Phase II study of AVR118 in the management of cancer related anorexia/cachexia

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Background: AVR118 represents a new class of cytoprotective drugs in managing symptoms associated with anorexia\/ cachexia. In a previous study in patients with advanced HIV-AIDS, an improvement in appetite, strength and alertness was noted. The precise mechanism of action is not understood, but activity may be related to AVR118's adenosine based components. Other active components include guanosine and branched chain amino acids leucine and valine. Objective: To determine the effect of AVR118 on appetite, early satiety and nutritional intake in patients with advanced cancer. Secondary endpoints include changes in performance status, lean muscle mass and quality of Life (QOL). Methods: Eligible adult patients received 4.0 ml of AVR118 subcutaneous daily injections. Patients underwent bi-monthly evaluations during the 28 day initial treatment (phase A) Evaluations included Karnofsky performance status, Edmonton Symptoms Assessment Scale (ESAS), Patient Generated Subjective Global Assessment (PG-SGA), Simmonds Functional Assessment, Dyspepsia Symptom Severity Index, Weight, Lean Body Mass, skin fold thickness and grip strength. Patients who benefited from phase A could elect to continue with therapy (phase B). Results: Currently, of 16 enrolled patients 7 have completed phase A. All 7 patients chose to continue with AVR118 treatment (phase B). Improvements in anorexia and PG-SGA scores were seen in 7/7 and 6/7 patients respectively. Weight stabilization or gain was observed in 5/7 patients. All other parameters showed no significant difference. There was AVR118 has been well tolerated and no serious side effects have been reported. Conclusions: Based on these positive results, the primary endpoints have been achieved and the study will be expanded from 14 to 30 patients.

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Depressed mothers' infants are less responsive to faces and voices

A review of our recent research suggests that infants of depressed mothers appeared to be less responsive to faces and voices as early as the neonatal period. At that time they have shown less orienting to the live face/voice stimulus of the Brazelton scale examiner and to their own and other infants' cry sounds. This lesser responsiveness has been attributed to higher arousal, less attentiveness and less "empathy." Their delayed heart rate decelerations to instrumental and vocal music sounds have also been ascribed to their delayed attention and/or slower processing. Later at 3-6 months they showed less negative responding to their mothers' non-contingent and still-face behavior, suggesting that they were more accustomed to this behavior in their mothers. The less responsive behavior of the depressed mothers was further compounded by their comorbid mood states of anger and anxiety and their difficult interaction styles including withdrawn or intrusive interaction styles and their later authoritarian parenting style. Pregnancy massage was effectively used to reduce prenatal depression and facilitate more optimal neonatal behavior. Interaction coaching was used during the postnatal period to help these dyads with their interactions and ultimately facilitate the infants' development.

Depressed pregnant black women have a greater incidence of prematurity and low birthweight outcomes

Pregnant black depressed women were compared to pregnant black non-depressed women on self-report stress measures and cortisol levels at mid and late pregnancy and on neonatal outcomes. The depressed women had higher anxiety, anger, daily hassles, sleep disturbance scores and cortisol levels at both prenatal visits. These higher stress levels may have contributed to the greater incidence of prematurity and low birthweight neonatal outcomes noted in the depressed group, and they may partially explain the higher rate of prematurity and low birthweight among black women.

Breakup distress in university students

A sample of 192 university students who had experienced a recent breakup of a romantic relationship was divided into high versus low score groups based on the Breakup Distress Scale. Females had higher Breakup Distress Scale scores. The group who had high Breakup Distress Scale scores reported having less time since the breakup occurred, did not initiate the breakup, reported that the breakup was sudden and unexpected, felt rejected and betrayed, and had not yet found a new relationship. They also scored higher on the Intrusive Thoughts Scale, on the Difficulty Controlling Intrusive Thoughts Scale, on The Sleep Disturbance Scale, and on the depression (CES-D) and anxiety scales (STAI). In a regression analysis, the most important predictors of the Breakup Distress scores were the depression score (CES-D), the feeling of being betrayed by the breakup, shorter time since the breakup occurred, and a higher rating of the relationship prior to the breakup. This explained as much as 37% of the variance, suggesting that these factors are important contributors to relationship breakup distress.

