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Hill A, Khalil H, Laborc K, Kounelis-Wuillaume S, Gavade S, Johnston C, Singer BH, Spencer-Segal JL. Corticosteroid Treatment During Sepsis Alters Hippocampal Function in Male and Female Survivors. BIOLOGICAL PSYCHIATRY GLOBAL OPEN SCIENCE 2024; 4:336-345. [PMID: 38298779 PMCID: PMC10829652 DOI: 10.1016/j.bpsgos.2023.08.001] [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: 05/23/2023] [Revised: 07/30/2023] [Accepted: 08/01/2023] [Indexed: 02/02/2024] Open
Abstract
Background Millions of sepsis survivors annually face neuropsychiatric sequelae of their illness. Corticosteroids are frequently administered for sepsis, and their use improves neuropsychiatric outcomes, but the mechanisms are unknown. In light of prior work that has shown persistent inflammation in sepsis survivors, we hypothesized that short-term corticosteroid treatment during illness would reverse the long-term impact of sepsis on inflammatory gene expression in the hippocampus and rescue associated changes to affective behaviors. Methods Male and female mice underwent cecal ligation and puncture or a sham surgery to induce acute infection and were treated for 5 days with corticosterone or vehicle. Starting 2 weeks after the surgery, we performed functional phenotyping in the survivor mice followed by hippocampal RNA sequencing to identify underlying mechanisms. Results Long-term cecal ligation and puncture survivors exhibited anxiety-like behavior, increased central hypothalamic-pituitary-adrenal axis activity, and persistent systemic and neuroinflammation. Corticosterone treatment during illness did not reverse anxiety-like behavior or inflammation in survivors. Instead, corticosterone treatment impaired object memory and increased active coping behavior in females. History of corticosterone treatment influenced the expression of >10% of detectable transcripts in the dorsal and ventral hippocampus, including a coordinated downregulation of activity-dependent genes. Conclusions Corticosterone treatment during sepsis impaired memory formation in survivors and caused a lasting decrease in hippocampal neural activity, which could underlie its effect on memory. Future studies should focus on how this lasting effect of corticosteroid treatment on hippocampal activity and memory translates into improved neuropsychiatric outcomes in human sepsis survivors.
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Affiliation(s)
- Alice Hill
- Michigan Neuroscience Institute, University of Michigan, Ann Arbor, Michigan
| | - Huzefa Khalil
- Michigan Neuroscience Institute, University of Michigan, Ann Arbor, Michigan
| | - Klaudia Laborc
- Michigan Neuroscience Institute, University of Michigan, Ann Arbor, Michigan
| | | | - Swapnil Gavade
- Michigan Neuroscience Institute, University of Michigan, Ann Arbor, Michigan
| | - Colin Johnston
- Michigan Neuroscience Institute, University of Michigan, Ann Arbor, Michigan
| | - Benjamin H. Singer
- Michigan Neuroscience Institute, University of Michigan, Ann Arbor, Michigan
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Joanna L. Spencer-Segal
- Michigan Neuroscience Institute, University of Michigan, Ann Arbor, Michigan
- Division of Metabolism, Endocrinology, and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
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Hill A, Johnston C, Agranoff I, Gavade S, Spencer-Segal J. Corticosterone enhances formation of non-fear but not fear memory during infectious illness. Front Behav Neurosci 2023; 17:1144173. [PMID: 37091592 PMCID: PMC10118046 DOI: 10.3389/fnbeh.2023.1144173] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 03/20/2023] [Indexed: 04/08/2023] Open
Abstract
Introduction Survivors of critical illness are at high risk of developing post-traumatic stress disorder (PTSD) but administration of glucocorticoids during the illness can lower that risk. The mechanism is not known but may involve glucocorticoid modulation of hippocampal- and amygdala-dependent memory formation. In this study, we sought to determine whether glucocorticoids given during an acute illness influence the formation and persistence of fear and non-fear memories from the time of the illness. Methods We performed cecal ligation and puncture in male and female mice to induce an acute infectious illness. During the illness, mice were introduced to a neutral object in their home cage and separately underwent contextual fear conditioning. We then tested the persistence of object and fear memories after recovery. Results Glucocorticoid treatment enhanced object discrimination but did not alter the expression of contextual fear memory. During context re-exposure, neural activity was elevated in the dentate gyrus irrespective of fear conditioning. Conclusions Our results suggest that glucocorticoids given during illness enhance hippocampal-dependent non-fear memory processes. This indicates that PTSD outcomes in critically ill patients may be improved by enhancing non-fear memories from the time of their illness.
