The role of obesity measures in the development and persistence of major depressive disorder

The Crystal Structure of Mouse Ces2c, a Potential Ortholog of Human CES2, Shows Structural Similarities in Substrate Regulation and Product Release to Human CES1

Members of the carboxylesterase 2 (Ces2/CES2) family have been studied intensively with respect to their hydrolytic function on (pro)drugs, whereas their physiological role in lipid and energy metabolism has been realized only within the last few years. Humans have one CES2 gene which is highly expressed in liver, intestine, and kidney. Interestingly, eight homologous Ces2 (Ces2a to Ces2h) genes exist in mice and the individual roles of the corresponding proteins are incompletely understood. Mouse Ces2c (mCes2c) is suggested as potential ortholog of human CES2. Therefore, we aimed at its structural and biophysical characterization. Here, we present the first crystal structure of mCes2c to 2.12 Å resolution. The overall structure of mCes2c resembles that of the human CES1 (hCES1). The core domain adopts an α/β hydrolase-fold with S230, E347, and H459 forming a catalytic triad. Access to the active site is restricted by the cap, the flexible lid, and the regulatory domain. The conserved gate (M417) and switch (F418) residues might have a function in product release similar as suggested for hCES1. Biophysical characterization confirms that mCes2c is a monomer in solution. Thus, this study broadens our understanding of the mammalian carboxylesterase family and assists in delineating the similarities and differences of the different family members.

Severe psychiatric disorders and general medical comorbidities: inflammation-related mechanisms and therapeutic opportunities

Individuals with severe psychiatric disorders, such as mood disorders and schizophrenia, are at increased risk of developing other medical conditions, especially cardiovascular and metabolic diseases. These medical conditions are underdiagnosed and undertreated in these patients contributing to their increased morbidity and mortality. The basis for this increased comorbidity is not well understood, possibly reflecting shared risks factors (e.g. lifestyle risk factors), shared biological mechanisms and/or reciprocal interactions. Among overlapping pathophysiological mechanisms, inflammation and related factors, such as dysbiosis and insulin resistance, stand out. Besides underlying the association between psychiatric disorders and cardiometabolic diseases, these mechanisms provide several potential therapeutic targets.

A single intravenous administration of a sub-anesthetic ketamine dose during the perioperative period of cesarean section for preventing postpartum depression: A meta-analysis

The feasibility of intravenous ketamine administration during the perioperative period of cesarean section to prevent postpartum depression (PPD) has not been determined by meta-analysis. To evaluate the efficacy, safety and dose of prophylactic ketamine in offsetting PPD, we retrieved the following databases in English or Chinese from inception to December 2020: Pubmed, Embase, Web of Science, The Cochrane Library, CNKI, VIP and Wanfang. A total of 10 studies (9 RCTs and 1 retrospective study) were included with 2087 cases. Meta-analysis showed that in ketamine group, the score and the prevalence of PPD within 1 week postpartum were significantly reduced, whereas PPD score after 4 weeks postpartum showed no superiority. There was no significant difference in terms of total adverse events rate, although vomiting occurred more frequently in the ketamine group. In addition, we found that ketamine efficacy emerged at 0.5 mg/kg. By meta-regression, we observed that: (1) Age and BMI are negatively associated with mood response to ketamine. (2) An analgesic pump containing ketamine for continuous 48 h postpartum administration was more efficacious than an intravenous injection of ketamine during cesarean section. Current evidence shows ketamine could be efficacious and safe in the prophylactic management of PPD in women having a cesarean section.

The Multifaceted Actions of Curcumin in Obesity

Obesity remains a pervasive health concern worldwide with concomitant comorbidities such as cardiovascular diseases, diabetes, inflammation, and other metabolic disorders. A wealth of data validates dietary and lifestyle modifications such as restricting caloric intake and increasing physical activity to slow the obesity development. Recently, the advent of phytochemicals such as curcumin, the active ingredient in turmeric, has attracted considerable research interest in tracking down their possible effects in protection against obesity and obesity-related comorbidities. According to the existing literature, curcumin may regulate lipid metabolism and suppress chronic inflammation interacting with white adipose tissue, which plays a central role in the complications associated with obesity. Curcumin also inhibits the differentiation of adipocyte and improves antioxidant properties. In the present review, we sought to deliberate the possible effects of curcumin in downregulating obesity and curtailing the adverse health effects of obesity.