Prenatal dysthymia versus major depression effects on early mother-infant interactions: a brief report

Maternal dysthymia and major depression effects on mother-infant interactions were assessed when the infants were 3-months-old. The dysthymia group mothers spent less time smiling, touching and imitating their infants and more time moving their infants' limbs. The infants of the dysthymia group mothers spent less time smiling and more time showing distress behaviors.

Use of Barcelona Test for cognitive assessment of patients with schizophrenia

INTRODUCTION

In recent years different neuropsychological batteries have been developed to assess cognitive performance in schizophrenia. However, no test has been validated in Spanish for this purpose. The Barcelona Test has been one of the tests used. This present article has aimed to present a specific neurocognitive battery for schizophrenia by selecting specific subtests from the Barcelona Test. Normative data for patients with schizophrenia are presented and the influence of a number of variables is taken into account.

METHODS

The sample included 209 patients. The relationship between cognitive performance and gender, age, educational level, age of onset, duration of illness and symptomatology were assessed. Symptomatology was collected with the Positive and Negative Syndrome Scale for Schizophrenia.

RESULTS

More of the 50% of the sample had cognitive impairment when compared with standardized percentile scores of the Barcelona Test. No significant relationships between cognitive performance and variables assessed were found, except for in the educational level. Thus, percentile scores for the total sample and for the sample in terms of educational level were obtained.

CONCLUSIONS

The high percentage of patients with cognitive impairment when standardized percentile scores were used reinforces the need to use normative data appropriate for the schizophrenia group. The lack of relationship between cognitive performance and the variables assessed supports the hypothesis that cognitive impairment is a core feature in schizophrenia.

Vagal activity, early growth and emotional development

A review of the research on infant vagal tone suggests that vagal activity is associated with both infant growth and infant socioemotional development. Vagal activity has been noted to increase following the stimulation of pressure receptors as in massage therapy. Vagal activity, in turn, stimulates gastric motility which mediates weight gain in infants. Vagal activity has also been notably elevated during synchronous mother-infant interactions and positive affect, providing confirmatory data for the Porges "social engagement system" model. In contrast, low vagal activity has been noted in prenatally depressed mothers (and prenatally angry and anxious mothers) and their infants, as well as in children with autism. These studies highlight the relations between vagal activity and the social behaviors of attentiveness, facial expressions and vocalizations.

Lavender bath oil reduces stress and crying and enhances sleep in very young infants

Very young infants were given a bath with or without lavender-scented bath oil. The mothers in the lavender bath oil group were more relaxed, smiled and touched their infants more during the bath. Their infants looked at them a greater percentage of the bath time and cried less and spent more time in deep sleep after bath. The cortisol levels of this group of mothers and infants significantly decreased, confirming the behavioral data showing increased relaxation of the mothers and their infants. These findings support a body of research showing the relaxing and sleep-inducing properties of lavender aroma.

Preterm infants show reduced stress behaviors and activity after 5 days of massage therapy

Preterm infants residing in an NICU were randomly assigned to a massage therapy or to a control group. The preterm infants in the massage therapy group received three 15-min massages each day for 5 consecutive days, with the massages consisting of moderate pressure stroking to the head, shoulders, back, arms and legs and kinesthetic exercises consisting of flexion and extension of the limbs. Infant stress behaviors and activity were recorded on the first and last day of the study. Preterm infants receiving massage therapy showed fewer stress behaviors and less activity from the first to the last day of the study. The findings suggest that massage has pacifying or stress reducing effects on preterm infants, which is noteworthy given that they experience numerous stressors during their hospitalization.

