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Tomba E, Tecuta L, Gardini V, Tomei G, Lo Dato E. Staging models in eating disorders: A systematic scoping review of the literature. Compr Psychiatry 2024; 131:152468. [PMID: 38460478 DOI: 10.1016/j.comppsych.2024.152468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 02/28/2024] [Accepted: 03/02/2024] [Indexed: 03/11/2024] Open
Abstract
Eating Disorders (ED) are characterized by low remission rates, treatment drop-out, and residual symptoms. To improve assessment and treatment of ED, the staging approach has been proposed. This systematic scoping review is aimed at mapping the existing staging models that explicitly propose stages of the progression of ED. A systematic search of PubMed, PsycINFO, Scopus was conducted with the terms staging, anorexia nervosa, bulimia nervosa, binge-eating disorders, eating disorders. Eleven studies met inclusion criteria presenting nine ED staging models, mostly for anorexia nervosa. Three were empirically tested, one of which was through an objective measure specifically developed to differentiate between stages. Most staging models featured early stages in which the exacerbation of EDs unfolds and acute phases are followed by chronic stages. Intermediate stages were not limited to acute stages, but also residual phases, remission, relapse, and recovery. The criteria for stage differentiation encompassed behavioral, psychological, cognitive, and physical features including body mass index and illness duration. One study recommended stage-oriented interventions. The current review underscores the need to empirically test the available staging models and to develop and test new proposals of staging models for other ED populations. The inclusion of criteria based on medical features and biomarkers is recommended. Staging models can potentially guide assessment and interventions in daily clinical settings.
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Affiliation(s)
- E Tomba
- Department of Psychology, University of Bologna, Bologna, Italy.
| | - L Tecuta
- Department of Psychology, University of Bologna, Bologna, Italy
| | - V Gardini
- Department of Psychology, University of Bologna, Bologna, Italy
| | - G Tomei
- Department of Psychology, University of Bologna, Bologna, Italy
| | - E Lo Dato
- Department of Psychology, University of Bologna, Bologna, Italy
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Meisenzahl E, Wege N, Stegmüller V, Schulte-Körne G, Greimel E, Dannlowski U, Hahn T, Romer G, Romanos M, Deserno L, Klingele C, Theisen C, Kieckhäfer C, Forstner A, Ruhrmann S, Schultze-Lutter F. Clinical high risk state of major depressive episodes: Assessment of prodromal phase, its occurrence, duration and symptom patterns by the instrument the DEpression Early Prediction-INventory (DEEP-IN). J Affect Disord 2024; 351:403-413. [PMID: 38181843 DOI: 10.1016/j.jad.2023.12.084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 12/20/2023] [Accepted: 12/28/2023] [Indexed: 01/07/2024]
Abstract
BACKGROUND To decrease the incidence of major depressive episodes, indicated prevention that targets clinical high-risk individuals with first detectable signs that forecast mental disorder is a highly relevant topic of preventive psychiatry. Still little is known about the prodrome of MDE. The aim of the current study was to identify the occurrence of a clinical high-risk state of depression, its duration and symptom constellation. METHODS Seventy-three patients with a diagnosed affective disorder in partial remission were assessed with our newly developed semi-structured extensive clinical instrument, the DEpression Early Prediction-INventory (DEEP-IN). Within DEEP-IN the course of prodromal symptoms was explored by using a life-chart method. RESULTS The significant majority of patients (93.2 %) reported a prodromal phase. The mean duration was 7.9 months (SD = 12.5). Within the group with an identified prodromal phase, psychopathological (95.6 %) as well as somatic symptoms (88.2 %) were reported. Somatic symptoms showed a moderate-to-strong effect of sex with higher prevalence in females than in males (97.6 % vs 73.1 %; V = 0.370). LIMITATIONS This feasibility study had only a small sample size. CONCLUSIONS The majority of patients with affective disorders reported a clinical prodromal phase with both psychopathological and somatic symptoms that developed months before the onset of the depressive episode. The development of structured instruments for the assessment of depressive risk states is a promising approach for indicated prevention of depression in the future.