Metabolic variables associated with response to cognitive behavioural therapy for depression in females: A Canadian biomarker integration network for depression (CAN-BIND) study

INTRODUCTION

Cognitive behavioural therapy (CBT) is an established first-line treatment for depression; however, it remains unclear which factors predict a positive outcome with this approach. Prior work suggests that co-morbid obesity predicts a poorer response to antidepressant medication. The current study examined whether there is an association between weight parameters and improvement of depressive symptoms with CBT.

METHODS

This was a secondary analysis of data from the "Clinical and Biological Markers of Response to Cognitive Behavioural Therapy for Depression - 6" (CANBIND-6; https://clinicaltrials.gov/ct2/show/NCT02883257) study. Adult participants (n = 41) with a diagnosis of Major Depressive Disorder (MDD) or Persistent Depressive Disorder (PDD) were recruited from an outpatient tertiary psychiatric centre in Canada. Participants completed 20 individual sessions of CBT over 16 weeks. The primary measure for treatment outcome was the Montgomery-Åsberg Depression Rating Scale (MADRS) total score at week 16.

RESULTS

Thirty-seven participants completed assessments pre and post CBT. Baseline weight parameters were not correlated with treatment response to CBT in the entire group. There was a significant sex*waist circumference (WC) (B:-1.34; p = 0.004) and sex*body mass index (BMI) interaction (B:-2.03; p:0.009). In female participants, baseline waist circumference, but not BMI, significantly predicted week 16 MADRS after controlling for age and baseline MADRS (B:0.422 p:0.049).

LIMITATIONS

The major limitation of our preliminary finding is the small sample size.

CONCLUSION

Our preliminary findings suggest that higher waist circumference may be associated with a better treatment response to CBT for depression in females. This result could be of clinical relevance and warrants further investigation in larger and independent samples.

Does Patient Body Mass Index Affect the Outcome of Multimodal Rehabilitation in Chronic Mechanical Low Back Pain?

STUDY DESIGN

Retrospective.

OBJECTIVE

The aim of this study was to investigate the effect of body mass index (BMI) on pain and disability in patients with chronic mechanical low back pain (LBP) treated with multimodal rehabilitation.

SUMMARY OF BACKGROUND DATA

Despite being a well-known risk factor for developing LBP, there is minimal data on the effect of BMI on pain and disability in patients with chronic mechanical low back pain (LBP) treated with multimodal rehabilitation.

METHODS

Data from patients with chronic mechanical LBP who underwent multimodal rehabilitation treatment at a chain of spine rehabilitation outpatient clinics in one of the three BMI groups-1564 patients in normal body weight (BMI ≥18.5-24.9), 1990 patients in overweight (BMI ≥25-29.9), and 891 patients in obese (BMI ≥ 30) groups-were retrospectively analyzed. Pre- and post-treatment Numerical Pain Rating Scale (NPRS) and Oswestry Disability Index (ODI) scores, and final treatment outcomes were compared between the three groups. Multivariate analysis was used to determine the association between pre-treatment covariates and post-treatment clinical outcomes.

RESULTS

Post-treatment, the mean NPRS (P = 0.005) and mean ODI (P < 0.001) scores were significantly higher with a significantly lower percentage of full success outcome (P = 0.009) in the obese group when compared to normal and overweight groups. However, multivariate analysis showed a significant correlation between age, the number of treatment sessions, pre-treatment NPRS and ODI scores, and post-treatment NPRS and ODI scores and treatment failure, and no correlation with patient BMI.

