major Depressive Disorder (MDD), the neuroendocrine and immune systems interactions are impaired. We investigated the pro/anti-inflammatory Th1/Th2 cytokine balance in MDD patients and in non-depressed control group. The MDD subjects showed higher levels of cortisol and TNF-alpha, increased CD3+CD8+ and NK percentages, diminished B cell counts and no significant variations in CD3+CD4+ lymphocyte. Moreover, higher levels of IL-4 and IL-13 (Th2) and significantly lower measurements of IL-2 and IFN-gamma (Th1) cytokines were also observed in the MDD group. Overall, we propose that all these changes could be related to the elevated cortisol levels seen in the MDD patients. Further studies are necessary to explore these findings and its implication in future therapeutic approach of MDD patients.

Melatonin attenuates antipsychotic metabolic effects: an eight-week randomized, double-blind, parallel-group, placebo-controlled clinical trial.

Second‐generation antipsychotics (SGAs) are among the first‐line treatments for bipolar disorder and schizophrenia, but have a tendency to generate metabolic disturbances. These features resemble a metabolic syndrome for which a central autonomic imbalance has been proposed that may originate from the hypothalamic suprachiasmatic nuclei. In a clinical trial, we hypothesized that melatonin, a hormone that regulates the suprachiasmatic nucleus, could attenuate SGA‐induced adverse metabolic effects.

The association between chronotype and perceived academic stress to depression in medical students.

ABSTRACT Depression is a multifactorial illness that is highly prevalent among medical students (MS). Chronotypes, which reflect circadian preference in humans, as well as academic stress have been associated with depression in different populations. However, it is not known how chronotype and stress might alone or in combination, associate with depression in MS. Thus, we aimed to evaluate the association between stress, chronotype and depression in MS. In a cross-sectional study, we evaluated a total of 1068 medical students from a public Medical School in Mexico City. The Patient Health Questionnaire-9 (PHQ-9) was used to evaluate depressive symptom severity and the presence of a current depressive episode with a cutoff score of 10 or higher. The Morning-Evening Questionnaire (MEQ) was used to establish chronotype and the Academic Stress Inventory was used to measure perceived academic stress (PAS). We observed that depressive symptom severity was higher in non-morning chronotypes and moderate/severe PAS groups. A factorial ANOVA showed an association between PAS groups and depressive symptom severity. Linear regression showed an association between depressive symptom severity and variables such as PAS scores (p = 0.001), family history of depression (p = 0.001), gender (p = 0.001) and academic year (p = 0.029). Logistic regression analysis showed that evening chronotype (OR: 2.3, 95% CI: 1.2–4.3, p = 0.01) and severe PAS (OR: 4.4, 95% CI: 2.8–7.0, p = 0.0001) were associated with depression. Further, MS with the combination of severe PAS and morning (OR: 5.9, 95% CI: 1.6–22.2, p = 0.01), intermediate (OR: 7.5, 95% CI: 2.3–24.4, p = 0.001) or evening (OR: 10.6, 95% CI: 2.8–40.0, p = 0.001) chronotypes showed a greater association with depression than any PAS or chronotype group alone. Being female, perceiving restricted or limited economic resources, having severe scores of academic stress, and evening chronotype were associated with an increased probability to suffer a current depressive episode. Collectively, these results show that chronotype and PAS are factors associated with depression in MS, and when combined promote this association. Our results might aid in early identification of MS susceptible to depression. Future research could focus on the implementation of simple, low cost preventive strategies, such as chronotype-oriented academic schedules.

Gonadal hormone levels and platelet tryptophan and serotonin concentrations in perimenopausal women with or without depressive symptoms.

Abstract Introduction: The etiology of depressive symptoms associated with the transition to menopause is still unknown; hormonal changes, serotonergic system or insomnia, could be a trigger to depressive symptomatology. The aim of the present study was to evaluate gonadal hormonal levels, platelet serotonin concentrations and platelet tryptophan concentrations in a group of depressed perimenopausal women and their healthy counterparts. Methods: A total of 63 perimenopausal women between 45 and 55 years old were evaluated; of these, 44 were depressed patients, and 19 were perimenopausal women without depression. The instruments that were applied included the Center for Epidemiologic Studies Depression Scale (CES-D), the Hamilton Depression Rating Scale (HDRS) and the Green Climacteric Scale (GCS); gonadal hormone levels and platelet tryptophan and serotonin concentrations were measured in all participants. Differences in hormonal levels and tryptophan and serotonin concentrations were evaluated with respect to specific symptoms, such as insomnia, hot flashes, nervousness, depressed mood and loss of interest. Results: No differences between groups were observed with respect to hormonal levels and tryptophan and serotonin concentrations; mean sleep hours and insomnia were significantly correlated with platelet tryptophan concentrations. Conclusions: In this sample, all symptoms of depression could not be explained by platelet tryptophan and serotonin concentrations and hormonal levels; differences were observed only when we evaluated insomnia and hot flashes.

The INTERPRET-DD study of diabetes and depression: a protocol.

People with diabetes are at an increased risk of developing depression and other psychological disorders. However, little is known about the prevalence, correlates or care pathways in countries other than the UK and the USA. A new study, the International Prevalence and Treatment of Diabetes and Depression Study (INTERPRET–DD) aims to address this dearth of knowledge and identify optimal pathways to care across the globe.

Estudio comparativo sobre depresión y los factores asociados en alumnos del primer año de la Facultad de Medicina y del Internado

SUMMARY The prevalence of depression in Medical Students (MS) is higher than in the general population and changes with time. It is not known whether the prevalence of depression is higher and the associated factors different between students that initiate the last and first academic years in Medical School.

