Riccardo N. Caniato

A psychoneuroimmunological review on cytokines involved in antidepressant treatment response

The literature exploring the role that cytokine functioning plays in the pathogenesis and treatment of depressive illness is reviewed. The review focuses on the influence of antidepressants on cytokines, and on how treatment response might be affected by genetic variants of cytokines.

Combined effects of major depression, pain and somatic disorders on general functioning in the general adult population

&NA; This study was carried out to assess the prevalence of major depressive disorder (MDD) in persons suffering from pain symptoms in various locations, both with and without comorbid somatic disorders and to analyze the single and combined effects of MDD, pain symptoms and somatic disorders on general functioning in the community. The 12‐month prevalence of MDD, somatic disorders and pain symptoms, grouped according to location, were determined among 4181 participants from a community sample. Depression was assessed utilising the Composite International Diagnostic Interview. Pain symptoms were self‐reported by participants whereas medical diagnoses were validated by medical examinations. General functioning was evaluated utilising the established MOS‐SF‐36 scale. The prevalence of MDD was significantly increased for persons with pain in any location. In the absence of a somatic disorder, MDD prevalence was highest in persons with abdominal/chest pain (9.3%) and arm or leg pain (7.9%) and lowest in persons with back pain (6.2%). Mental and physical well‐being were lowest for persons with both MDD and a somatic disorder, irrespective of pain locations. Increasing numbers of pain locations impaired mental and physical well‐being across all groups, but the effect on mental well‐being was most marked in participants with MDD and comorbid somatic disorders. The presence of pain increases risk of associated MDD. The number of pain locations experienced, rather than the specific location of pain, has the greatest impact on general functioning. Not only chronic pain, but pain of any type may be an indicator of MDD and decreased general functioning.

Individual development of preschool children-prevalences and determinants of delays in Germany: a cross-sectional study in Southern Bavaria

BackgroundEven minor abnormalities of early child development may have dramatic long term consequences. Accurate prevalence rates for a range of developmental impairments have been difficult to establish. Since related studies have used different methodological approaches, direct comparisons of the prevalence of developmental delays are difficult. The understanding of the key factors affecting child development, especially in preschool aged children remains limited. We used data from school entry examinations in Bavaria to measure the prevalence of developmental impairments in pre-school children beginning primary school in 1997–2009.MethodsThe developmental impairments of all school beginners in the district of Dingolfing- Landau, Bavaria were assessed using modified “Bavarian School Entry Model” examination from 1997 to 2009 (N=13,182). The children were assessed for motor, cognitive, language and psychosocial impairments using a standardised medical protocol. Prevalence rates of impairments in twelve domains of development were estimated. Using uni- and multivariable logistic regression models, association between selected factors and development delays were assessed.ResultsThe highest prevalence existed for impairments of pronunciation (13.8%) followed by fine motor impairments (12.2%), and impairments of memory and concentration (11.3%) and the lowest for impairments of rhythm of speech (3.1%). Younger children displayed more developmental delays. Male gender was strongly associated with all developmental impairments (highest risk for fine motor impairments = OR 3.22, 95% confidence interval 2.86-3.63). Preschool children with siblings (vs. children without any siblings) were at higher risk of having impairments in pronunciation (OR 1.31, 1.14-1.50). The influence of the non-German nationality was strong, with a maximum risk increase for the subareas of grammar and psychosocial development. Although children with non-German nationality had a reduced risk of disorders for the rhythm of speech and pronunciation, in all other 10 subareas their risk was increased.ConclusionsIn preschool children, most common were delays of pronunciation, memory and concentration. Age effects suggest that delays can spontaneously resolve, but providing support at school entry might be helpful. Boys and migrant children appear at high risk of developmental problems, which may warrant tailored intervention strategies.