CONCLUSION

Patient BMI may not affect pain and disability outcomes in patients undergoing a multimodal rehabilitation treatment for chronic LBP. In contrast to BMI, other covariates such as age, treatment sessions, and pre-treatment NPRS and ODI scores may be associated with increased risk for poor treatment outcome. Obese individuals can expect clinical outcomes similar to normal or overweight individuals with multimodal physical rehabilitation for chronic LBP.Level of Evidence: 3.

C-reactive protein is associated with cognitive performance in a large cohort of euthymic patients with bipolar disorder

Data support the notion that 40-60% of patients with bipolar disorder (BD) have neurocognitive deficits. It is increasingly accepted that functioning in BD is negatively impacted by these deficits, yet they have not been a successful target for treatment. The biomarkers that predict cognitive deficits in BD are largely unknown, however recent evidence suggests that inflammation may be associated with poorer cognitive outcomes in BD. We measured C-reactive protein (CRP), a marker of systemic inflammation and risk of inflammatory disease, in 222 euthymic BD patients and 52 healthy controls. Within the patient sample, using multivariate analyses of covariance (MANCOVA) we compared cognitive performance of those with high CRP (≥5 mg/L) versus the remaining subjects (<5 mg/L) on a battery of cognitive tests. We evaluated relationships with several other relevant clinical features. We also examined the role of CRP in cognitive decline using a proxy cognitive decline metric, defined as the difference between premorbid and current IQ estimates, in a logistic regression analysis. Approximately 80% of our sample were BD-I, and the remainder were BD-II and 42.6% of our sample had a history of psychosis. We found a statistically significant effect of CRP on cognitive performance on a broad range of tests; participants with CRP ≥ 5 mg/L had worse performance on several measures of executive functioning, MATRICS processing speed and MATRICS reasoning and problem solving relative to those with lower CRP. We also identified CRP as a significant positive predictor of proxy cognitive decline. Our results indicate that elevated CRP is associated with a broad cognitive dysfunction in affectively remitted BD patients. These results may point to a subgroup of patients who might benefit from treatments to reduce inflammation.

Body Mass Index as a Moderator of Treatment Response to Ketamine for Major Depressive Disorder

PURPOSE/BACKGROUND

Major depressive disorder (MDD) and obesity commonly co-occur. We sought to assess the impact of body mass index (BMI) on the acute antidepressant effects of ketamine in patients with treatment-resistant depression.

METHODS/PROCEDURES

Post hoc analyses were conducted from a multisite, randomized, double-blind, placebo-controlled trial designed to assess the rapid-onset effects of intravenous ketamine. Patients (n = 99) were randomized to a single dose administration of ketamine 0.1 mg/kg (n = 18), ketamine 0.2 mg/kg (n = 20), ketamine 0.5 mg/kg (n = 22), ketamine 1.0 mg/kg (n = 20), or active placebo, midazolam 0.045 mg/kg (n = 19). Patients were stratified for BMI. For patients randomized to ketamine (n = 80), BMI was assessed as a continuous variable and also categorically (obese, overweight, not obese/overweight [reference]). The primary outcome measure was the change on the 6-item Hamilton Depression Rating Scale 24 hours after treatment. Outcomes at day 3 were also assessed.

FINDINGS/RESULTS

The 6-item Hamilton Depression Rating Scale change scores at 24 hours were inversely associated with BMI (-0.28 ± 0.12, P = 0.02). With BMI operationalized categorically, both obese (-4.15 ± 1.41, P = 0.004) and overweight (-1.99 ± 1.14, P = 0.08) categories were inversely related to the 6-item Hamilton Depression Rating Scale change score at 24 hours, statistically significant for the obese category, as compared with the reference group. Similar but weaker findings were observed at 72 hours after infusion.

IMPLICATIONS/CONCLUSIONS

Higher BMI and obesity were associated with a more robust acute antidepressant response to ketamine. This may have clinical relevance for a great number of patients who have both MDD and obesity.

CLINICAL TRIAL REGISTRATION

NCT01920555.