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Affiliation(s)
- Eva Meisenzahl
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, LVR Düsseldorf, Düsseldorf, Germany.
| | - Natalia Wege
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, LVR Düsseldorf, Düsseldorf, Germany
| | - Veronika Stegmüller
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, LVR Düsseldorf, Düsseldorf, Germany
| | - Gerd Schulte-Körne
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Ellen Greimel
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Udo Dannlowski
- Institute for Translational Psychiatry, University of Muenster, Muenster, Germany
| | - Tim Hahn
- Institute for Translational Psychiatry, University of Muenster, Muenster, Germany
| | - Georg Romer
- Department of Child Adolescence Psychiatry and Psychotherapy, University of Muenster, Muenster, Germany
| | - Marcel Romanos
- Centre of Mental Health, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Wuerzburg, Wuerzburg, Germany
| | - Lorenz Deserno
- Centre of Mental Health, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Wuerzburg, Wuerzburg, Germany; Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany; Neuroimaging Center, Technical University of Dresden, Dresden, Germany
| | - Cosima Klingele
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Christian Theisen
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, LVR Düsseldorf, Düsseldorf, Germany
| | - Carolin Kieckhäfer
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, LVR Düsseldorf, Düsseldorf, Germany
| | - Andreas Forstner
- Institute of Human Genetics, University of Bonn, School of Medicine & University Hospital Bonn, Bonn, Germany
| | - Stefan Ruhrmann
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Frauke Schultze-Lutter
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, LVR Düsseldorf, Düsseldorf, Germany
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Zhang J, Song Z, Huo Y, Li G, Lu L, Wei C, Zhang S, Gao X, Jiang X, Xu Y. Engeletin alleviates depressive-like behaviours by modulating microglial polarization via the LCN2/CXCL10 signalling pathway. J Cell Mol Med 2024; 28:e18285. [PMID: 38597406 PMCID: PMC11005460 DOI: 10.1111/jcmm.18285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 03/10/2024] [Accepted: 03/22/2024] [Indexed: 04/11/2024] Open
Abstract
Microglial polarization and associated inflammatory activity are the key mediators of depression pathogenesis. The natural Smilax glabra rhizomilax derivative engeletin has been reported to exhibit robust anti-inflammatory activity, but no studies to date have examined the mechanisms through which it can treat depressive symptoms. We showed that treatment for 21 days with engeletin significantly alleviated depressive-like behaviours in chronic stress social defeat stress (CSDS) model mice. T1-weighted imaging (T1WI), T2-weighted imaging (T2WI) imaging revealed no significant differences between groups, but the bilateral prefrontal cortex of CSDS mice exhibited significant increases in apparent diffusion coefficient and T2 values relative to normal control mice, with a corresponding reduction in fractional anisotropy, while engeletin reversed all of these changes. CSDS resulted in higher levels of IL-1β, IL-6, and TNF-a production, enhanced microglial activation, and greater M1 polarization with a concomitant decrease in M2 polarization in the mPFC, whereas engeletin treatment effectively abrogated these CSDS-related pathological changes. Engeletin was further found to suppress the LCN2/C-X-C motif chemokine ligand 10 (CXCL10) signalling axis such that adeno-associated virus-induced LCN2 overexpression ablated the antidepressant effects of engeletin and reversed its beneficial effects on the M1/M2 polarization of microglia. In conclusion, engeletin can alleviate CSDS-induced depressive-like behaviours by regulating the LCN2/CXCL10 pathway and thereby altering the polarization of microglia. These data suggest that the antidepressant effects of engeletin are correlated with the polarization of microglia, highlighting a potential avenue for future design of antidepressant strategies that specifically target the microglia.
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Affiliation(s)
- Jie Zhang
- Department of RadiologyBinzhou Medical University HospitalBinzhouShandongP. R. China
| | - Zheng Song
- Department of PharmacyBinzhou Medical University HospitalBinzhouShandongP. R. China
| | - Yanchao Huo
- Department of PharmacyBinzhou Medical University HospitalBinzhouShandongP. R. China
| | - Guangqiang Li
- Department of PharmacyBinzhou Medical University HospitalBinzhouShandongP. R. China
| | - Liming Lu
- Department of PharmacyBinzhou Medical University HospitalBinzhouShandongP. R. China
| | - Chuanmei Wei
- Department of PharmacyBinzhou Medical University HospitalBinzhouShandongP. R. China
| | - Shuping Zhang
- College of Basic MedicineBinzhou Medical UniversityYantaiShandongP.R. China
| | - Xinfu Gao
- Department of PharmacyBinzhou Medical University HospitalBinzhouShandongP. R. China
| | - Xingyue Jiang
- Department of RadiologyBinzhou Medical University HospitalBinzhouShandongP. R. China
| | - Yangyang Xu
- Department of PharmacyBinzhou Medical University HospitalBinzhouShandongP. R. China