The Effects of Dysthymic Disorder on Health-Related Quality of Life and Disability Days in Persons with Comorbid Medical Conditions in the General Population

Background: We aimed to investigate in medical disorders the effects of comorbid dysthymic disorder as compared to major depressive disorder (MDD) on health-related quality of life (HR-QoL) and disability days in the general population. Methods: In a population-based study 4,181 individuals were assessed for the presence of dysthymic disorder and depression, utilizing the Composite International Diagnostic Interview. Each participant received a thorough medical examination to assess the presence of comorbid somatic conditions. HR-QoL was evaluated using the Medical Outcomes Survey Short-Form 36 (SF-36) and disability days were provided by self-report. Descriptive statistics, analysis of variance and multivariable logistic regression were used. Results: Comorbidity with illnesses from a maximum of 6 somatic disease groups was more prevalent in persons with dysthymic disorder (78.7%) than in those with MDD (70.4%). Persons with dysthymic disorder had a significantly lower mental health summary score in the SF-36 and more disability days than those with MDD. The physical health summary scores were not significantly different between participants with dysthymic disorder and MDD (after Bonferroni correction), suggesting that limitations in physical functioning due to comorbid medical conditions were similar in both affective disorder groups. Conclusions: These results show that affective disorders comorbid with medical, somatic illnesses have a major impact on HR-QoL and disability with more pronounced effects in dysthymic disorder than in MDD. Differences in the time course of both conditions might contribute to this finding. Our results support the need for an improved identification and treatment of affective disorders in patients with somatic illnesses.

Kindergarten attendance may reduce developmental impairments in children: Results from the Bavarian Pre-School Morbidity Survey:

Background: The relative risks and benefits of children attending kindergarten or pre-school remain uncertain and controversial. We used data from the Bavarian Pre-School Morbidity Survey (BPMS) to look at the prevalence of developmental impairments in pre-school children entering primary school and to assess if these were correlated with the duration of kindergarten attendance. Methods: We collected data from all school beginners in the district of Dingolfing, Bavaria from 2004 to 2007 (n = 4,005) and utilised a retrospective cross-sectional study design to review the information. The children were assessed for motor, cognitive, language and psychosocial impairments using a standardized medical assessment. Point prevalence of impairments of speech, cognition, motor functioning and psychosocial functioning were compared by χ2-test for the variable of time spent in kindergarten. Results: We detected a high incidence of impairments, with boys showing higher rates than girls in all the areas assessed. Longer length of time spent in kindergarten was associated with reduced rates of motor, cognitive and psychosocial impairments. There was no clear correlation between length of kindergarten attendance and speech disorders. Conclusions: Kindergarten attendance may have a positive effect on a number of domains of development including motor, cognitive and psychosocial development, but no significant effect on speech impairments. Implications for public health policies are discussed.

Erratum to: Changing rates of physical and psychosocial impairments over 9 years in cohorts of school beginners in Germany

Some results of the article by Caniato et al. titled “Changing rates of physical and psychosocial impairments over 9 years in cohorts of school beginners in Germany” (Caniato et al. 2009) have to be revised due to partial data coding problems during electronic data processing producing mainly underestimated prevalence rates of impairments. Due to this problem, we underestimated prevalence rates of impairments in a number of domains, especially in rates of male motor disorders and in cognitive impairments for both males and females. The correct prevalence rates of impairments versus the incorrect published rates are summarised in Table 1.

Health service utilization in patients with major depression and co‐morbid pain

Aims:  Patients with depression often have co‐morbid pain symptoms. However, rates of service utilization by psychiatric in‐patients with co‐morbid pain symptoms are unknown. The purpose of this study is to estimate whether patients with major depression and co‐morbid pain access medical treatment for their pain as much as their counterparts with psychiatric diagnoses other than major depression.

Malingered psychotic symptoms and quetiapine abuse in a forensic setting

Quetiapine is an antipsychotic drug whose effect appears to be mediated through antagonist activity at the dopamine and serotonin receptors. While Quetiapine is not currently classified as a controlled substance, there have been a growing number of reports of the drug being abused both in American prisons and in general community settings. These accounts have included reports of both intranasal and intravenous uses. In this paper we report two cases of prisoners deliberately feigning psychotic symptoms for the purposes of obtaining quetiapine. In both cases there appears to be some evidence of psychological dependence and of a discontinuation syndrome when the medication was ceased. Our report adds support to the possibility that quetiapine has clinically relevant reinforcing properties with potential for producing both dependence and withdrawal symptoms and as such it should be re-evaluated as a drug with addictive potential and abuse risk.