Obesity as a risk factor for COVID-19: an overview

The current coronavirus disease-2019 (COVID-19) pandemic presents a huge challenge for health-care systems worldwide. Many different risk factors are associated with disease severity, such as older age, diabetes, hypertension, and most recently obesity. The incidence of obesity has been on the rise for the past 25 years, reaching over 2 billion people throughout the world, and obesity itself could be considered a pandemic. In this review, we summarize aspects involved with obesity, such as changes in the immune response, nutritional factors, physiological factors, and the gut-lung axis, that impact the viral response and the COVID-19 prognosis.

Association of poorer dietary quality and higher dietary inflammation with greater symptom severity in depressed individuals with appetite loss

BACKGROUND

Major depressive disorder (MDD) is the leading cause of years lived with disability; however, little is known about its etiology to inform treatment. For a subset of MDD patients, appetite change and/or bodily inflammation may play a role in exacerbating symptoms. The goal of this study is to examine whether, relative to healthy comparisons (HC), MDD individuals with increased versus decreased appetite symptoms show a differential relationship between diet quality and inflammation.

METHODS

Unmedicated current MDD (n = 61) varying in appetite change (decrease (MDD-DE): n = 39; increase (MDD-IN): n = 22) and HC (n = 42) completed 24-hour dietary recall and state depression/anxiety measures. Healthy eating and dietary inflammatory indices were calculated from dietary reports. Blood samples measured five inflammation-related biomarkers. Analyses investigated between- and within-group differences in the Healthy Eating Index (HEI), the Dietary Inflammatory Index (DII), inflammation-related blood biomarkers, and symptom severity.

RESULTS

While both MDD-DE and MDD-IN exhibited lower HEI scores than HC, only MDD-IN showed higher plasma interleukin-1 receptor antagonist (IL-1RA) and interleukin-6 (IL-6) levels than HC. In contrast, MDD-DE exhibited higher DII scores than MDD-IN and HC. Within MDD-DE, greater symptom severity was associated with lower HEI and higher DII.

LIMITATIONS

Modest sample sizes and the cross-sectional study design limited power to detect within-MDD effects.

CONCLUSIONS

Although MDD, regardless of appetite change, is linked to poorer dietary quality, depression severity was related to dietary characteristics only in subjects who reported appetite loss. Thus, increasing the quality of dietary intake could be a treatment target for some individuals with depression.

Neuroinflammation in Bipolar Depression

Bipolar disorder (BD) is a leading cause of worldwide disability among mood disorders. Pathological mechanisms are still vastly unclear, and current treatments with conventional medications are often unsatisfactory in maintaining symptoms control and an adequate quality of life. Consequently, current research is focusing on shedding new light on disease pathogenesis, to improve therapeutic effectiveness. Recent evidence has suggested a prominent role of inflammation in mood disorders. Elevated levels of peripheral proinflammatory mediators have been reported in BD, as well as in other mood disorders, and people with systemic autoimmune diseases have an increased risk of developing BD. These immunological alterations are stable, and current medications are unable to alter peripheral concentrations even when clinical improvement is evident. These findings have also been replicated in the central nervous system (CNS) milieu, whereas genetic studies have shown that these immune alterations are not due to the disorder itself, being detectable before the illness onset. Moreover, these inflammatory modifications seem to be affected by and linked to other biomarkers of the disorder, such as alterations of white matter (WM) microstructure, metabolism, kynurenine pathway, and circadian rhythmicity. Finally, these immune variations seem to be useful as predictors of therapeutic responsiveness to medications, and in discriminating between clinically different outcomes. The objective of this review is to summarize available evidence on the connection between inflammation and BD, focusing on peripheral inflammatory markers and recent findings on their connection with other typical features of BD, to outline a general overview of the disorder. Moreover, it is meant to analyze the issues with data gathering and interpretation, given the partially contradictory and inconsistent nature of results.

