Gastric dysmotility in major depression

Abnormal cortical-striatal-thalamic-cortical circuit centered on the thalamus in MDD patients with somatic symptoms: Evidence from the REST-meta-MDD project

OBJECTIVE

Somatic symptoms are common comorbidities of major depressive disorder (MDD), and negatively impact the course and severity of the disease. In order to enrich the understanding of the pathological mechanism and clarify the neurobiological basis of somatic symptoms in depression, we attempted to explore the changes of brain structure and function in a large sample between depression with and without somatic symptoms.

METHODS

Structure magnetic resonance imaging (MRI) data were collected from 342 patients with somatic symptoms (SD), 208 patients without somatic symptoms (NSD), and 510 healthy controls (HCs) based on the REST-meta-MDD project. We analyzed the whole brain VBM maps of the three groups, and combined with weight degree centrality (DC) index, we investigated whether the brain regions with gray matter volume (GMV) and gray matter density (GMD) abnormalities in MDD patients with somatic symptoms had corresponding brain functional abnormalities.

RESULTS

Between depression with and without somatic symptoms, we found that there are extensive GMV and GMD differences involving cortical regions such as the temporal lobe, occipital lobe, and insula, as well as subcortical brain regions such as thalamus and striatum. The comparison results of weight DC signals of GMV and GMD abnormal clusters between the SD and NSD groups were basically consistent with the GMV and GMD abnormal clusters.

CONCLUSION

The results indicate that the structure and function of cortical-striatal-thalamic-cortical (CSTC) circuit centered on the thalamus were abnormal in MDD patients with somatic symptoms. This may be the neurobiological basis of somatic symptoms in MDD.

Altered Metabolomics in Bipolar Depression With Gastrointestinal Symptoms

OBJECTIVE

Although gastrointestinal (GI) symptoms are very common in patients with bipolar disorder (BD), Few studies have researched the pathomechanism behind these symptoms. In the present study, we aim at elucidate the pathomechanism of GI symptoms in BD through metabolomic analysis.

METHOD

BD patients were recruited from Shanxi Bethune Hospital that divided into two groups, each group assessed with the 24-item Hamilton Depression Rating Scale (HAMD-24) according to the presence or absence of GI symptoms. Healthy controls were recruited from the medical examination center of the same hospital. Differential metabolites were identified and further analyzed using Metabo Analyst 3.0 to identify associated metabolic pathways.

RESULTS

There were significantly higher HAMD-24 scores in the GI symptoms group than that of non-GI symptoms group (p = 0.007). Based on metabolomic analysis results, we found that the common disturbances metabolic pathway of both two patients groups was ketone body metabolism, and the unique disturbances metabolic pathways of BD with GI symptoms were fatty acid biosynthesis and tyrosine metabolism, and these changes were independent of dietary habits.

CONCLUSION

BD patients with GI symptoms exhibited disturbances in fatty acid and tyrosine metabolism, perhaps suggesting that the GI symptoms in BD patients are related to disturbances of the gut microbiome. Both groups of patients jointly exhibit disturbances of ketone body metabolism, which may serve as a biomarker for the pathogenesis of BD patients.

Brain structural alterations in MDD patients with gastrointestinal symptoms: Evidence from the REST-meta-MDD project

OBJECTIVE

While gastrointestinal (GI) symptoms are very common in patients with major depressive disorder (MDD), few studies have investigated the neural basis behind these symptoms. In this study, we sought to elucidate the neural basis of GI symptoms in MDD patients by analyzing the changes in regional gray matter volume (GMV) and gray matter density (GMD) in brain structure.

METHOD

Subjects were recruited from 13 clinical centers and categorized into three groups, each of which is based on the presence or absence of GI symptoms: the GI symptoms group (MDD patients with at least one GI symptom), the non-GI symptoms group (MDD patients without any GI symptoms), and the healthy control group (HCs). Structural magnetic resonance images (MRI) were collected of 335 patients in the GI symptoms group, 149 patients in the non-GI symptoms group, and 446 patients in the healthy control group. The 17-item Hamilton Depression Rating Scale (HAMD-17) was administered to all patients. Correlation analysis and logistic regression analysis were used to determine if there was a correlation between the altered brain regions and the clinical symptoms.