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Affiliation(s)
- Alice Hill
- Michigan Neuroscience Institute, University of Michigan, Ann Arbor, MI, United States
| | - Colin Johnston
- Michigan Neuroscience Institute, University of Michigan, Ann Arbor, MI, United States
| | - Isaac Agranoff
- Michigan Neuroscience Institute, University of Michigan, Ann Arbor, MI, United States
| | - Swapnil Gavade
- Michigan Neuroscience Institute, University of Michigan, Ann Arbor, MI, United States
| | - Joanna Spencer-Segal
- Michigan Neuroscience Institute, University of Michigan, Ann Arbor, MI, United States
- Division of Metabolism, Endocrinology, and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States
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Oh TK, Park HY, Song IA. Suicide Risk in Survivors of Acute Respiratory Distress Syndrome: A Nationwide Cohort Study in South Korea. Psychiatry Investig 2022; 19:646-653. [PMID: 36059053 PMCID: PMC9441462 DOI: 10.30773/pi.2022.0053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 05/24/2022] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE We aimed to examine the prevalence and risk factors of suicide among patients with acute respiratory distress syndrome (ARDS). METHODS Data were extracted from the National Health Insurance Service database in South Korea. This study included all adults admitted to intensive care units with a diagnosis of ARDS from January 1, 2010 to December 31, 2019, who survived ≥365. The primary endpoint in this study was suicide within 1 year of an ARDS diagnosis, which was determined as death by a suicide attempt or self-harm. RESULTS Analysis included 9,928 patients identified as ARDS survivors. One-year all-cause mortality occurred in 5,021 patients, 186 (1.9%) of which died by suicide. In multivariable Cox regression, older age, continuous renal replacement therapy, cardiopulmonary resuscitation incidence, history of self-harm or attempted suicide and concurrent substance abuse were associated with a higher risk of death by suicide among ARDS survivors. CONCLUSION During the 1-year follow-up period, 1.9% of ARDS survivors died by suicide in South Korea, and some factors were identified as potential risk factors for death by suicide. Knowledge of the factors associated with suicide might allow for earlier intervention to potentially reduce the death by suicide among ARDS survivors.
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Affiliation(s)
- Tak Kyu Oh
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.,Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hye Yoon Park
- Department of Psychiatry, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - In-Ae Song
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.,Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
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Hornick MG, Olson ME, Jadhav AL. SARS-CoV-2 Psychiatric Sequelae: A Review of Neuroendocrine Mechanisms and Therapeutic Strategies. Int J Neuropsychopharmacol 2022; 25:1-12. [PMID: 34648616 PMCID: PMC8524640 DOI: 10.1093/ijnp/pyab069] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 09/07/2021] [Accepted: 10/12/2021] [Indexed: 12/15/2022] Open
Abstract
From the earliest days of the coronavirus disease 2019 (COVID-19) pandemic, there have been reports of significant neurological and psychological symptoms following Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection. This narrative review is designed to examine the potential psychoneuroendocrine pathogenic mechanisms by which SARS-CoV-2 elicits psychiatric sequelae as well as to posit potential pharmacologic strategies to address and reverse these pathologies. Following a brief overview of neurological and psychological sequelae from previous viral pandemics, we address mechanisms by which SARS-CoV-2 could enter or otherwise elicit changes in the CNS. We then examine the hypothesis that COVID-19-induced psychiatric disorders result from challenges to the neuroendocrine system, in particular the hypothalamic-pituitary-adrenal stress axis and monoamine synthesis, physiological mechanisms that are only further enhanced by the pandemic-induced social environment of fear, isolation, and socioeconomic pressure. Finally, we evaluate several FDA-approved therapeutics in the context of COVID-19-induced psychoneuroendocrine disorders.
