Sabrina Mörkl

Depression-Burnout Overlap in Physicians

Background Whether burnout is a distinct phenomenon rather than a type of depression and whether it is a syndrome, limited to three “core” components (emotional exhaustion, depersonalization and low personal accomplishment) are subjects of current debate. We investigated the depression-burnout overlap, and the pertinence of these three components in a large, representative sample of physicians. Methods In a cross-sectional study, all Austrian physicians were invited to answer a questionnaire that included the Major Depression Inventory (MDI), the Hamburg Burnout Inventory (HBI), as well as demographic and job-related parameters. Of the 40093 physicians who received an invitation, a total of 6351 (15.8%) participated. The data of 5897 participants were suitable for analysis. Results Of the participants, 10.3% were affected by major depression. Our study results suggest that potentially 50.7% of the participants were affected by symptoms of burnout. Compared to physicians unaffected by burnout, the odds ratio of suffering from major depression was 2.99 (95% CI 2.21–4.06) for physicians with mild, 10.14 (95% CI 7.58–13.59) for physicians with moderate, 46.84 (95% CI 35.25–62.24) for physicians with severe burnout and 92.78 (95% CI 62.96–136.74) for the 3% of participants with the highest HBI_sum (sum score of all ten HBI components). The HBI components Emotional Exhaustion, Personal Accomplishment and Detachment (representing depersonalization) tend to correlate more highly with the main symptoms of major depression (sadness, lack of interest and lack of energy) than with each other. A combination of the HBI components Emotional Exhaustion, Helplessness, Inner Void and Tedium (adj.R2 = 0.92) explained more HBI_sum variance than the three “core” components (adj.R2 = 0.85) of burnout combined. Cronbach’s alpha for Emotional Exhaustion, Helplessness, Inner Void and Tedium combined was 0.90 compared to α = 0.54 for the combination of the three “core” components. Conclusions This study demonstrates the overlap of burnout and major depression in terms of symptoms and the deficiency of the three-dimensional concept of burnout. In our opinion, it might be preferable to use multidimensional burnout inventories in combination with valid depression scales than to rely exclusively on MBI when clinically assessing burnout.

Akute Psychose nach Konsum von synthetischen Cannabinoiden

INTRODUCTION Mocarz is a Legal high that consists of dried parts of plants mixed with synthetic cannabinoids. There is currently limited information on its acute toxicity. CASE REPORT We describe a 35-year-old patient with no previous medical and psychiatric history who was admitted to the psychiatric clinic after developing agitation and paranoid psychotic symptoms following the use of Mocarz purchased over the internet. CONCLUSION Legal highs are a challenge in psychiatric acute care, because they provoke unpredictable mental states endangering self and others.

The Role of Nutrition and the Gut-Brain Axis in Psychiatry: A Review of the Literature

Introduction: Individuals suffering from psychiatric disorders experience high levels of illness burden and a significantly reduced quality of life. Despite targeted psychopharmacological strategies and complementary psychotherapeutic procedures only moderate effects are obtained, and the risk of relapse is high in many patients. Worldwide, psychiatric diseases such as depression are continuously increasing, challenging the personal life of the affected as well as their families, but also whole societies by increasing disability, early retirement and hospitalization. According to current scientific knowledge psychiatric disorders are caused by a multifactorial pathogenesis, including genetics, inflammation and neurotransmitter imbalance; furthermore, also lifestyle-associated factors gain rising importance. In line with this, there is growing evidence that the gut microbiota and nutrition have an impact on the onset and course of psychiatric disorders. Aim: This narrative review highlights the important role of nutrition in psychiatric care and underlines the significance of nutritional advice in the multifactorial, biopsychosocial treatment of patients. It focuses on current dietary interventions such as the Mediterranean diet, dietary supplements and modifications of the gut microbiota with pre-, pro- and postbiotics. Results: Recent studies support the connection between the quality of diet, gut microbiota and mental health through regulation of metabolic functions, anti-inflammatory and antiapoptotic properties and the support of neurogenesis. Dietary coaching to improve mental health seems to be an additional, cost-effective, practical, nonpharmacological intervention for individuals with psychiatric disorders. Conclusion: The use of nutritional interventions in psychiatry equips therapists with a promising tool for both the prevention and treatment of psychiatric disorders. Besides pharmacological therapy, psychotherapy and physical activity, nutritional interventions are an important pillar in the multifactorial, biopsychosocial treatment of psychiatric disease and could be used as a potential therapeutic target.

