Women's Psychiatry

The joint effect of mental illness and parental suicide attempt on offspring suicide attempt and death: A Danish nationwide, registry-based study using multistate modeling

AIM

The aim of this study was to analyse the joint impact of moderate-to-severe mental illness and parental suicidal attempts on suicidal attempt and premature death.

METHODS

Using the Danish, nationwide health registries, a cohort study was conducted including the birth cohorts 1983-1989. Cox regression and multistate models were used to estimate relative and absolute risks of suicide attempt and premature death.

OUTCOME

We included 384,569 individuals and 7,218 individuals experienced their first suicide attempt during follow-up, while 2,762 individuals died of all causes. Joined exposure to parental suicide attempt and own mental illness increased the relative risk of suicide attempt (HR 22.57) and premature death all causes (HR 3.17). The absolute risk of suicide attempt before the age of 35 years was 20 % for offspring exposed to both parental suicide attempts and own mental illness (23 % for women vs. 15 % for men), while the risk of death was 4 % (0.6 % for women vs. 7 % for men).

CONCLUSION

Exposure to both parental suicide attempt and own mental illness increases the relative and absolute risks of suicide attempt and premature death with considerable differences across sex. These findings are important in the clinical assessment of individuals with suicidal behavior.

Τhe neuroprotective role of environmental enrichment against behavioral, morphological, neuroendocrine and molecular changes following chronic unpredictable mild stress: A systematic review

Environmental factors interact with biological and genetic factors influencing the development and well-being of an organism. The interest in better understanding the role of environment on behavior and physiology led to the development of animal models of environmental manipulations. Environmental enrichment (EE), an environmental condition that allows cognitive and sensory stimulation as well as social interaction, improves cognitive function, reduces anxiety and depressive-like behavior and promotes neuroplasticity. In addition, it exerts protection against neurodegenerative disorders, cognitive aging and deficits aggravated by stressful experiences. Given the beneficial effects of EE on the brain and behavior, preclinical studies have focused on its protective role as an alternative, non-invasive manipulation, to help an organism to cope better with stress. A valid, reliable and effective animal model of chronic stress that enhances anxiety and depression-like behavior is the chronic unpredictable mild stress (CUMS). The variety of stressors and the unpredictability in the time and sequence of exposure to prevent habituation, render CUMS an ethologically relevant model. CUMS has been associated with dysregulation of the hypothalamic-pituitary-adrenal axis, elevation in the basal levels of stress hormones, reduction in brain volume, dendritic atrophy and alterations in markers of synaptic plasticity. Although numerous studies have underlined the compensatory role of EE against the negative effects of various chronic stress regimens (e.g. restraint and social isolation), research concerning the interaction between EE and CUMS is sparse. The purpose of the current systematic review is to present up-to-date research findings regarding the protective role of EE against the negative effects of CUMS.

Sex Differences in Depression and Anxiety

Depression and anxiety disorders carry a tremendous worldwide burden and emerge as a significant cause of disability among western societies. Both disorders are known to disproportionally affect women, as they are twice more likely to be diagnosed and moreover, they are also prone to suffer from female-specific mood disorders. Importantly, the prevalence of these affective disorders has notably risen after the COVID pandemic, especially in women. In this chapter, we describe factors that are possibly contributing to the expression of such sex differences in depression and anxiety. For this, we overview the effect of transcriptomic and genetic factors, the immune system, neuroendocrine aspects, and cognition. Furthermore, we also provide evidence of sex differences in antidepressant response and their causes. Finally, we emphasize the importance to consider sex as a biological variable in preclinical and clinical research, which may facilitate the discovery and development of new and more efficacious antidepressant and anxiolytic pharmacotherapies for both women and men.