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Langenecker SA, Westlund Schreiner M, Bessette KL, Roberts H, Thomas L, Dillahunt A, Pocius SL, Feldman DA, Jago D, Farstead B, Pazdera M, Kaufman E, Galloway JA, Kerig PK, Bakian A, Welsh RC, Jacobs RH, Crowell SE, Watkins ER. Rumination-Focused Cognitive Behavioral Therapy Reduces Rumination and Targeted Cross-network Connectivity in Youth With a History of Depression: Replication in a Preregistered Randomized Clinical Trial. BIOLOGICAL PSYCHIATRY GLOBAL OPEN SCIENCE 2024; 4:1-10. [PMID: 38021251 PMCID: PMC10654545 DOI: 10.1016/j.bpsgos.2023.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 08/16/2023] [Accepted: 08/19/2023] [Indexed: 12/01/2023] Open
Abstract
Background Rumination-focused cognitive behavioral therapy (RF-CBT) is designed to reduce depressive rumination or the habitual tendency to dwell on experiences in a repetitive, negative, passive, and global manner. RF-CBT uses functional analysis, experiential exercises, and repeated practice to identify and change the ruminative habit. This preregistered randomized clinical trial (NCT03859297, R61) is a preregistered replication of initial work. We hypothesized a concurrent reduction of both self-reported rumination and cross-network connectivity between the left posterior cingulate cortex and right inferior frontal and inferior temporal gyri. Methods Seventy-six youths with a history of depression and elevated rumination were randomized to 10 to 14 sessions of RF-CBT (n = 39; 34 completers) or treatment as usual (n = 37; 28 completers). Intent-to-treat analyses assessed pre-post change in rumination response scale and in functional connectivity assessed using two 5 minute, 12 second runs of resting-state functional magnetic resonance imaging. Results We replicated previous findings: a significant reduction in rumination response scale and a reduction in left posterior cingulate cortex to right inferior frontal gyrus/inferior temporal gyrus connectivity in participants who received RF-CBT compared with those who received treatment as usual. Reductions were large (z change = 0.84; 0.73, respectively [ps < .05]). Conclusions This adolescent clinical trial further demonstrates that depressive rumination is a brain-based mechanism that is modifiable via RF-CBT. Here, we replicated that RF-CBT reduces cross-network connectivity, a possible mechanism by which rumination becomes less frequent, intense, and automatic. This National Institute of Mental Health-funded fast-fail study continues to the R33 phase during which treatment-specific effects of RF-CBT will be compared with relaxation therapy.
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Affiliation(s)
- Scott A. Langenecker
- Department of Psychiatry and Behavioral Health, Ohio State University, Columbus, Ohio
- Departments of Psychiatry and Psychology, University of Utah, Salt Lake City, Utah
- Departments of Psychiatry and Psychology, University of Illinois at Chicago, Chicago, Illinois
| | | | - Katie L. Bessette
- Departments of Psychiatry and Psychology, University of Utah, Salt Lake City, Utah
- Departments of Psychiatry and Psychology, University of Illinois at Chicago, Chicago, Illinois
- Center for Cognitive Neuroscience, University of California Los Angeles, Los Angeles, California
| | - Henrietta Roberts
- Department of Experimental and Applied Clinical Psychology, University of Exeter, Sir Henry Wellcome Building for Mood Disorders Research, Exeter, United Kingdom
| | - Leah Thomas
- Departments of Psychiatry and Psychology, University of Utah, Salt Lake City, Utah
| | - Alina Dillahunt
- Departments of Psychiatry and Psychology, University of Utah, Salt Lake City, Utah
| | - Stephanie L. Pocius
- Departments of Psychiatry and Psychology, University of Utah, Salt Lake City, Utah
| | - Daniel A. Feldman
- Departments of Psychiatry and Psychology, University of Utah, Salt Lake City, Utah
| | - Dave Jago
- Department of Experimental and Applied Clinical Psychology, University of Exeter, Sir Henry Wellcome Building for Mood Disorders Research, Exeter, United Kingdom
| | - Brian Farstead
- Departments of Psychiatry and Psychology, University of Utah, Salt Lake City, Utah
| | - Myah Pazdera
- Departments of Psychiatry and Psychology, University of Utah, Salt Lake City, Utah
| | - Erin Kaufman
- Departments of Psychiatry and Psychology, University of Utah, Salt Lake City, Utah
| | - Jennica A. Galloway
- Departments of Psychiatry and Psychology, University of Utah, Salt Lake City, Utah
| | - Patricia K. Kerig
- Departments of Psychiatry and Psychology, University of Utah, Salt Lake City, Utah
| | - Amanda Bakian
- Departments of Psychiatry and Psychology, University of Utah, Salt Lake City, Utah
| | - Robert C. Welsh
- Departments of Psychiatry and Psychology, University of Utah, Salt Lake City, Utah
- Center for Cognitive Neuroscience, University of California Los Angeles, Los Angeles, California
| | - Rachel H. Jacobs
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Sheila E. Crowell
- Departments of Psychiatry and Psychology, University of Utah, Salt Lake City, Utah
| | - Edward R. Watkins
- Department of Experimental and Applied Clinical Psychology, University of Exeter, Sir Henry Wellcome Building for Mood Disorders Research, Exeter, United Kingdom
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