Massage therapy reduces pain in pregnant women, alleviates prenatal depression in both parents and improves their relationships

Prenatally depressed women (N=47) were randomly assigned to a group that received massage twice weekly from their partners from 20 weeks gestation until the end of pregnancy or a control group. Self-reported leg pain, back pain, depression, anxiety and anger decreased more for the massaged pregnant women than for the control group women. In addition, the partners who massaged the pregnant women versus the control group partners reported less depressed mood, anxiety and anger across the course of the massage therapy period. Finally, scores on a relationship questionnaire improved more for both the women and the partners in the massage group. These data suggest that not only mood states but also relationships improve mutually when depressed pregnant women are massaged by their partners.

Depressed mothers' newborns show less discrimination of other newborns' cry sounds

Newborns' crying in response to the cry of another newborn has been called an empathetic response. The purpose of this study was to determine whether newborns of depressed mothers showed the same response. Newborns of depressed and non-depressed mothers were presented with cry sounds of themselves or other infants, and their sucking and heart rate were recorded. The newborns of non-depressed mothers responded to the cry sounds of other infants with reduced sucking and decreased heart rate. In contrast, the newborns of depressed mothers did not show a change in their sucking or heart rate to the cry sounds of other infants. This lesser attentiveness/responsiveness to other infants' cry sounds may predict their later lack of empathy.

Sleep disturbances in depressed pregnant women and their newborns

Pregnant women (N=253) were recruited during their second trimester of pregnancy (M=22.3 weeks gestation) and assigned to depressed (N=83) and non-depressed groups based on a SCID diagnosis of depression. They were then given self-report measures on sleep disturbance, depression, anxiety and anger, and their urine was assayed for norepinephrine and cortisol. These measures were repeated during their third trimester (M=32.4 weeks). Their newborns were then observed during sleep. During both the second and third trimesters, the depressed women had more sleep disturbances and higher depression, anxiety and anger scores. They also had higher norepinephrine and cortisol levels. The newborns of the depressed mothers also had more sleep disturbances including less time in deep sleep and more time in indeterminate (disorganized) sleep, and they were more active and cried/fussed more.

Prenatal paternal depression

Prenatal depressive symptoms, anxiety, anger and daily hassles were investigated in 156 depressed and non-depressed pregnant women and their depressed and non-depressed partners (fathers-to-be). Depressed versus non-depressed fathers had higher depression, anxiety and daily hassles scores. Although the pregnant women in general had lower anxiety, anger and daily hassles scores than the men, the scores on the measures for depressed fathers and depressed mothers did not differ. Paternal depression appeared to have less effect than maternal depression on their partners' scores. However, the similarity between the scores of depressed mothers and depressed fathers highlights the importance of screening for depression in fathers-to-be as well as mothers-to-be during pregnancy.

Instrumental and vocal music effects on EEG and EKG in neonates of depressed and non-depressed mothers

Neonates (M age=16 days) born to depressed and non-depressed mothers were randomly assigned to hear an audiotaped lullaby of instrumental music with vocals or without vocals. Neonatal EEG and EKG were recorded for 2min (baseline) of silence and for 2min of one or the other music presentation. Neonates of non-depressed mothers showed greater relative right frontal EEG asymmetry to both types of music, suggesting a withdrawal response. Neonates of depressed mothers on the other hand showed greater relative left frontal EEG asymmetry to the instrumental without vocal segment, suggesting an approach response, and greater relative right frontal EEG asymmetry to the instrumental with vocal segment, suggesting a withdrawal response. Heart rate decelerations occurred following the music onset for both groups of infants, however, compared to infants of non-depressed mothers, infants of depressed mothers showed a delayed heart rate deceleration, suggesting slower processing and/or delayed attention. These findings suggest that neonates of depressed and non-depressed mothers show different EKG and EEG responses to instrumental music with versus without vocals.

[Insight, neurocognition and psychopathology in schizophrenia]

INTRODUCTION

In recent years, research has been aimed at finding variables mediating between neurocognition and psychosocial functioning in schizophrenia, proposing insight as one of these variables. Some authors have found associations between insight and functional outcome, and between insight and symptomatology, although these associations remain unclear. These different findings could be explained by the insight definition used. The current study evaluates insight unidimensionally and multidimensionally and studies its relationship with cognitive and psychopathological variables.