RESULTS

There were significantly higher HAMD-17 scores in the GI symptoms group than that of the non-GI symptoms group (P < 0.001). Both GMV and GMD were significant different among the three groups for the bilateral superior temporal gyrus, bilateral middle temporal gyrus, left lingual gyrus, bilateral caudate nucleus, right Fusiform gyrus and bilateral Thalamus (GRF correction, cluster-P < 0.01, voxel-P < 0.001). Compared to the HC group, the GI symptoms group demonstrated increased GMV and GMD in the bilateral superior temporal gyrus, and the non-GI symptoms group demonstrated an increased GMV and GMD in the right superior temporal gyrus, right fusiform gyrus and decreased GMV in the right Caudate nucleus (GRF correction, cluster-P < 0.01, voxel-P < 0.001). Compared to the non-GI symptoms group, the GI symptoms group demonstrated significantly increased GMV and GMD in the bilateral thalamus, as well as decreased GMV in the bilateral superior temporal gyrus and bilateral insula lobe (GRF correction, cluster-P < 0.01, voxel-P < 0.001). While these changed brain areas had significantly association with GI symptoms (P < 0.001), they were not correlated with depressive symptoms (P > 0.05). Risk factors for gastrointestinal symptoms in MDD patients (p < 0.05) included age, increased GMD in the right thalamus, and decreased GMV in the bilateral superior temporal gyrus and left Insula lobe.

CONCLUSION

MDD patients with GI symptoms have more severe depressive symptoms. MDD patients with GI symptoms exhibited larger GMV and GMD in the bilateral thalamus, and smaller GMV in the bilateral superior temporal gyrus and bilateral insula lobe that were correlated with GI symptoms, and some of them and age may contribute to the presence of GI symptoms in MDD patients.

Relative risk of functional dyspepsia in patients with sleep disturbance: a population-based cohort study

Increased prevalence of sleep disorders has been found in patients with functional dyspepsia; however, direction of causality remains unclear. Our aim was to compare the risk of incident functional dyspepsia between patients with and without sleep disturbance from a large population-based sample. Utilizing a nation-wide health insurance administrative dataset, we assembled an 11-year historic cohort study to compare subsequent incidence of diagnosed functional dyspepsia between adult patients with any diagnosis of sleep disturbance and age- and gender-matched controls. Hazard ratios adjusted for other relevant comorbidities and medications were calculated using Cox regression models. 45,310 patients with sleep disorder and 90,620 controls were compared. Patients with sleep apnea had a 3.3-fold (95% confidence interval: 2.82 ~ 3.89) increased hazard of functional dyspepsia compared with controls. This increased risk persisted regardless of previously diagnosed depression coexisted. Sleep disturbance was associated with an increased risk of subsequent functional dyspepsia. Potential mechanisms are discussed.

Gut Hormones as Potential Therapeutic Targets or Biomarkers of Response in Depression: The Case of Motilin

Recent research has identified the gut–brain axis as a key mechanistic pathway and potential therapeutic target in depression. In this paper, the potential role of gut hormones as potential treatments or predictors of response in depression is examined, with specific reference to the peptide hormone motilin. This possibility is explored through two methods: (1) a conceptual review of the possible links between motilin and depression, including evidence from animal and human research as well as clinical trials, based on a literature search of three scientific databases, and (2) an analysis of the relationship between a functional polymorphism (rs2281820) of the motilin (MLN) gene and cross-national variations in the prevalence of depression based on allele frequency data after correction for potential confounders. It was observed that (1) there are several plausible mechanisms, including interactions with diet, monoamine, and neuroendocrine pathways, to suggest that motilin may be relevant to the pathophysiology and treatment of depression, and (2) there was a significant correlation between rs2281820 allele frequencies and the prevalence of depression after correcting for multiple confounding factors. These results suggest that further evaluation of the utility of motilin and related gut peptides as markers of antidepressant response is required and that these molecular pathways represent potential future mechanisms for antidepressant drug development.

Functional dyspepsia in depression: A population-based cohort study

BACKGROUND

Patients with functional dyspepsia (FD) are more likely to have persistent depression, yet whether depression and antidepressant treatments are associated with subsequent risk of FD remain unclear.

METHODS

Using population-based insurance administrative data of Taiwan, an 11-year historic cohort study was assembled, comparing cases aged 18 and above with the diagnosis of depressive disorder, to a propensity score-matched sample of adults without depression. Incident FD as a primary diagnosis was ascertained. Hazard ratios of FD were calculated using Cox regression models by age, gender, other comorbidities, nonsteroidal anti-inflammatory medications, antidepressants and antidiabetic agents.