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Affiliation(s)
- Mary G Hornick
- Roosevelt University, College of Science, Health and Pharmacy, Schaumburg, Illinois, USA
| | - Margaret E Olson
- Roosevelt University, College of Science, Health and Pharmacy, Schaumburg, Illinois, USA
| | - Arun L Jadhav
- Roosevelt University, College of Science, Health and Pharmacy, Schaumburg, Illinois, USA
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Holla VV, Prasad S, Pal PK. Neurological effects of respiratory dysfunction. HANDBOOK OF CLINICAL NEUROLOGY 2022; 189:309-329. [PMID: 36031312 DOI: 10.1016/b978-0-323-91532-8.00001-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The respiratory and the nervous systems are closely interconnected and are maintained in a fine balance. Central mechanisms maintain strict control of ventilation due to the high metabolic demands of brain which depends on a continuous supply of oxygenated blood along with glucose. Moreover, brain perfusion is highly sensitive to changes in the partial pressures of carbon dioxide and oxygen in blood, which in turn depend on respiratory function. Ventilatory control is strictly monitored and regulated by the central nervous system through central and peripheral chemoreceptors, baroreceptors, the cardiovascular system, and the autonomic nervous system. Disruption in this delicate control of respiratory function can have subtle to devastating neurological effects as a result of ensuing hypoxia or hypercapnia. In addition, pulmonary circulation receives entire cardiac output and this may act as a conduit to transmit infections and also for metastasis of malignancies to brain resulting in neurological dysfunction. Furthermore, many neurological paraneoplastic syndromes can have underlying lung malignancies resulting in respiratory dysfunction. It is essential to understand the underlying mechanisms and the resulting manifestations in order to prevent and effectively manage the many neurological effects of respiratory dysfunction. This chapter explores the various neurological effects of respiratory dysfunction with focus on their pathophysiology, etiologies, clinical features and long-term neurological sequelae.
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Affiliation(s)
- Vikram V Holla
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Shweta Prasad
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India; Department of Clinical Neurosciences, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Pramod Kumar Pal
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India.
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Oh TK, Park HY, Song IA. Depression and mortality among survivors of acute respiratory distress syndrome in South Korea: A nationwide cohort study conducted from 2010 to 2018. J Psychiatr Res 2021; 145:6-12. [PMID: 34839134 DOI: 10.1016/j.jpsychires.2021.11.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 10/07/2021] [Accepted: 11/20/2021] [Indexed: 01/16/2023]
Abstract
It has been reported that survivors of acute respiratory distress syndrome (ARDS) experience depression. However, the relationship between newly developed depression and mortality among survivors of ARDS has not been elucidated. Thus, the aim of this study was to investigate the prevalence and associated factors of depression among survivors of ARDS and determine whether newly developed depression is associated with long-term mortality among them. The data used for this study were extracted from the national health insurance database of South Korea. All adult patients who were admitted into intensive care units for ARDS between January 1, 2010, and December 31, 2018, and survived for ≥1 year after treatment were defined as ARDS survivors and included in this study. A total of 4,452 ARDS survivors were included in the final analysis. Of these, 581 (13.4%) were newly diagnosed with depression within 1 year after ARDS diagnosis. Multivariable logistic regression showed that underlying anxiety disorder (odds ratio [OR], 2.35; 95% confidence interval [CI], 1.93-2.86; P < 0.001), substance abuse (OR, 2.18; 95% CI, 1.48-3.20; P < 0.001), and post-traumatic stress disorder (OR, 15.52; 95% CI, 2.57-93.51; P = 0.003) were associated with a higher prevalence of post-ARDS depression among survivors. Multivariable Cox regression analysis showed that post-ARDS depression was associated with a 1.49-fold increased risk of 2-year all-cause mortality (hazard ratio, 1.49; 95% CI, 1.18-1.88; P = 0.001). Underlying psychiatric illness is a potential risk factor for the development of depression among ARDS survivors. Post-ARDS depression is associated with an increased risk of 2-year all-cause mortality.
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Affiliation(s)
- Tak Kyu Oh
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea; Department of Anesthesiology and Pain Medicine, College of Medicine, Seoul National University, Seoul, South Korea
| | - Hye Yoon Park
- Department of Psychiatry, Seoul National University Hospital, Seoul, South Korea
| | - In-Ae Song
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea.