Factors Affecting Consumer Food Preferences: Food Taste and Depression-Based Evoked Emotional Expressions with the Use of Face Reading Technology

In this study, several factors (social status, age, gender, education, knowledge about healthy eating, and attitude to food) affecting consumer food choices (FC), including the relationship between the taste of food, FC, and depression, were analysed by using sensory traits and face reading technology. The first stage of the experimental scheme was the analysis of factors affecting consumer food preferences by using a questionnaire, while the second stage was evaluation of emotional expressions evoked by different food tastes in individuals with and without depressive disorders (DD), using the FaceReader 6 software. We show that gender is a significant factor for most emotional motivations, with a higher effect in females where there was an indication of increased cravings for sweets when feeling depressed. Age was a significant factor in the motivation to eat for positive feelings, while education had a significant influence on perceptions regarding healthy eating. Face reading technology was found to be sufficiently accurate to detect differences in facial expressions induced by different tastes of food, for groups with and without DD. In conclusion, many factors are of high importance in the analysis of food choices, and the results obtained using the FaceReader 6 technique are very promising for food-mood relation analysis. We suggest that mood has a strong link with the choice of food.

The synergic relationship of social anxiety, depressive symptoms and waist circumference in adolescents: Mediation analysis

BACKGROUND

It is not well established whether depression leads to weight loss or weight gain, or whether a relationship exists among depression, social anxiety, and weight status. The aim of this study was to evaluate the synergic association among social anxiety, depressive symptoms, and waist circumference (WC) during adolescence and examine whether depression mediated the relationship between social anxiety and WC.

METHODS

A cross-sectional study was performed with 1296 adolescents from a northeastern district in Brazil. It was used the Social Anxiety Scale for Adolescents (SAS-A) to evaluate symptoms of social anxiety and the Depression Scale of the Center for Epidemiologic Studies (CES-D) for symptoms of depression. Structural equation modeling was used to determine whether depression, social anxiety, and WC were synergically associated. Analysis was adjusted for sex, age, height, and mother's educational level.

RESULTS

Symptoms of social anxiety were directly associated with symptoms of depression and WC, whereas symptoms of depression were not associated with WC.

LIMITATIONS

This is a cross-sectional study, and so we cannot infer causality in the interpretation of results.

CONCLUSION

Social anxiety was found to be associated with depressive symptoms and WC. General medical doctors and health practitioners who observe overweight adolescents with any symptoms of anxiety might consider a thorough evaluation of the patient's mental health.

Relating shape/weight based self-esteem, depression, and anxiety with weight and perceived physical health among young adults

Simultaneous contributions of self-esteem, depression, and anxiety to weight and perceived physical health in young adults is understudied. A diverse sample of 424 young adults completed measures of shape/weight based self-esteem, depression, anxiety, and perceived physical health. Height and weight were measured to calculate body mass index (BMI). Latent profile analysis was conducted to derive patterns of depression, anxiety, and shape/weight based self-esteem. Then, we examined the association of the profiles with weight status and perceived physical health. Three profiles emerged: (1) High Shape/Weight Influence (HSWI); (2) Low Shape/Weight, Depression, & Anxiety Influence (LSWDAI); and (3) High Depression & Anxiety Influence (HDAI). The HSWI profile had significantly higher BMI than the LSWDAI and HDAI profiles, and significantly lower perceived physical health than the LSWDAI profile. Over emphasis on shape/weight, regardless of depression and anxiety, is associated with elevated weight and negative internalized health views.

Development of the Weight-Related Sign and Symptom Measure

BACKGROUND

Overweight and obesity have been associated with physical and emotional signs & symptoms. Research has shown that modest weight loss can mitigate some symptoms in individuals with overweight or obesity. This study's purpose was to conduct concept elicitation (CE) interviews to provide documented qualitative support for the development of the Weight-Related Sign and Symptom Measure (WRSSM) to assess weight-related signs/symptoms in U.S. adults with overweight or obesity, with or without type 2 diabetes (T2DM).Eight focus groups were conducted in the U.S. with adults with overweight or obesity to understand weight-related sign/symptom impact from the patient perspective. Individual interviews were conducted with clinical experts to understand the impact of overweight or obesity on patient signs and symptoms. Transcripts were analyzed to identify symptoms and observable signs. A clinical challenge was conducted with clinical experts to confirm the signs/symptoms were clinically relevant, important to patients, and would improve with modest weight loss. Cognitive debriefing (CD) was conducted with individuals with overweight or obesity to confirm readability and symptom relevance.