RESULTS

A total of 20,197 people with depressive disorder and 20,197 propensity score-matched comparisons without depression were followed up. The incidence of FD was 1.7-fold greater in the depressive cohort than in comparisons (12.9 versus 7.57 per 1000 person-years), with an adjusted hazard ratio (aHR) of 2.16 (95% confidence interval (CI) 1.93~2.41). Increased risks were significant regardless of comorbidities or medication uses, the highest in the untreated depression group compared to the group without depression, with an aHR of 2.51(95% CI 2.15~2.93).

CONCLUSIONS

This population-based study showed that patients with depressive disorder are at elevated risk of FD. Antidepressant treatment could reduce the risk of FD.

Sulprostone-Induced Gastric Dysrhythmia in the Ferret: Conventional and Advanced Analytical Approaches

Nausea and emesis resulting from disease or drug treatment may be associated with disrupted gastric myoelectric activity (GMA). Conventional analytical techniques can determine the relative degrees of brady-, normo-, and tachygastric power, but lose information relative to the basic slow wave shape. The aim of the present study was to investigate the application of advanced analytical techniques in the analysis of disrupted GMA recorded after administration of sulprostone, a prostaglandin E_3/1 agonist, in ferrets. Ferrets were implanted with radiotelemetry devices to record GMA, blood pressure, heart rate (HR) and core body temperature 1 week before the administration of sulprostone (30 μg/kg) or vehicle (saline, 0.5 mL/kg). GMA was initially analyzed using fast Fourier transformations (FFTs) and a conventional power partitioning. Detrended fluctuation analysis (DFA) was also applied to the GMA recordings to reveal information relative to the fluctuation of signals around local trends. Sample entropy (SampEn) analysis was used for examining the regularity of signals. Conventional signal processing techniques revealed that sulprostone increased the dominant frequency (DF) of slow waves, with an increase in the percentage power of the tachygastric range and a decrease in the percentage power of the normogastric range. DFA revealed that sulprostone decreased the fluctuation function, indicative of a loss of the variability of GMA fluctuations around local trends. Sulprostone increased SampEn values, indicating a loss of regularity in the GMA data. Behaviorally, sulprostone induced emesis and caused defecation. It also increased blood pressure and elevated HR, with an associated decrease in HR variability (HRV). Further analysis of HRV revealed a decrease in both low-frequency (LF) and high-frequency (HF) components, with an overall increase in the LF/HF ratio. Sulprostone did not affect core body temperature. In conclusion, DFA and SampEn permit a detailed analysis of GMA, which is necessary to understand the action of sulprostone to modulate gastric function. The action to decrease HRV and increase the LF/HF ratio may be consistent with a shift toward sympathetic nervous system dominance, commonly seen during nausea.

The Changes of qEEG Approximate Entropy during Test of Variables of Attention as a Predictor of Major Depressive Disorder

Evaluating brain function through biosignals remains challenging. Quantitative electroencephalography (qEEG) outcomes have emerged as a potential intermediate biomarker for diagnostic clarification in psychological disorders. The Test of Variables of Attention (TOVA) was combined with qEEG to evaluate biomarkers such as absolute power, relative power, cordance, and approximate entropy from covariance matrix images to predict major depressive disorder (MDD). EEG data from 18 healthy control and 18 MDD patients were monitored during the resting state and TOVA. TOVA was found to provide aspects for the evaluation of MDD beyond resting electroencephalography. The results showed that the prefrontal qEEG theta cordance of the control and MDD groups were significantly different. For comparison, the changes in qEEG approximate entropy (ApEn) patterns observed during TOVA provided features to distinguish between participants with or without MDD. Moreover, ApEn scores during TOVA were a strong predictor of MDD, and the ApEn scores correlated with the Beck Depression Inventory (BDI) scores. Between-group differences in ApEn were more significant for the testing state than for the resting state. Our results provide further understanding for MDD treatment selection and response prediction during TOVA.

The prognosis and changes of regional brain gray matter volume in MDD with gastrointestinal symptoms