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Öztürk Çopur E, Karasu F. The impact of the COVID-19 pandemic on the quality of life and depression, anxiety, and stress levels of individuals above the age of eighteen. Perspect Psychiatr Care 2021; 57:1645-1655. [PMID: 33512758 PMCID: PMC8014617 DOI: 10.1111/ppc.12730] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 12/29/2020] [Accepted: 12/30/2020] [Indexed: 01/10/2023] Open
Abstract
PURPOSE The aim of this study is to analyze the impact of the COVID-19 pandemic on the quality of life and the depression, anxiety, and stress levels of individuals above the age of eighteen. DESIGN AND METHODS This study used the snowball method. Data were collected using the sociodemographic question form, the Depression, Anxiety, Stress Scale-21, and the SF-12 Life Quality Scale. FINDINGS A statistically significant relationship (p < .05) was measured between age, gender, health condition, concomitant chronic and mental disease, fear of the COVID-19 pandemic, home confinement in this particular period, and the need for psychological support as well as mean scores of Depression, Anxiety, Stress Scale-21, and SF-12 Life Quality Scale. PRACTICE IMPLICATIONS Against the likelihood of facing new pandemics in the future, a guideline could be planned to protect and improve prospective the psychosocial wellness of individuals and society.
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Affiliation(s)
- Ebru Öztürk Çopur
- Department of Nursing, Yusuf Şerefoğlu Health Sciences Faculty, Kilis 7 Aralık University, Kilis, Turkey
| | - Fatma Karasu
- Department of Nursing, Yusuf Şerefoğlu Health Sciences Faculty, Kilis 7 Aralık University, Kilis, Turkey
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8
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Crowe TV. Psychiatric Functioning, Resilience, and Recovery Among Deaf Consumers of Public Behavioral Health Services. Community Ment Health J 2021; 57:1164-1174. [PMID: 33170422 DOI: 10.1007/s10597-020-00747-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 11/05/2020] [Indexed: 11/27/2022]
Abstract
Studies of deaf individuals generally indicate higher levels of mental illness and negative mental health outcomes compared to the general population (Anglemyer and Crespi in JAMA 2018: 3285153, 2018; Dammeyer and Chapman in JAMA 52: 807-813, 2017; Fellinger et al. in JAMA 379: 17-23, 2012; Hall et al. in JAMA 52: 761-776, 2017; as reported by Leigh and Pollard (M. Marschark and P. Spencer (eds) Oxford handbook of deaf studies, language and education, Oxford University Press, UK 2003); Landsberger et al. in JAMA 45, 42-51, 2014; Pollard in JAMA 39, 147-160, 1994). The purpose of this study is to understand the demographic variables, psychiatric symptoms, functioning, resilience, and recovery in a sample of 11,703 deaf adults. The de-identified dataset was provided by Beacon Health Options and Maryland Behavioral Health Administration and includes information about deaf adult consumers of public behavioral health services. Findings revealed that compared to hearing consumers in the dataset, deaf consumers were less likely to live in independent housing. They were more likely to live in structured community housing, such as group homes, or be homelessness. They had higher rates of arrests and incarcerations, higher proportion of unemployment, and higher rates of cigarette smoking. Deaf participants had lower rates of substance use. Deaf women in this sample reported significantly more difficulty in managing their psychiatric symptoms than deaf men. Deaf people of color had lower levels of psychiatric dysfunction, lower resilience, and greater recovery compared to white participants, which was inconsistent with other studies of people of color. Younger participants had significantly more difficulty with psychiatric symptoms and functioning than those in the older groups. Those who were 31-55 years old had higher resilience than those who were older than 56 years old. The author offers several recommendations for further research of the mental health of deaf populations, especially round race, age, and gender.
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Affiliation(s)
- Teresa V Crowe
- Department of Social Work, Gallaudet University, 800 Florida Avenue, Washington, DC, NE, 20002, USA.