METHODS

The sample consisted of 94 subjects admitted to an outpatient Psychosocial Rehabilitation Program, all diagnosed of schizophrenia according to ICD-10 diagnostic criteria. A brief version of the Neuropsychology Battery Test Barcelona and the Wisconsin Card Sorting Test were used to evaluate cognitive variables. The Positive and Negative Syndrome Scale (PANSS) was used to evaluate psychopathology. Insight was assessed with the PANSS item ((lack of judgment and insight)), and with a semi-structured interview.

RESULTS

Two insight factors were found, one including more specific knowledge about the disease and its consequences (cognitive factor), that is related to executive functions, and another referring to unspecific knowledge about suffering from an illness and the need for treatment (psychotic factor). Each factor was statistically related to positive symptoms and superior cognitive functions.

CONCLUSIONS

These findings support a relationship between insight and low cognitive performance.

Prenatal depression effects on the fetus and newborn: a review

A review of research on prenatal depression effects on the fetus and newborn suggests that they experience prenatal, perinatal and postnatal complications. Fetal activity is elevated, prenatal growth is delayed, and prematurity and low birthweight occur more often. Newborns of depressed mothers then show a biochemical/physiological profile that mimics their mothers' prenatal biochemical/physiological profile including elevated cortisol, lower levels of dopamine and serotonin, greater relative right frontal EEG activation and lower vagal tone. Elevated prenatal maternal cortisol is the strongest predictor of these neonatal outcomes. Moderate pressure massage can alleviate these effects including reducing prematurity.

Greater arousal and less attentiveness to face/voice stimuli by neonates of depressed mothers on the Brazelton Neonatal Behavioral Assessment Scale

Neonates born to depressed (n=44) versus non-depressed (n=43) mothers were compared on individual items of the Brazelton Neonatal Behavioral Assessment Scale (NBAS). The neonates of depressed mothers received lower scores on orienting to the live face/voice stimulus and on the alertness items, suggesting they were less attentive. They also scored less optimally on the cuddliness and hand-to-mouth activity items, suggesting they were more aroused. These data lend support to the model that infants of depressed mothers are more aroused and less attentive.

Stability of mood states and biochemistry across pregnancy

Four hundred and thirty pregnant women were recruited during their second trimester of pregnancy (M=20 weeks). They were designated depressed (N=172) or nondepressed (N=258) on the Structured Clinical Interview of Depression (SCID) and the Center for Epidemiological Studies Depression scale (CES-D). They were given a second assessment when they were approximately 32 weeks gestational age. At both assessments they were given self-report measures (CES-D, the State Anxiety Inventory, and the State Anger Inventory) and provided urine samples for assays of cortisol, catecholamines (norepinephrine, epinephrine and dopamine) and serotonin. They were also given the VITAS scale for lower back pain and leg pain and a sleep disturbance scale. The stability of mood states and biochemistry across pregnancy (20 and 32 weeks) were assessed inasmuch as mood states, and biochemistry have been noted to predict prematurity and low birthweight. Significant correlations were noted for all variables except serotonin. Relationships between mood states and biochemistry were also noted but only between cortisol and depression, cortisol and anxiety, and epinephrine and anxiety. Significant stability was noted between the 20-week measures and the 32-week measures including depression, anxiety, anger, and cortisol. These were, in turn, correlated with each other and with, low back pain, leg pain, and sleep disturbance. These data suggest the stability of mood states and cortisol across pregnancy.

Prenatal cortisol, prematurity and low birthweight

Three hundred depressed pregnant women were recruited at approximately 20 weeks gestation. They were then divided by a median split into high and low urinary cortisol level groups. The high cortisol group had higher CES-D depression scores and higher inhibition (BIS) scores prenatally. Their fetuses had smaller head circumference, abdominal circumference, biparietal diameter and fetal weight. The high cortisol group neonates were shorter gestational age and lower birthweight and they had lower Brazelton habituation and higher Brazelton reflex scores. Discriminant function analyses suggested that cortisol levels more accurately classified short gestation and low birthweight groups than CES-D depression scores.