Objective: It is common that major depressive disorder (MDD) is accompanied by gastrointestinal (GI) symptoms. However, few studies have focused on the clinical characteristics and its possible mechanism, while brain gray matter (GM) structure is important in the pathogenesis of GI symptoms. In this study, we aimed to investigate the basic clinical characteristics and regional GM volume changes in MDD accompanied by GI symptoms. Method: Patients with MDD (n=49) and age, gender, and educational level-matched healthy controls (n=30) were recruited. Patients with MDD were divided into two groups based on the GI status: MDD with (n=27) and without (n=22) GI symptoms. The 24-item Hamilton Depression Rating Scale (HAMD) was administered. T1-weighted anatomical images were obtained and analyzed. Correlation analysis was used to identify the possible associations between changed regional GM volume and GI symptoms and depressive symptoms. Results: The HAMD reductive ratio for 2 weeks of treatment in the GI symptoms group was significantly higher than the non-GI symptoms group (P<0.05). The regional GM volume showed significant differences among the three groups (Gaussian Random Field [GRF] correction, voxel-P<0.01, cluster-P <0.05). Compared with non-GI symptoms group, GI symptoms group exhibited significantly increased GM volume in the left hippocampus, left parahippocampal gyrus, right parahippocampal gyrus; and decreased GM volume in the right middle frontal gyrus, right precentral gyrus, right cuneus, right precuneus, right superior occipital gyrus (GRF correction, voxel-P <0.01, cluster-P <0.05). These altered brain areas were correlated with the GI symptoms, not depressive symptoms. Conclusion: The changed regional brain GM volume in GI-MDD group may be the pathogenesis for the GI symptoms. In addition, the GI symptoms may predict the prognosis of MDD.

Pupillary light reflex is altered in adolescent depression

Major depressive disorder is associated with abnormal autonomic regulation which could be noninvasively studied using pupillometry. However, the studies in adolescent patients are rare. Therefore, we aimed to study the pupillary light reflex (PLR), which could provide novel important information about dynamic balance between sympathetic and parasympathetic nervous system in adolescent patients suffering from major depression. We have examined 25 depressive adolescent girls (age 15.2+/-0.3 year) prior to pharmacotherapy and 25 age/gender-matched healthy subjects. PLR parameters were measured separately for both eyes after 5 min of rest using Pupillometer PLR-2000 (NeurOptics, USA). The constriction percentual change for the left eye was significantly lower in depressive group compared to control group (-24.12+/-0.87 % vs. -28.04+/-0.96 %, p<0.01). Furthermore, average constriction velocity and maximum constriction velocity for the left eye were significantly lower in depressive group compared to control group (p<0.05, p<0.01, respectively). In contrast, no significant between-groups differences were found for the right eye. Concluding, this study revealed altered PLR for left eye indicating a deficient parasympathetic activity already in adolescent major depression. Additionally, the differences between left and right eye could be related to functional lateralization of autonomic control in the central nervous system.

Autonomic dysfunction of gastric motility in major depression

BACKGROUND

Patients suffering from major depressive disorder (MDD) often complain about somatic symptoms. Cardiac complaints have been examined predominantly. However, gastrointestinal complaints are also reported frequently and are associated with worse outcomes. The research concerning changes in gastric motility of these patients is rather sparse. The aim of our study was to determine dysfunction of gastric motility and gastrointestinal symptoms in MDD. The duration and severity of MDD were examined regarding its influence over gastric emptying.

METHODS

Gastric emptying was determined by a ¹³C-acetate breath test in patients with MDD (n = 29) and healthy control subjects (n = 51). Prior to this, depressive illness was operationalized using external and self-assessment scales (HAMD-21, MADRS, BDI, CGI). Whether the severity or duration of MDD influenced the gastric emptying parameters was examined using Spearman's correlation. In addition, autonomic complaints were recorded by means of an ANS score. Each ANS score item was determined using a Mann-Whitney U or Kruskal-Wallis test concerning the gastric emptying parameters.

RESULTS

There was a significant difference in the parameters of the maximum gastric emptying rate (T_max) and gastric half emptying time T_1/2b between patients with MDD and healthy control subjects (T_max 66.21min vs 53.35min, p < 0.006, T_1/2b 207.59min vs 133.27min, p < 0.005). There was a significant negative correlation between T_max and the severity of MDD determined with the depression rating scales BDI (Spearman's rank - 0.521, p = 0.013) and HAMD-21 (r - 0.384, p = 0.048). No correlation was found between the duration of MDD and the maximum gastric emptying rate (r - 0.125, p = 0.519) and gastric half emptying time (r - 0.62, p = 0.749).

CONCLUSION

Gastrointestinal motility is significantly impaired in patients with MDD compared to healthy control subjects. Autonomic complaints were indicated frequently in MDD patients. The duration of MDD had no influence over the time of gastric emptying. There was a significant negative correlation between the severity of MDD and T_max, indicating that the T_max was reached earlier with the progression of MDD. The slowing of gastric motility in MDD patients is likely a result of a dysfunction of the autonomic nervous system.