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Steinman MQ, Kirson D, Wolfe SA, Khom S, D'Ambrosio SR, Spierling Bagsic SR, Bajo M, Vlkolinský R, Hoang NK, Singhal A, Sureshchandra S, Oleata CS, Messaoudi I, Zorrilla EP, Roberto M. Importance of sex and trauma context on circulating cytokines and amygdalar GABAergic signaling in a comorbid model of posttraumatic stress and alcohol use disorders. Mol Psychiatry 2021; 26:3093-3107. [PMID: 33087855 PMCID: PMC8058115 DOI: 10.1038/s41380-020-00920-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Revised: 09/29/2020] [Accepted: 10/06/2020] [Indexed: 02/08/2023]
Abstract
Alcohol use disorder (AUD) and anxiety disorders are frequently comorbid and share mechanisms that could be therapeutic targets. To facilitate mechanistic studies, we adapted an inhibitory avoidance-based "2-hit" rat model of posttraumatic stress disorder (PTSD) and identified predictors and biomarkers of comorbid alcohol (ethanol)/PTSD-like symptoms in these animals. Stressed Wistar rats received a single footshock on two occasions. The first footshock occurred when rats crossed into the dark chamber of a shuttle box. Forty-eight hours later, rats received the second footshock in a familiar (FAM) or novel (NOV) context. Rats then received 4 weeks of two-bottle choice (2BC) ethanol access. During subsequent abstinence, PTSD-like behavior responses, GABAergic synaptic transmission in the central amygdala (CeA), and circulating cytokine levels were measured. FAM and NOV stress more effectively increased 2BC drinking in males and females, respectively. Stressed male rats, especially drinking-vulnerable individuals (≥0.8 g/kg average 2-h ethanol intake with >50% ethanol preference), showed higher fear overgeneralization in novel contexts, increased GABAergic transmission in the CeA, and a profile of increased G-CSF, GM-CSF, IL-13, IL-6, IL-17a, leptin, and IL-4 that discriminated between stress context (NOV > FAM > Control). However, drinking-resilient males showed the highest G-CSF, IL-13, and leptin levels. Stressed females showed increased acoustic startle and decreased sleep maintenance, indicative of hyperarousal, with increased CeA GABAergic transmission in NOV females. This paradigm promotes key features of PTSD, including hyperarousal, fear generalization, avoidance, and sleep disturbance, with comorbid ethanol intake, in a sex-specific fashion that approximates clinical comorbidities better than existing models, and identifies increased CeA GABAergic signaling and a distinct pro-hematopoietic, proinflammatory, and pro-atopic cytokine profile that may aid in treatment.
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Affiliation(s)
- Michael Q Steinman
- Department of Molecular Medicine, The Scripps Research Institute, La Jolla, CA, 92037, USA
| | - Dean Kirson
- Department of Molecular Medicine, The Scripps Research Institute, La Jolla, CA, 92037, USA
| | - Sarah A Wolfe
- Department of Molecular Medicine, The Scripps Research Institute, La Jolla, CA, 92037, USA
| | - Sophia Khom
- Department of Molecular Medicine, The Scripps Research Institute, La Jolla, CA, 92037, USA
| | - Shannon R D'Ambrosio
- Department of Molecular Medicine, The Scripps Research Institute, La Jolla, CA, 92037, USA
| | | | - Michal Bajo
- Department of Molecular Medicine, The Scripps Research Institute, La Jolla, CA, 92037, USA
| | - Roman Vlkolinský
- Department of Molecular Medicine, The Scripps Research Institute, La Jolla, CA, 92037, USA
| | - Noah K Hoang
- Department of Molecular Medicine, The Scripps Research Institute, La Jolla, CA, 92037, USA
| | - Anshita Singhal
- Department of Molecular Medicine, The Scripps Research Institute, La Jolla, CA, 92037, USA
| | - Suhas Sureshchandra
- Department of Molecular Biology and Biochemistry, University of California Irvine, Irvine, CA, 92697, USA
| | - Christopher S Oleata
- Department of Molecular Medicine, The Scripps Research Institute, La Jolla, CA, 92037, USA
| | - Ilhem Messaoudi
- Department of Molecular Biology and Biochemistry, University of California Irvine, Irvine, CA, 92697, USA
| | - Eric P Zorrilla
- Department of Molecular Medicine, The Scripps Research Institute, La Jolla, CA, 92037, USA.
| | - Marisa Roberto
- Department of Molecular Medicine, The Scripps Research Institute, La Jolla, CA, 92037, USA.
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Meduri GU, Rochwerg B. POINT: Should Corticosteroids Be Routine Treatment in Early ARDS? Yes. Chest 2021; 159:25-29. [PMID: 33422200 DOI: 10.1016/j.chest.2020.07.057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 07/19/2020] [Indexed: 02/04/2023] Open
Affiliation(s)
- Gianfranco Umberto Meduri
- Departments of Medicine, Pulmonary, Critical Care, and Sleep Medicine Service, Memphis Veterans Affairs Medical Center, Memphis, TN.