Los especialistas en psiquiatría en México: año 2016

Introduction. In 2011 we had 3823 psychiatrists in Mexico, with an estimated rate of 3.4 per 100 000 inhabitants. In order to achieve the global targets of mental health attention, it is important to update this information. Objetive. To estimate the total number of psychiatrists in Mexico in 2016; detemine their geographic distribution and compare the results with the ones obtained in 2011. Method. Longitudinal and comparative study. Diverse sources of information were consulted in order to update the number of psychiatrists in 2016 and to know their sociodemographic characteristics, that were compared with the ones obtained in 2011. Results. 4 393 psychiatrists practiced their specialty in Mexico in 2016. With a population of 119 530 753 inhabitants, we obtained a rate of 3.68 psychiatrists per 100 000 inhabitants. There´s a poor distribution of theese specialists in the country. Around 60% of all psychiatrists practice in the tree major cities of Mexico. Discussion and conclusion. The national rate of psychiatrists increase in comparisson with the one we found in 2011, it remains lower that the one recommended by the World Health Organization (WHO). Geographic distribution of the psychiatrists is inequitative because of centralization and economic factors. Key words: Mexico, psychiatrists, distribution, board certification.

Public policies on the use of drugs in Mexico and Latin America

Recently, there has been a more profound political debate in Latin American countries around the possibilities of legal regulation and decriminalization of currently controlled drugs, particularly cannabis. This debate is a complex one that deals with a growing drug trade towards North America and Europe, as well as oversaturated judicial and health systems across Latin America. Mexicos role in the production and/or distribution of controlled drugs has been recognized for many years, but only recently has Mexico’s own problematic use of drugs, especially in the cities of the northern and southern borders, been raised as an issue. Drug policy in Mexico has a long history, which can only be understood in its political and economic contexts and its relations with the United States. Mexican drug policy is stipulated in several legal documents such as the Constitution, the General Health Law and specific Official Mexican Standards, amongst others. In these documents possession, use and sale of drugs are considered illegal, but in case of some drugs like cannabis, cocaine, opium, heroin, MDA, MDMA, Meth (crystal), and LSD, the maximum amount that an individual may possess for personal use is stipulated. Currently, there are controversies in Mexico regarding exempting the use of certain drugs (especially cannabis) for medical indications as well as increasing the maximum amounts under which possession is deemed for personal use whilst reducing the penalty in case of personal use in small doses.

Olanzapine-induced Early Cardiovascular Effects are Mediated by the Biological Clock and Prevented by Melatonin

Second generation antipsychotics (SGA) are associated with adverse cardiometabolic side effects contributing to premature mortality in patients. While mechanisms mediating these cardiometabolic side effects remain poorly understood, three independent studies recently demonstrated that melatonin was protective against cardiometabolic risk in SGA‐treated patients. As one of the main target areas of circulating melatonin in the brain is the suprachiasmatic nucleus (SCN), we hypothesized that the SCN is involved in SGA‐induced early cardiovascular effects in Wistar rats. We evaluated the acute effects of olanzapine and melatonin in the biological clock, paraventricular nucleus and autonomic nervous system using immunohistochemistry, invasive cardiovascular measurements, and Western blot. Olanzapine induced c‐Fos immunoreactivity in the SCN followed by the paraventricular nucleus and dorsal motor nucleus of the vagus indicating a potent induction of parasympathetic tone. The involvement of a SCN‐parasympathetic neuronal pathway after olanzapine administration was further documented using cholera toxin‐B retrograde tracing and vasoactive intestinal peptide immunohistochemistry. Olanzapine‐induced decrease in blood pressure and heart rate confirmed this. Melatonin abolished olanzapine‐induced SCN c‐Fos immunoreactivity, including the parasympathetic pathway and cardiovascular effects while brain areas associated with olanzapine beneficial effects including the striatum, ventral tegmental area, and nucleus accumbens remained activated. In the SCN, olanzapine phosphorylated the GSK‐3β, a regulator of clock activity, which melatonin prevented. Bilateral lesions of the SCN prevented the effects of olanzapine on parasympathetic activity. Collectively, results demonstrate the SCN as a key region mediating the early effects of olanzapine on cardiovascular function and show melatonin has opposing and potentially protective effects warranting additional investigation.

The Affective and Emotional Composite Temperament Scale (AFECTS): Psychometric properties of the Spanish version in a community sample from Mexico City and comparison between remitted psychiatric patients

INTRODUCTION AFECTS is a novel psychometric instrument that provides an integrated framework based on affective temperamental traits and their trait dimensions. It has the potential to be used in clinical and research fields to study psychopathology and mental health. It is now necessary to field-test this instrument with diverse populations and psychopathological entities. OBJECTIVE The primary aim was to test the construct validity and the internal consistency of the Spanish Version of the AFECTS instrument on Mexican subjects. AFECTS characteristics were then compared between general population and stable psychiatric patients. METHODS A cross-sectional design involving 350 subjects from the general population in México City and 91 stable patients with a bipolar disorder (BPD, n=20), major depressive disorder (MDD, n=35), or with a schizophrenia (n=36) diagnosis. RESULTS A six-factor structure in trait dimensions, explaining 61.4% of the variance, with a Cronbach׳s alpha of 0.93 was found. Euthymic (23%) and hyperthymic (12%) affective temperaments were the most frequent, while dysphoric (3%) and apathetic (3%) were the least. Trait dimension differences were found in Volition, Sensitivity, and the Instability Index between the groups, particularly those with a bipolar disorder. LIMITATIONS Use of a self report instrument, and a small sample not representative of the Mexican population or patients with psychiatric conditions. CONCLUSIONS The Spanish Version of the AFECTS instrument has adequate psychometric properties. This version of AFECTS will allow the use of this instrument among Spanish speaking populations and contribute to the continued research efforts on integrative models such as AFECT.