Altered Resting-State Brain Activities in Drug-Naïve Major Depressive Disorder Assessed by fMRI: Associations With Somatic Symptoms Defined by Yin-Yang Theory of the Traditional Chinese Medicine

Identification of biological markers for defining subtypes of major depressive disorder (MDD) is critical for better understanding MDD pathophysiology and finding effective treatment intervention. The "Yin and Yang" theory is a fundamental concept of traditional Chinese Medicine (TCM). The theory differentiates MDD patients into two subtypes, Yin and Yang, based on their somatic symptoms, which had empirically been used for the delivery of effective treatment in East Asia. Nonetheless, neural processes underlying Yin and Yang types in MDD are poorly understood. In this study, we aim to provide physiological evidence using functional magnetic resonance imaging (fMRI) to identify altered resting-state brain activity associated with Yin and Yang types in drug-naïve MDD patients. The Yin type and Yang type MDD patients showed increased amplitude of low-frequency fluctuation (ALFF) in different cortical brain areas in the parietal, temporal, and frontal lobe, compared to matched healthy controls. Differential ALFF is also observed in several cortical areas in frontal lobe and insula between Yin and Yang type group. Of note, although ALFF is increased in the inferior parietal lobe in both Yin and Yang type group, inferior parietal lobe-centered functional connectivity (FC) is increased in Yang type, but is decreased in Ying type, compared with matched healthy controls. These results suggest that differential resting-state brain activity and functional connectivity in Yin and Yang types may contribute to biological measures for better stratification of heterogeneous MDD patients.

The role of incongruence between the perceived functioning by patients and clinicians in the detection of psychological distress among functional and motor digestive disorders

OBJECTIVES

Previous research on gastrointestinal and other medical conditions has shown the presence of incongruence between self- and clinician-reported functioning and its relation with psychopathology. The main objective of this study was to test whether inconsistencies between clinician- and self-assessed functionality can be used to detect psychopathology among patients diagnosed of motor or functional gastrointestinal disorders.

METHODS

One hundred and three patients from a gastroenterology inpatient unit were included in this study. All patients underwent clinical assessment, including intestinal manometry, Rome III criteria for functional gastrointestinal disorders, and psychological and psychiatric evaluation. Patients with suspected gastroparesis underwent a scintigraphic gastric emptying test. Definitive diagnoses were made at discharge.

RESULTS

Patients with higher levels of incongruence differed in various sociodemographic (age, educational level, work activity and having children) and psychopathological (all SCL-90-R subscales except anxiety and hostility) characteristics. Using general lineal models, incongruence was found to be the variable with stronger relations with psychopathology even when controlling for diagnosis. Interactions were found between incongruence and diagnosis reflecting a pattern in which patients with functional disorders whose subjective evaluation of functioning is not congruent with that of the clinician, have higher levels of psychopathology than patients with motor disorders.

CONCLUSIONS

Incongruence between clinician and self-reported functionality seems to be related to higher levels of psychopathology in patients with functional disorders. These findings underscore the need for routine psychosocial assessment among these patients. Gastroenterologists could use the concept of incongruence and its clinical implications, as a screening tool for psychopathology, facilitating consultation-liaison processes.

An exploratory study comparing psychological profiles and its congruence with clinical performance among patients with functional or motility digestive disorders

Functional gastrointestinal disorders have been related with different psychological conditions. On the contrary, the role of psychological factors within gastrointestinal motor disorders remains unclear. The objective of this study was to explore the differences and congruence with clinical performance of the psychological profile and subjective functionality among patients diagnosed with functional gastrointestinal disorders and gastrointestinal motor disorders. Using a double-blind design, 56 inpatients from a Gastroenterology Department were included in the study. No major differences were detected between the two groups. However, clinical performance was coherent with subjective physical functioning only among patients diagnosed with gastrointestinal motor disorders. These results may provide useful information for gastroenterologists dealing with patients' complaints not consistent with their clinical profile.

Factors associated with frovatriptan response in patients with migraine: A prospective, observational study

BACKGROUND

Almost one-third of patients with migraine do not adequately respond to triptans. We examined factors contributing to frovatriptan response in patients with migraine.

METHODS

We enrolled new patients with migraine who consecutively visited our headache clinic. Eligible patients were instructed to take 2.5 mg of frovatriptan as soon as possible after migraine attack. The responsiveness was determined by whether headache was relieved or absent within 4 hours after the intake of frovatriptan. We assessed frovatriptan to be efficacious when headache responded to its administration in at least one of two successive migraine attacks and inefficacious when headache was not relieved in either attack. We included demographic, clinical and psychiatric variables in the analysis of factors associated with frovatriptan response.