| | - Bram Rochwerg
- Department of Medicine, Division of Critical Care, McMaster University, Hamilton
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Abstract
Treatment for critical illness typically focuses on a patient's short-term physical recovery; however, recent work has broadened our understanding of the long-term implications of illness and treatment strategies. In particular, survivors of critical illness have significantly elevated risk of developing lasting cognitive impairment and psychiatric disorders. In this review, we examine the role of endogenous and exogenous glucocorticoids in neuropsychiatric outcomes following critical illness. Illness is marked by acute elevation of free cortisol and adrenocorticotropic hormone suppression, which typically normalize after recovery; however, prolonged dysregulation can sometimes occur. High glucocorticoid levels can cause lasting alterations to the plasticity and structural integrity of the hippocampus and prefrontal cortex, and this mechanism may plausibly contribute to impaired memory and cognition in critical illness survivors, though specific evidence is lacking. Glucocorticoids may also exacerbate inflammation-associated neural damage. Conversely, current evidence indicates that glucocorticoids during illness may protect against the development of post-traumatic stress disorder. We propose future directions for research in this field, including determining the role of persistent glucocorticoid elevations after illness in neuropsychiatric outcomes, the role of systemic vs neuroinflammation, and probing unexplored lines of investigation on the role of mineralocorticoid receptors and the gut-brain axis. Progress toward personalized medicine in this area has the potential to produce tangible improvements to the lives patients after a critical illness, including Coronavirus Disease 2019.
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Affiliation(s)
- Alice R Hill
- Undergraduate Program in Neuroscience, University of Michigan, Ann Arbor, MI, USA
- Michigan Neuroscience Institute, University of Michigan, Ann Arbor, MI, USA
| | - Joanna L Spencer-Segal
- Michigan Neuroscience Institute, University of Michigan, Ann Arbor, MI, USA
- Deparment of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
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12
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Meduri GU, Annane D, Confalonieri M, Chrousos GP, Rochwerg B, Busby A, Ruaro B, Meibohm B. Pharmacological principles guiding prolonged glucocorticoid treatment in ARDS. Intensive Care Med 2020; 46:2284-2296. [PMID: 33150472 PMCID: PMC7641258 DOI: 10.1007/s00134-020-06289-8] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 10/08/2020] [Indexed: 12/15/2022]
Abstract
Current literature addressing the pharmacological principles guiding glucocorticoid (GC) administration in ARDS is scant. This paucity of information may have led to the heterogeneity of treatment protocols and misinterpretation of available findings. GCs are agonist compounds that bind to the GC receptor (GR) producing a pharmacological response. Clinical efficacy depends on the magnitude and duration of exposure to GR. We updated the meta-analysis of randomized trials investigating GC treatment in ARDS, focusing on treatment protocols and response. We synthesized the current literature on the role of the GR in GC therapy including genomic and non-genomic effects, and integrated current clinical pharmacology knowledge of various GCs, including hydrocortisone, methylprednisolone and dexamethasone. This review addresses the role dosage, timing of initiation, mode of administration, duration, and tapering play in achieving optimal response to GC therapy in ARDS. Based on RCTs' findings, GC plasma concentration-time profiles, and pharmacodynamic studies, optimal results are most likely achievable with early intervention, an initial bolus dose to achieve close to maximal GRα saturation, followed by a continuous infusion to maintain high levels of response throughout the treatment period. In addition, patients receiving similar GC doses may experience substantial between-patient variability in plasma concentrations affecting clinical response. GC should be dose-adjusted and administered for a duration targeting clinical and laboratory improvement, followed by dose-tapering to achieve gradual recovery of the suppressed hypothalamic-pituitary-adrenal (HPA) axis. These findings have practical clinical relevance. Future RCTs should consider these pharmacological principles in the study design and interpretation of findings.
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Affiliation(s)
- Gianfranco Umberto Meduri
- Memphis Veterans Affairs Medical Center Research Service, Departments of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA.
- Pulmonary, Critical Care, and Sleep Medicine Service and Research Service, Memphis Veterans Affairs Medical Center, 1030 Jefferson Avenue, Suite room #CW444, Memphis, TN, 38104, USA.
