Correlation of psychological and physical symptoms with chronically elevated cytokine levels associated with a common immune dysregulation

How contact lens comfort may be influenced by psychiatric and psychological conditions and mechanisms

End-of-day soft contact lens awareness, dryness and discomfort are common related problems and may be associated with lens surface dryness and soiling as well as signs of ocular discomfort. Similar symptoms may be reported by patients who do not have obviously degraded lenses or ocular signs of discomfort. This review examines some psychiatric and psychological conditions and mechanisms which may predispose toward or enhance the likelihood of these symptoms occurring and becoming a problem. For example, conditions such as depression, anxiety and stress may lower the threshold for the perception of discomfort. Chronic ocular inflammation associated with contact lens wear may result in neuroplastic lowering of nociceptive thresholds and enhancement of the perception of discomfort. End-of-day tiredness and reduced levels of demand from top-down activity may make it harder to maintain goal-relevant attention and the associated ability to inhibit sensory stimuli (such as lens awareness) that would otherwise not capture attention. Lens surface lubricity experienced on lens insertion may be higher than normal for corneal or conjunctival surfaces and create expectations of very high comfort levels, which are not apparent after lens surface dehydration, soiling or other lens changes have accumulated during the day. Psychiatric and psychological conditions and mechanisms may not only contribute to the perception of discomfort, when the lens and ocular condition appear normal but also may contribute to the perception of discomfort, when lens surface drying and soiling are evident and/or discomfort such as chronic ocular inflammation is apparent.

Frequency of non-asthma GP visits predicts asthma exacerbations: an observational study in general practice

BACKGROUND

Being able to identify patients at risk of exacerbations is useful as it enables resources to be targeted at these patients.

AIMS

To test the theoretically-derived prediction that the frequency of non-asthma related visits to the general practitioner (GP) predicts exacerbations.

METHODS

Clinical and demographic data and both self-report and prescription-based adherence data were obtained from 166 patients diagnosed with asthma attending a GP clinic, all of whom were prescribed inhaled corticosteroids (ICS). Asthma exacerbations (treated by the GP or in hospital) and non-asthma visits and symptoms were assessed from notes for the subsequent 5 years.

RESULTS

Exacerbations correlated with non-asthma visits (0.35), severity as measured by BTS step (0.28), and with prescription-based adherence (0.28). Asthma severity correlated with non-asthma visits (0.35). Receiver operating curves showed that ≥2 non-asthma visits per year provided 79% sensitivity and 58% specificity for detecting ≥3 exacerbations over 5 years. Poor adherence predicted outcomes only for patients with high levels of non-asthma visits (≥3) and only for those reporting regular-but-less ICS use but not symptom-directed ICS use.

CONCLUSIONS

Non-asthma visits are a good predictor of asthma exacerbations, particular in non-adherent patients. These results are consistent with a mechanism where exacerbations result from a combination of random oscillating specific and non-specific inflammatory processes. It is important to consider the total patient rather than just the lung when managing patients with asthma.

Individual differences in pre-carcinogen cytokine and corticosterone concentrations and depressive-like behavior predict tumor onset in rats exposed to a carcinogen

Individual variation in the susceptibility to chronic disease can be attributed to both genetic and environmental factors. Measures of the immune, nervous, and endocrine systems are predictive of survival outcomes after a chronic disease is diagnosed. However, determining biomarkers or "traits" that predict risk before chronic disease development remains elusive. In this study, natural individual variation in circulating cytokines, corticosterone, and depressive-like behaviors (using the Porsolt forced swim test) were measured in female rats before induction of mammary tumors using a chemical carcinogen (N-nitroso-N-methylurea). Early tumor onset was associated with relatively high (but within the physiologically typical range) circulating cytokine concentrations (IL-1α, IL-1β, TNFα) and depressive-like behavior and with relatively low corticosterone concentrations, all of which were assessed at baseline before carcinogen treatment. Multiple regression analyses indicated that IL-1β was primarily responsible for the variation in tumor onset when controlling for corticosterone concentration. These results suggest that the susceptibility to tumor initiation and/or growth may be related to individual differences in baseline immune and endocrine physiology and emotional tone present at the time of carcinogen exposure. Investigation of the mechanistic relevance of these individual differences may lead to prophylactic approaches to cancer treatment in the context of carcinogen exposure.

No effect of 12 weeks' supplementation with 1 g DHA-rich or EPA-rich fish oil on cognitive function or mood in healthy young adults aged 18–35 years

Then-3 PUFA are a unique class of fatty acids that cannot be manufactured by the body, and must be acquired via dietary sources. In the UK, as well as in other Western nations, these ‘essential’ fatty acids are consumed in quantities that fall below government guidelines. The present study explored the effects of 12 weeks' dietary supplementation with 1 g/d of two types of fish oil (FO; DHA-rich and EPA-rich) in 159 healthy young adults aged 18–35 years. An assessment of performance on a battery of computerised cognitive tasks and mood measures took place before and following the 12-week treatment regimen. Venous blood samples were also supplied by participants at both time points which were later analysed for serum fatty acid concentrations. Despite good adherence to the study protocol – as reflected in increased concentrations ofn-3 serum fatty acids – compared with placebo, the observed effects of both active treatments were minimal. The only finding of note revealed that supplementation with EPA-rich FO may reduce subjective mental fatigue at times of high cognitive demand, although further investigation is required. These findings, taken together with other recent reports of null effects, suggest that dietary supplementation withn-3 PUFA in healthy, normally developing and impairment-free populations is unlikely to result in cognitive enhancement.

Network origins of anxiety and depression

Cramer et al. contrast two possible explanations for psychological symptoms: latent variables (i.e., specific cause) versus a network of causality between symptoms. There is a third explanation: The reason for comorbidity and the reported network structure of psychological symptoms is that the underlying biological cause is a psychoneuroimmunoendocrine information network which, when dysregulated, leads to several maladaptive psychological and somatic symptoms.

Antibody response following hepatitis B vaccination in dialysis patients: does depression and life quality matter?

Previously, it was demonstrated that antibody production against hepatitis B virus (HBV) surface antigen (anti-HBs) achieved in hemodialysis patients is suboptimal. Decreased health-related quality of life (HRQOL) and depression is common among hemodialysis patients. This study evaluated whether HRQOL and depressive behavior are associated with antibody response against HBV surface antigen in hemodialysis patients. Depressive symptoms and HRQOL were assessed by Beck Depression Inventory (BDI) and Medical Outcomes Study Short Form (SF-36), respectively. Patients were separated into non-seroconversion (anti-HBs antibody titers <10 IU/L) and seroconversion (anti-HBs antibody titers > or =10 IU/L) groups. Among 188 patients, 37 (19.7%) were diagnosed as nonresponsive to vaccination (anti-HBs antibody titers <10 IU/L). Anti-HBs response is positively associated with Physical Component Summary Score of SF-36 (odds ratio: 1.44; P: 0.009) and albumin (odds ratio: 10.615, P: 0.007), and negatively with BDI score (odds ratio: 0.903, P: 0.007). We concluded that HRQOL and depression is closely related with antibody response following HBV vaccine in hemodialysis patients.