RESULTS

Of 128 eligible patients, 28 (21.9%) experienced frovatriptan inefficacy. In 24 patients with current major depressive disorder, 12 (50.0%) had frovatriptan inefficacy. Only current major depressive disorder was identified as a risk factor for inefficacy (odds ratio = 5.500, 95% confidence interval 2.103-14.382, ITALIC! p = 0.001).

CONCLUSIONS

Depression may be a risk factor of frovatriptan inefficacy in patients with migraine, even though half of patients with major depressive disorder respond to frovatriptan.

Heart rate time irreversibility is impaired in adolescent major depression

We aimed to study heart rate time irreversibility--a nonlinear qualitative characteristics of heart rate variability indicating complexity of cardiac autonomic control at rest and in response to physiological stress (orthostasis) in never-treated major depressive disorder (MDD) adolescent female patients.

METHODS

We studied 20 MDD girls and 20 healthy age-matched girls at the age of 15 to 18 years. The ECG was recorded in supine position and in response to position change from lying to standing (orthostasis). Time irreversibility analysis was performed using Porta's (P%), Guzik's (G%) and Ehlers' (E) index. The depressive disorder severity was evaluated using Montgomery-Asberg Depression Rating Scale (MADRS) and Children's Depression Inventory (CDI).

RESULTS

Resting heart rate time irreversibility indices (logG%, logP%, Ehlers' index) were significantly reduced in MDD female patients without significant differences in response to orthostasis in MDD girls compared to controls. No significant correlations between time irreversibility and MDD severity were observed.

CONCLUSION

This study revealed the impaired heart rate asymmetry pattern indicating an altered complexity of cardiac autonomic regulation in adolescent female patients suffering from MDD.

Patterns of cardiorespiratory coordination in young women with recurrent major depressive disorder treated with escitalopram or venlafaxine

Evidence from previous studies suggests autonomic dysregulation in patients with major depressive disorder (MDD). Antidepressant treatment may also affect central autonomic function. We investigated whether the type of antidepressant might be associated with the pattern of cardiorespiratory coordination in non-depressed women with recurrent MDD. Resting electrocardiograms and respiratory signals were simultaneously recorded from 38 euthymic women with recurrent MDD who were treated with either escitalopram (n=19) or venlafaxine (n=19) monotherapy and from 38 healthy women. Linear measures of heart rate variability were extracted to assess cardiac autonomic control. Sample entropy (SampEn) was computed to assess the complexity of heart rate and respiratory signals, and cross-SampEn was calculated to measure the nonlinear interaction of both signals. Significant decreases in the cardiovagal tone and cardiorespiratory coupling of women with recurrent MDD receiving venlafaxine, and tendencies toward lower cardiovagal tone and cardiorespiratory coupling in women with recurrent MDD receiving escitalopram were observed when compared with healthy controls. Effect sizes for these differences were large between women receiving venlafaxine and healthy controls. We found a positive association between cardiorespiratory decoupling and venlafaxine dose. Norepinephrine-enhancement, within a therapeutic dose range, seems to be closely associated with decreased vagal tone and reduced nonlinear coupling between heart rate and respiration in euthymic women with recurrent MDD. However, the effects of serotonin enhancement on cardiovagal tone should be considered. Our results suggest that the pharmacodynamic properties of antidepressants may affect autonomic regulation of women with recurrent MDD even in euthymic state.

Pharmacobezoar in an obese patient with intragastric balloon: a case revealed at endoscopy

Pharmacobezoar formation is a very rare complication that occurs in cases of altered gastrointestinal motility or to a background of disturbed anatomy of the gastrointestinal tract. The case of an obese and depressed patient treated by an intragastric balloon for weight loss, who was revealed to have a pharmacobezoar during endoscopy for early balloon removal, is presented. The possible causes of pharmacobezoar formation in such a patient treated with an intragastric balloon are discussed.

Cardio-respiratory coupling in untreated patients with major depression

BACKGROUND

Depressive disorders are known to be associated with higher risks of cardiovascular diseases. Several studies have reported an imbalance within the autonomic nervous system (ANS) as one putative cause. Previous investigations showed decreased cardio-respiratory coupling in depressive patients that were treated with nortriptyline. We aimed to compare parameters of heart rate variability and cardio-respiratory coupling between unmedicated patients suffering from major depressive disorder (MDD) and healthy controls in order to further understand autonomic dysfunction in the disease.