| | - Djillali Annane
- Department of Critical Care, Raymond Poincaré Hospital (AP-HP), Laboratory Infection and Inflammation, U1173, Faculty of Health Science Simone Veil, University of Versailles SQY, University Paris Saclay, INSERM, FHU SEPSIS, RHU RECORDS, Versailles, France
| | - Marco Confalonieri
- Pulmonology Department, University Hospital of Cattinara, University of Trieste, Trieste, Italy
| | - George P Chrousos
- University Research Institute of Maternal and Child Health and Precision Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Bram Rochwerg
- Department of Medicine, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Amanda Busby
- Health Research Methods Unit, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - Barbara Ruaro
- Pulmonology Department, University Hospital of Cattinara, University of Trieste, Trieste, Italy
| | - Bernd Meibohm
- Department of Pharmaceutical Sciences, University of Tennessee Health Science Center, Memphis, TN, USA
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13
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Sami R, Soltaninejad F, Amra B, Naderi Z, Haghjooy Javanmard S, Iraj B, Haji Ahmadi S, Shayganfar A, Dehghan M, Khademi N, Sadat Hosseini N, Mortazavi M, Mansourian M, Mañanas MA, Marateb HR, Adibi P. A one-year hospital-based prospective COVID-19 open-cohort in the Eastern Mediterranean region: The Khorshid COVID Cohort (KCC) study. PLoS One 2020; 15:e0241537. [PMID: 33151983 PMCID: PMC7644058 DOI: 10.1371/journal.pone.0241537] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 10/17/2020] [Indexed: 01/08/2023] Open
Abstract
The COVID-19 is rapidly scattering worldwide, and the number of cases in the Eastern Mediterranean Region is rising. Thus, there is a need for immediate targeted actions. We designed a longitudinal study in a hot outbreak zone to analyze the serial findings between infected patients for detecting temporal changes from February 2020. In a hospital-based open-cohort study, patients are followed from admission until one year from their discharge (the 1st, 4th, 12th weeks, and the first year). The patient recruitment phase finished at the end of August 2020, and the follow-up continues by the end of August 2021. The measurements included demographic, socio-economics, symptoms, health service diagnosis and treatment, contact history, and psychological variables. The signs improvement, death, length of stay in hospital were considered primary, and impaired pulmonary function and psychotic disorders were considered main secondary outcomes. Moreover, clinical symptoms and respiratory functions are being determined in such follow-ups. Among the first 600 COVID-19 cases, 490 patients with complete information (39% female; the average age of 57±15 years) were analyzed. Seven percent of these patients died. The three main leading causes of admission were: fever (77%), dry cough (73%), and fatigue (69%). The most prevalent comorbidities between COVID-19 patients were hypertension (35%), diabetes (28%), and ischemic heart disease (14%). The percentage of primary composite endpoints (PCEP), defined as death, the use of mechanical ventilation, or admission to an intensive care unit was 18%. The Cox Proportional-Hazards Model for PCEP indicated the following significant risk factors: Oxygen saturation < 80% (HR = 6.3; [CI 95%: 2.5,15.5]), lymphopenia (HR = 3.5; [CI 95%: 2.2,5.5]), Oxygen saturation 80%-90% (HR = 2.5; [CI 95%: 1.1,5.8]), and thrombocytopenia (HR = 1.6; [CI 95%: 1.1,2.5]). This long-term prospective Cohort may support healthcare professionals in the management of resources following this pandemic.
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Affiliation(s)
- Ramin Sami
- Department of Internal Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Forogh Soltaninejad
- The Respiratory Research Center, Pulmonary Division, Department of Internal Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Babak Amra
- Bamdad Respiratory Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Zohre Naderi
- Department of Internal Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shaghayegh Haghjooy Javanmard
- Department of Physiology, School of Medicine, Applied Physiology Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Bijan Iraj
- Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Somayeh Haji Ahmadi
- Department of Radiology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Azin Shayganfar
- Department of Radiology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mehrnegar Dehghan
- School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Nilufar Khademi
- School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Mojgan Mortazavi
- Isfahan Kidney Diseases Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Marjan Mansourian
- Department of Epidemiology and Biostatistics, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
- Biomedical Engineering Research Centre (CREB), Automatic Control Department (ESAII), Universitat Politècnica de Catalunya-Barcelona Tech (UPC), Barcelona, Spain
| | - Miquel Angel Mañanas
- Biomedical Engineering Research Centre (CREB), Automatic Control Department (ESAII), Universitat Politècnica de Catalunya-Barcelona Tech (UPC), Barcelona, Spain