RESULTS

CE interviews were conducted with four clinical experts, and 61 people, 32% of whom had T2DM, participated in the focus groups. Analyses identified two major areas of obesity impacts: weight-related physical signs/symptoms, and emotional impacts. The most frequently reported physical signs/symptoms were feeling tired (74%), shortness of breath (69%), and joint pain (64%). The most often reported emotional impacts included poor self-image (72%) and depression (51%). Twelve signs/symptoms were identified during item generation and included on the preliminary measure. Twelve adults with overweight/obesity, who were not part of the focus groups, participated in CD. After the CD, a validation-ready, 10-item WRSSM measure was generated.

CONCLUSIONS

Findings provide evidence of content validity for the validation-ready WRSSM in U.S. adults with overweight or obesity, including people with and without T2DM.

Regulatory T Cells As Supporters of Psychoimmune Resilience: Toward Immunotherapy of Major Depressive Disorder

There is growing evidence that inflammation plays a role in major depressive disorder (MDD). As the main role of regulatory T cells (Tregs) is to control inflammation, this might denote a Treg insufficiency in MDD. However, neither a qualitative nor a quantitative defect of Tregs has been ascertained and no causality direction between inflammation and depression has been established. Here, after reviewing the evidence supporting a relation between Treg insufficiency and MDD, we conclude that a novel therapeutic approach based on Treg stimulation could be valuable in at least the subset of patients with inflammatory MDD. Low-dose interleukin-2 appears to be a good candidate as it is not only a safe stimulator of Tregs in humans but also an inhibitor of pro-inflammatory Th17 lymphocytes. Here, we discuss that a thorough immune investigation as well as immunotherapy will be heuristic for deciphering the pathophysiology of MDD.

Sex Differences in Obesity and Mental Health

PURPOSE OF REVIEW

The purposes of this study were to examine the relationships between obesity and a wide range of mental health issues and to identify where sex differences exist and may vary across disorders.

RECENT FINDINGS

Research on sex differences in the relationship between obesity and psychiatric disorders is more abundant in some areas, such as depression and eating disorders, than others, such as anxiety, trauma, and substance use. However, for most of the disorders, their relationships with obesity and sex are complex and are usually moderated by additional variables. Thus, studies that find stronger relationships for women between depression and obesity cross-sectionally do not tell the whole story, as longitudinal studies suggest that this relationship may also be present among men, particularly when confounders are considered. For those with eating disorders, men and women with obesity are fairly equally affected, and weight and shape concerns may play a role in maintaining these behaviors for both sexes. Weight stigma, though, seems to have worse consequences for women than men with obesity. Sex differences exist in relation to the associations between mental health and obesity. However, these differences vary by disorder, with disorder-specific moderators playing a role, such as age for depressive disorders, comorbid depression for anxiety disorders, and weight and shape concerns for eating disorders. More work is needed to understand if sex differences play a role in the relationship between obesity and anxiety, trauma, and substance use disorders.

The effect of obesity on treatment outcomes for low back pain

Background

The objective of this study was to estimate the effect of obesity, as measured by body mass index (BMI), on treatment outcomes for low back pain (LBP).

Methods

Data from the University of California, Los Angeles, and Friendly Hills Healthcare Network low back pain study (collected from 1995 to 2000) were used to perform a secondary data analysis of this randomized clinical trial on adults who sought care for LBP. BMI was the primary predictor variable. Binary logistic regression modeling was performed to estimate odds ratios adjusted for the effects of confounders.