METHODS

We investigated eighteen unmedicated patients with major depressive disorder and eighteen matched healthy controls. Electrocardiogram and respiratory signals were obtained during a twenty minute resting period. Time- and frequency based parameters of HRV, respiratory sinus arrhythmia (RSA), approximate entropy of heart rate (ApEn(RR)) and respiratory rate (ApEn(Resp)) were calculated. Additionally, cross-ApEn between RR-intervals and respiration time series was determined, reflecting coupling of both signals.

RESULTS

Patients showed an increased heart rate and LF/HF-ratio. Respiratory sinus arrhythmia (RSA) and ApEn(RR) were reduced in patients in comparison to controls. Breathing rate, ApEn(Resp) and cross-ApEn did not differ between the two groups.

DISCUSSION

Increased heart rate, increased LF/HF-ratio, reduced RSA and reduced ApEn(RR) indicate a decrease of cardiac vagal modulation in depressive patients. No difference of cardio-respiratory coupling was observed. Respiratory parameters and cross-ApEn did not differ between both groups, and thus we conclude that diminished vagal modulation is mainly limited to cardiac modulation.

Autonomic modulation in healthy first-degree relatives of patients with major depressive disorder

BACKGROUND

Cardiac mortality is known to be increased in patients with major depression. Several studies have reported an imbalance within the autonomic nervous system (ANS) of patients with major depressive disorder (MDD) as one putative cause. Since a heritability of autonomic modulation was demonstrated in healthy subjects, we aimed to investigate autonomic modulation in first-degree relatives of patients with MDD to find potential autonomic imbalances.

METHODS

We included 30 patients with MDD, 30 of their first-degree relatives (siblings or offspring) and 30 matched healthy controls in our study. We obtained a high resolution electrocardiogram and beat to beat blood pressure measurements for 30 min at rest. Linear and nonlinear parameters of heart rate variability (HRV) and baroreflex sensitivity (BRS) were calculated.

RESULTS

Parameters of HRV and BRS did not differ significantly between relatives and controls. We found significant differences between patients and controls for some HRV and BRS parameters confirming results of previous studies.

DISCUSSION

Findings of our study suggest that an imbalance of autonomic function is related to patients with depression and not to first-degree relatives. Thus, a genetic background for autonomic dysfunction is rather unlikely.

Gender-dependent impact of major depression on autonomic cardiovascular modulation

Depression has been shown to increase the risk for cardiovascular disease (CVD) more strongly in women than in men. Although the underlying mechanisms are unknown, a putative role of increased sympathetic modulation has been suggested for the association of CVD and depression. The aim of this study was to investigate possible gender-associated differences of autonomic function in healthy volunteers and patients suffering from major depressive disorder (MDD). Linear as well as non-linear measures of heart rate variability (HRV), blood pressure variability (BPV) and baroreflex sensitivity (BRS) were obtained in each 18 male and 18 female unmedicated patients and respective control subjects. Gender differences were detectable in healthy subjects showing predominant sympathetic modulation in males. This was most obvious in BPV analysis. These gender differences were abolished in patients suffering from MDD, mainly due to altered autonomic modulation in female patients. Our results indicate that BPV is more sensitive to reveal depression-associated changes of autonomic function as compared to HRV. Moreover, female patients contribute most to the overall difference between patients and controls. The shift in the balance of autonomic function in women might account for the increased prevalence of CVD in these patients.

Gastroduodenal motility

PURPOSE OF REVIEW

Abnormalities of gastroduodenal motility are considered key players in the pathogenesis of upper gastrointestinal symptoms in disorders such as functional dyspepsia and gastroparesis. Abnormalities of sensory control are considered another important factor that contributes to symptom generation. This review summarizes recent progress in our understanding of gastroduodenal motility and sensitivity in health and in disease.

RECENT FINDINGS

Although gastric and small intestinal motility remain an important focus of research, including the application of the SmartPill (SmartPill Corp., Buffalo, New York, USA) wireless motility monitoring capsule, duodenal sensitivity and low-grade duodenal inflammation are new areas of interest in the pathogenesis of functional dyspepsia. A number of genetic polymorphisms associated with functional dyspepsia are being investigated, but large-scale studies are still lacking. Central processing of visceral stimuli, and its role in the pathogenesis of functional dyspepsia, is another important emerging topic. Therapeutic studies have reported on novel pharmacological approaches in functional dyspepsia and gastroparesis, as well as gastric electrical stimulation in the treatment of refractory gastroparesis.