Sex Differences in Blood–Brain Barrier Transport of Psychotropic Drugs

Treatment of neuropsychiatric disorders relies on the effective delivery of therapeutic molecules to the target organ, the brain. The blood–brain barrier (BBB) hinders such delivery and proteins acting as transporters actively regulate the influx and importantly the efflux of both endo- and xeno-biotics (including medicines). Neuropsychiatric disorders are also characterized by important sex differences, and accumulating evidence supports sex differences in the pharmacokinetics and pharmacodynamics of many drugs that act on the brain. In this minireview we gather preclinical and clinical findings on how sex and sex hormones can influence the activity of those BBB transporter systems and affect the brain pharmacokinetics of psychotropic medicines. It emerges that it is not well understood which psychotropics are substrates for each of the many and not well-studied brain transporters. Indeed, most evidence originates from studies performed in peripheral tissues, such as the liver and the kidneys. None withstanding, accumulated evidence supports the existence of several sex differences in expression and activity of transport proteins, and a further modulating role of gonadal hormones. It is proposed that a closer study of sex differences in the active influx and efflux of psychotropics from the brain may provide a better understanding of sex-dependent brain pharmacokinetics and pharmacodynamics of psychotropic medicines.

Imperatorin Influences Depressive-like Behaviors: A Preclinical Study on Behavioral and Neurochemical Sex Differences

Imperatorin, a naturally derived furanocoumarin, exerts promising neuropharmacological properties. Therefore, it might be applicable in the treatment of brain diseases such as depression. In the present project, we aimed to investigate the sex-dependent effects of imperatorin (1, 5, and 10 mg/kg) on behavior and neurochemistry associated with antidepressant effects. The depressive-like behaviors of male and female Swiss mice were investigated in a forced swim test (FST). Subsequently, High-Performance Liquid Chromatography (HPLC) was used to evaluate the level of serotonin, its metabolite, 5-HIAA, and noradrenaline, in mouse brains. The study revealed that only males responded to imperatorin (1 and 5 mg/kg) treatment and caused an antidepressant effect, such as with respect to depressive-like behaviors, lowering immobility time and increasing immobility latency. The HPLC analysis demonstrated that serotonin levels in the prefrontal cortex of females decreased with the middle dose of imperatorin (5 mg/kg), while in the male prefrontal cortex, the lower dose (1 mg/kg) boosted serotonin levels. There were no evident changes observed with respect to noradrenaline and serotonin metabolite levels in the male hippocampus. To conclude, we propose that imperatorin has antidepressant potential, seemingly only in males, influencing brain serotonin level, but the direct mechanism of action requires further investigation.

Adolescent and young adult stress and coping during COVID-19: the utility of a pediatric emergency department screener

Background

COVID-19 altered lives, especially adolescents and young adults who lost their emotional and social support systems and may be suffering.

Objective

In response to the coronavirus pandemic, a questionnaire was created and administered to Pediatric Emergency Department (PED) patients in order to identify psychosocial stress and coping abilities.

Methods

A 12-question (yes/no) quality improvement (QI) paper-based questionnaire was administered by PED providers to assess psychosocial stress and coping among patients 12 years and greater who presented to the PED at a tertiary Children’s Hospital, March-September 2020. Questions were asked/recorded to determine rates of distress and provide social work intervention, if needed. Analysis-Chi-squared, Fisher’s exact, and Mann-Whitney U tests.

Results

Among 1261 PED patients who participated in the study, the mean age was 15.4 years (SD = 2.4), (58% female, 41.5% male, 0.6% missing data). We identified 611 patients (48.5%) who admitted to feeling scared about contracting the disease, 876 patients (69.5%) who were concerned about the health of their families, and 229 patients (18.2%) who screened positive for food insecurity. In addition, 596 patients (47.3%) felt anxiety, 333 patients (26.4%) felt depressed, and 13 patients (1%) admitted to having suicidal ideation because of COVID-19. The majority of patients, 1165 (92.4%), felt supported during the pandemic. Social work was consulted for 235 (18.6%) of patients participating.

Conclusions

While patients typically present to PEDs for a somatic complaint, screening their psychosocial and emotional states may reveal underlying mental health concerns that require intervention and at times, assistance from social workers.