Pilotstudie: Mikrobiom und Darmbarriere bei Anorexia nervosa

INTRODUCTION Recent research has shown changes of the intestinal flora in anorexia nervosa (AN) patients. Alpha diversity (AD) represents the number of different bacterial species in the gut. Reduced AD and a leaky gut (zonulin) lead to inflammation and changes in nutrient absorption. METHODS AD was calculated from stool samples of 18 AN patients and 20 normal weight controls (NC) after 16S ribosomal RNA sequencing. Furthermore, Zonulin as an indicator of gut barrier function and inflammation parameters were investigated. RESULTS AN patients had significantly lower AD compared to NC (number of observed species p=0.042, Chao1 Diversity Index p=0.043). Zonulin was not significantly altered in AN patients compared to NC. There were no significant correlations of serum parameters and AD. DISCUSSION Regardless of gut permeability, AN patients showed significantly decreased AD compared to NC. Decreased AD can have an additional negative impact on calorie intake in AN. These results contribute to a better understanding of the illness and the development of new therapeutic options.

Probiotic Treatment in Individuals with Euthymic Bipolar Disorder: A Pilot-Study on Clinical Changes and Compliance

The importance of the microbiome for psychological well-being has gained rising interest in the last decade. A strategy to examine the role of the microbiome in different diseases is the intake of supplements that modulate the gut microbiome. Despite promising results in animal studies, research in humans is sparse to date and especially in individuals with psychiatric disorders almost missing. The current report of the ProbioBIP-one pilot study aims at describing general effects of the intake of the probiotic OMNi-BiOTiC Stress repair® on psychological parameters as well as gastrointestinal symptoms and general compliance in a cohort of euthymic individuals with bipolar disorder (BD), receiving daily probiotic treatment over a time period of 3 months. Twenty-seven individuals with BD took part in the present study (mean age = 50.7 years, SD = 12.2; females 40.7%). In sum, there was a high compliance rate with 81.5% of the study participants completing all 3 study visits and 85% of planned probiotic ingestions taken. Gastrointestinal problems were prevalent in more than half of the patients at the time of inclusion (t1). Expectedly, in the whole cohort, a high proportion of study participants experienced changes concerning digestion during probiotic treatment, around one third reported positive changes (reduced flatulence and easier and more frequent bowel movements) after 1 month (t2) and further after 3 months (t3). In contrast, a smaller part of study participants reported gastrointestinal discomfort after 1 and after 3 months (mainly flatulence and obstipation). We found a significantly reduced cognitive reactivity to sad mood between t2 and t3 indicating that participants under probiotic supplementation perceived themselves to be less distracted by ruminative thoughts. Further changes in psychiatric symptoms were small due to the euthymic state and already low scoring at the time of inclusion. Nevertheless, we found a significant symptom reduction in the rating scales measuring manic symptoms. From a clinical point of view, probiotic supplementation might provide a well-tolerated tool to positively influence gastrointestinal quality of life as well as mental and somatic health, cognition and immune response and potentially have effects on psychiatric symptoms.