SUMMARY

There is gradual progress in our understanding of the pathogenesis of gastroduodenal symptoms. Areas of recent advances including the recognition of low-grade duodenal inflammation, the role of central nervous system processing in visceral hypersensitivity and the exploration of novel pharmacotherapeutic approaches.

Gastric dysmotility in healthy first-degree relatives of patients with schizophrenia

Gastric dysmotility has been reported in patients suffering from major depression or schizophrenia. An increased sympathetic activity modulating the gastric pacemaker located in the antrum of the stomach has been suggested as the underlying pathology. Similar to patients suffering from schizophrenia, their first-degree relatives showed alterations in cardiac autonomic modulation. Here we aimed to investigate gastric myoelectrical activity in healthy relatives of patients suffering from paranoid schizophrenia. Electrogastrography (EGG) was performed before and after test meal ingestion in 20 patients with paranoid schizophrenia, 20 of their first-degree relatives and 20 healthy matched controls. Autonomic and abdominal symptoms were assessed by the autonomic symptom score as previously reported. Autonomic parameters were correlated with the positive and negative syndrome scale (PANSS). Only minimal differences were observed before test meal ingestion between relatives and controls. In contrast, after test meal ingestion we observed a significantly increased tachygastria within the signal of the gastric pacemaker in relatives compared to controls, whereas normogastria was reduced. Significant difference between relatives and controls were also found for postprandial ICDF (instability coefficient of dominant frequency) and slow wave, which represents the dominant frequency of gastric pacemaker activity, indicating gastric dysmotility in relatives. Between relatives and patients just a difference for ICDP (instability coefficient of dominant power) was observed. After stimulation of the enteric nervous system we have observed an increased sympathetic modulation in first-degree relatives of patients suffering from schizophrenia. This result adds evidence to an ongoing debate on the genetic influence of autonomic dysfunction in the disease.

Cardiac autonomic regulation is impaired in girls with major depression

We aimed to study short-term heart rate variability (HRV) as an index of cardiac autonomic control in never-treated major depressive disorder (MDD) adolescent patients using linear and nonlinear analysis.

METHODS

We have examined 20 MDD girls and 20 healthy age-matched girls at the age of 15 to 18yr. The ECG was recorded in three positions: the 1st supine rest, orthostasis, the 2nd supine position. HRV magnitude was quantified by time and frequency-domain analysis (mean RR interval, SDRR, RMSSD, spectral powers in low [LF] and high frequency [HF] bands). In addition to linear measures, HRV complexity was assessed by nonlinear (symbolic dynamics) indices: normalized complexity index (NCI), normalized unpredictability index (NUPI), and pattern classification measures (0V%, 1V%, 2LV%, 2UV%).

RESULTS

HRV magnitude (RMSSD, SDRR, LF and HF powers) was significantly decreased in MDD group in a supine rest and after posture change. HRV complexity was significantly reduced (lower NCI) in the standing position. Pattern classification analysis revealed significantly higher 0V% and lower 2LV% in MDD group in supine position and orthostasis.

CONCLUSION

The HRV linear and nonlinear analysis revealed decreased magnitude and complexity of heart rate time series indicating altered neurocardiac regulation in girls with major depression without pharmacotherapy.

Reduced cardio-respiratory coupling indicates suppression of vagal activity in healthy relatives of patients with schizophrenia

Previous studies have observed reduced vagal modulation in patients with acute schizophrenia and their first-degree relatives, thus suggesting a genetic predisposition. To investigate vagal modulation, we analyzed the coupling between heart rate and breathing as a putative measure of central autonomic function in 19 patients, 19 of their relatives and 19 matched control subjects. The interaction of heart rate and breathing was investigated in all groups applying the non-linear parameter cross-ApEn, indicating the asynchrony between both time series. In addition, measures of the time and frequency domain of heart rate variability (HRV) were obtained. The main finding of our study is a significantly increased cross-ApEn value, indicating reduced central vagal modulation both in relatives and patients suffering from schizophrenia. Non-linear measures of HRV proved to more sensitively differentiate relatives from control subjects. Furthermore, we observed a correlation between psychopathology and breathing, indicating that positive symptoms are associated with a higher degree of regularity in the breathing pattern. Our results suggest that autonomic dysfunction previously described for patients suffering from schizophrenia is also present in first-degree relatives. This might relate to changes of brainstem activity in patients and relatives, and a common genetic background in patients and their family members can be assumed.