Patient and provider knowledge of and attitudes toward medical conditions and medication during pregnancy

BACKGROUND

Knowledge of medical conditions and their evidence-based medications varies among individuals. This range of knowledge may affect attitudes and influence medical decision-making of both patients and providers. Perceptions may be even more impactful in pregnancy, a timeframe subject to bias, and in diseases that include behavioral symptoms and often carry significant societal stigma, such as opioid use disorder (OUD). We present our findings from a survey assessing participants' knowledge of three distinct medical conditions (diabetes mellitus, bipolar disorder, and OUD) and how this knowledge affects perceptions of these disease states during pregnancy.

METHODS

Using existing surveys in the literature as a guideline, we designed a cross-sectional survey including multiple-choice questions to evaluate our hypothesis that less knowledge about a medical condition would result in more negative opinions towards that condition and its treatment throughout pregnancy. Participants responded to perception statements using a 5-point Likert scale (1 = "strongly disagree," 5 = "strongly agree"). Surveys were administered to patients in prenatal care, patients in OUD treatment, medical students, and medical residents within a single institution. Response means were generated and compared using t tests and ANOVA.

RESULTS

A total of 323 participants completed the survey. There were differences in knowledge between respondent groups and by disease state, with prenatal patients having the least knowledge of all groups about OUD diagnosis (88.5% of prenatal patients answered correctly) and its treatment (91.8% answered correctly). Overall Likert means of all responses demonstrated that participants agreed that new mothers with OUD (mean 4.27, 5 = "strongly agree") and their babies (4.12) would have challenges that others would not, compared to mothers with bipolar disorder (4.03) and their babies (3.60) as well as mothers with diabetes (3.87) and their babies (3.47), p < .001. Overall, respondents were likely to agree that women with OUD should not try to get pregnant (3.47), whereas they overall disagreed with that statement when it pertained to women with bipolar disorder (2.69, 2 = "disagree") or diabetes (2.12), p = 0.03.

CONCLUSIONS

With this single-center study, we found that, though there were gaps in knowledge regarding disease and disease treatment during pregnancy, less knowledge was not associated with more negative perceptions of disease and disease treatment during pregnancy. Perceptions were especially negative toward pregnant women with OUD. Increasing awareness of lived experiences of patients with disease, as well as the biases carried by both patients and providers, could improve treatment of chronic diseases and outcomes for patients.

Sex, Gender, and Suicidal Behavior

This chapter reviews gender differences in suicide, commonly known as the gender paradox in suicide. While men are more likely to complete suicide, suicide attempts are more frequent in women. Although there are exceptions, this paradox occurs in most countries over the world, and it is partially explained by the preference of men for more lethal methods. Nevertheless, there are differences in the known risk factors for suicide between men and women, and this chapter summarizes the more relevant findings for the gender paradox. Apart from previous attempts, which still is the strongest predictor of death by suicide, with a higher rate in males than in females, we will emphasize in the role of male depression. It is commonly recognized that over 90% of people who die by suicide had a psychiatric diagnosis, mostly depression, and male depression seems to be a distinct clinical phenotype challenging to recognize, which might contribute to the gender paradox. Finally, in light of all the information reviewed, some recommendations on prevention of suicide from a gender perspective in the clinical setting will be made.

Sex matters in neuroscience and neuropsychopharmacology

Prevalence and symptoms of most psychiatric and neurological disorders differ in men and women and there is substantial evidence that their neurobiological basis and treatment also differ by sex. This special issue sought to bring together a series of empirical papers and targeted reviews to highlight the diverse impact of sex in neuroscience and neuropsychopharmacology. This special issue emphasizes the diverse impact of sex in neuroscience and neuropsychopharmacology, including 9 review papers and 17 research articles highlighting investigation in different species (zebrafish, mice, rats, and humans). Each contribution covers scientific topics that overlap with genetics, endocrinology, cognition, behavioral neuroscience, neurology, and pharmacology. Investigating the extent to which sex differences can impact the brain and behavior is key to moving forward in neuroscience research.