Results

Using normal weight as the referent population, underweight and overweight populations did not display significant odds ratios for any of the outcome variables. The obese population demonstrated odds ratios of 0.615 (0.379, 0.998) for improvement of disability and 0.550 (0.341, 0.889) for improvement of most severe back pain.

Conclusion

The results of this study support an association between obesity and less effective treatment outcomes whether measured by disability (Roland-Morris scale) or pain (most severe pain NRS). Overweight and underweight populations do not appear to have significantly different outcomes than normal weight populations.

Trial registration

This trial was designed and conducted prior to the advent of registries.

C-reactive protein concentrations across the mood spectrum in bipolar disorder: a systematic review and meta-analysis

BACKGROUND

Inflammatory processes and neural-immune interactions have been implicated in the pathogenesis of psychiatric conditions, but studies in bipolar disorder are inconclusive so far. We aimed to investigate whether peripheral concentrations of C-reactive protein (CRP), an acute-phase response protein of inflammatory activity, are increased in bipolar disorder across the mood spectrum.

METHODS

In this systematic review and meta-analysis, we searched MEDLINE, the Cochrane Library, Scopus, and Web of Knowledge from database inception to Aug 14, 2016, for studies that measured serum and plasma CRP concentrations in adult patients with bipolar disorder (as defined by DSM-IV-TR) and healthy controls. We extracted data from published reports. We did three between-group meta-analyses comparing CRP concentrations in patients in mania, depression, or euthymia, with those in healthy controls (cross-sectional studies), and two within-group meta-analyses comparing changes in CRP concentrations before and after treatment of an index manic or depressive episode (longitudinal studies). We used Hedges' adjusted g to calculate effect sizes and pooled results using random-effect models. We also did meta-regression analyses by mood state to investigate possible moderators of CRP concentrations.

FINDINGS

We identified 27 studies representing 2161 patients with bipolar disorder and 81 932 healthy controls. Compared with healthy individuals, CRP concentrations were moderately increased in people with bipolar disorder during depression (g 0·67, 95% CI 0·23 to 1·11; p=0·003) and euthymia (0·65, 0·40 to 0·90; p<0·0001) and more substantially increased during mania (0·87, 0·58 to 1·15; p<0·0001). The extent of the increases in CRP concentrations in mania and depression was not related to symptom severity (p=0·256 for mania and p=0·626 for depression). CRP concentrations were moderately decreased after resolution of an index manic episode (-0·36, -0·66 to -0·05; p=0·022) and slightly decreased after resolution of an index depressive episode (-0·18, -0·30 to -0·07; p=0·002).

INTERPRETATION

CRP concentrations are increased in bipolar disorder regardless of mood state, but are higher during mania than in depression and euthymia, suggesting an increased inflammatory burden in mania.

FUNDING

None.

Roux-en-Y Gastric Bypass

Background:

Roux-en-Y gastric bypass (RYGB) is considered the gold standard for gastric bypass, displaying better results for metabolic disorders than other surgical procedures over the long term. The aim of this study was to determine the effects of bariatric surgery, in particular the RYGB technique, on metabolic syndrome (MS) and other biochemical parameters implicit in the comorbid conditions associated with obesity, as well as to explore the influence of this surgical procedure on psychiatric comorbidity in the study population.

Method:

An observational retrospective cohort study based on 146 clinical records of patients having undergone RYGB between January 1, 2011, and January 1, 2014, was performed. Data related to metabolic and psychiatric comorbidity were gathered at three stages: prior to surgery and at 3 and 9 months following surgery.

Results:

There was a progressive and statistically significant reduction of all biochemical parameters analyzed at 3 and 9 months following surgery except high-density lipoprotein cholesterol, which significantly increased (beneficial) in value. These changes imply a remission of >90% for all metabolic disorders and the consequent tendency toward a reduction in prescribed pharmacological treatments, with MS found in only one subject at 9 months. There was, however, no significant reduction in pharmacological treatments for psychiatric comorbidities.

Conclusion:

Findings suggest that RYGB is an effective treatment for MS and other metabolic disorders but not for psychiatric comorbidities accompanying MS.