Response to Letter to the Editor to Gut microbiota, dietary intakes and intestinal permeability reflected by serum zonulin in women

Dear Prof. Rowland, Thank you for giving us the opportunity to answer the letter to the editor by Lucas Scheffler et al. which raised some important and interesting points regarding the zonulin ELISA kit by Immundiagnostik AG which was used in our study “Gut microbiota, dietary intakes and intestinal permeability reflected by serum zonulin in women” [1]. In 2009, Tripathi and co-workers from Fasano’s group published findings pointing to zonulin’s identity with prehaptoglobin-2 [2]. 15% of the general population (with a HP1-1 genotype) do not express pre-HP2 (zonulin). Hence, zonulin should not be detected in this subpopulation [3]. Nevertheless, the ELISA kit used in our study seems to measure zonulin-like immunoreactivity also in serum samples of Hp1-1 individuals. Importantly, this ELISA kit— using antibodies raised against a zonulin sequence earlier published by Fasano’s group [4]—does not recognize preHP2 (zonulin) but rather some other members of the zonulin family (such as properdin) with similar effects on gut permeability. This was recently described in a publication by Scheffler et al. [5]. Properdin is a plasma glycoprotein which is released from neutrophils, T-cells and macrophages in response to microbial exposure (alternate complement pathway). It has been intensively investigated during the last decade and owns important functions in inflammation and adipose tissue [6]. Thus, it is involved in cardiovascular diseases, arthritis, asthma and kidney diseases [7]. Alterations of complement activity by properdin caused changes in the innate and adaptive immune responses including pro-inflammatory cytokine production, immune cell infiltration, antigen presenting cell maturation and tissue damage subsequently leading to increased endothelial permeability [7–9]. Interestingly, up to now, to our best knowledge, there is only one study investigating serum properdin in patients with anorexia nervosa. Anorexia nervosa patients were also included in our aforementioned study [1]. Wyatt et al. described significantly decreased serum levels of properdin in five anorexia nervosa patients which did not increase after nutritional treatment [10]. In our pilot study, we could not identify differences of serum zonulin family members in anorexia nervosa patients compared to normal weight controls [11]. Further, we detected also no differences between serum levels of zonulin family members when the participants were segregated according to BMI [12] [AN patients (n = 17), NW participants (n = 25), OW participants (n = 21), OB participants (n = 19) and normal weight athletes (n = 20)] [1]. Therefore, gut permeability should be measured by overall immunoreactivity, zonulin and other members of the zonulin family. Future studies should also identify whether this zonulin subfamilies have different functional properties in regard to inflammation and gut permeability. In this context, the results of the Immundiagnostik ELISA correlated with metabolic traits linked to increased gut permeability [5]. Hence, we totally agree with the letter This response letter to a letter to the editor refers to the original publication by Mörkl et al. “Gut microbiota, dietary intakes and intestinal permeability reflected by serum zonulin in women” available under https ://doi.org/10.1007/s0039 4-018-1784-0 and the letter to the editor available here: https ://doi.org/10.1007/s0039 4-018-1835-6.

A step ahead: Exploring the gut microbiota in inpatients with bipolar disorder during a depressive episode

There is evidence that the gut microbiota plays a major role in the pathogenesis of diseases of the central nervous system through the gut–brain axis. The aim of the present study was to analyze gut microbiota composition in bipolar disorder (BD) and its relation to inflammation, serum lipids, oxidative stress, tryptophan (TRP)/kynurenine (KYN) levels, anthropometric measurements and parameters of metabolic syndrome. Further, microbial community differences of individuals with BD compared with healthy controls (HC) were explored.

Die Kraftwerke der Zellen- über die Behandlung von psychiatrischen Symptomen bei Patienten mit Mitochondriopathien

Introduction Mitochondriopathies are pathologies of cell organelles, which are essential for the formation of adenosine triphosphate (ATP), which is responsible for cellular energy stock. When mitochondrial mutations occur, symptoms arise frequently in those organs that rely on a continuous energy supply, such as the nervous system. Although psychiatric illness is increasingly prevalent in patients with mitochondrial disease, less attention has been paid to its psychiatric presentations. Case Report We describe a case of a 21-year-old woman who presented in our outpatient department with panic attacks and depression. The patient experienced major side effects after low-dose sertraline therapy. Conclusion Mitochondriopathies belong to the class of rare illnesses in psychiatry; nevertheless, they require adaptations of psychopharmacological therapy. Psychotropic drugs are potential respiratory chain inhibitors and could lead to distinct side effects.