- Biomedical Research Networking Center in Bioengineering, Biomaterials, and Nanomedicine (CIBER-BBN), Zaragoza, Spain
| | - Hamid Reza Marateb
- Biomedical Engineering Research Centre (CREB), Automatic Control Department (ESAII), Universitat Politècnica de Catalunya-Barcelona Tech (UPC), Barcelona, Spain
- Biomedical Engineering Department, Engineering Faculty, University of Isfahan, Isfahan, Iran
- Machine Learning Department, Isfahan Cardiovascular Research Center (a WHO-collaborating center), Isfahan University of Medical Sciences, Isfahan, Iran
| | - Peyman Adibi
- Digestive Diseases Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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Michopoulos V, Beurel E, Gould F, Dhabhar FS, Schultebraucks K, Galatzer-Levy I, Rothbaum BO, Ressler KJ, Nemeroff CB. Association of Prospective Risk for Chronic PTSD Symptoms With Low TNFα and IFNγ Concentrations in the Immediate Aftermath of Trauma Exposure. Am J Psychiatry 2020; 177:58-65. [PMID: 31352811 DOI: 10.1176/appi.ajp.2019.19010039] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Although several reports have documented heightened systemic inflammation in posttraumatic stress disorder (PTSD), few studies have assessed whether inflammatory markers serve as prospective biomarkers for PTSD risk. The present study aimed to characterize whether peripheral immune factors measured in blood samples collected in an emergency department immediately after trauma exposure would predict later chronic development of PTSD. METHODS Participants (N=505) were recruited from a hospital emergency department and underwent a 1.5-hour assessment. Blood samples were drawn, on average, about 3 hours after trauma exposure. Follow-up assessments were conducted 1, 3, 6, and 12 months after trauma exposure. Latent growth mixture modeling was used to identify classes of PTSD symptom trajectories. RESULTS Three distinct classes of PTSD symptom trajectories were identified: chronic (N=28), resilient (N=160), and recovery (N=85). Multivariate analyses of covariance revealed a significant multivariate main effect of PTSD symptom trajectory class membership on proinflammatory cytokines. Univariate analyses showed a significant main effect of trajectory class membership on plasma concentrations of proinflammatory tumor necrosis factor α (TNFα) and interferon-γ (IFNγ). Concentrations of proinflammatory TNFα and IFNγ were significantly lower in individuals in the chronic PTSD class compared with those in the recovery and resilient classes. There were no significant differences in interleukin (IL) 1β and IL-6 concentrations by PTSD symptom trajectory class. Anti-inflammatory and other cytokines, as well as chemokines and growth factor concentrations, were not associated with development of chronic PTSD. CONCLUSIONS Overall, the study findings suggest that assessing the proinflammatory immune response to trauma exposure immediately after trauma exposure, in the emergency department, may help identify individuals most at risk for developing chronic PTSD in the aftermath of trauma.
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Affiliation(s)
- Vasiliki Michopoulos
- The Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta (Michopoulos, Rothbaum, Ressler); the Yerkes National Primate Research Center, Atlanta (Michopoulos); the Department of Psychiatry and Behavioral Sciences (Beurel, Gould, Dhabhar), the Department of Biochemistry and Molecular Biology (Beurel), and the Sylvester Comprehensive Cancer Center (Dhabhar), University of Miami Miller School of Medicine, Miami; the Department of Psychology, University of Miami, Coral Gables, Fla. (Dhabhar); the Department of Psychiatry, New York University School of Medicine, New York (Schultebraucks, Galatzer-Levy); Mclean Hospital, Harvard Medical School, Belmont, Mass. (Ressler); the Department of Psychiatry, Dell Medical School, and the Institute for Early Life Adversity Research, University of Texas at Austin (Nemeroff)
| | - Eleonore Beurel
- The Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta (Michopoulos, Rothbaum, Ressler); the Yerkes National Primate Research Center, Atlanta (Michopoulos); the Department of Psychiatry and Behavioral Sciences (Beurel, Gould, Dhabhar), the Department of Biochemistry and Molecular Biology (Beurel), and the Sylvester Comprehensive Cancer Center (Dhabhar), University of Miami Miller School of Medicine, Miami; the Department of Psychology, University of Miami, Coral Gables, Fla. (Dhabhar); the Department of Psychiatry, New York University School of Medicine, New York (Schultebraucks, Galatzer-Levy); Mclean Hospital, Harvard Medical School, Belmont, Mass. (Ressler); the Department of Psychiatry, Dell Medical School, and the Institute for Early Life Adversity Research, University of Texas at Austin (Nemeroff)
| | - Felicia Gould
- The Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta (Michopoulos, Rothbaum, Ressler); the Yerkes National Primate Research Center, Atlanta (Michopoulos); the Department of Psychiatry and Behavioral Sciences (Beurel, Gould, Dhabhar), the Department of Biochemistry and Molecular Biology (Beurel), and the Sylvester Comprehensive Cancer Center (Dhabhar), University of Miami Miller School of Medicine, Miami; the Department of Psychology, University of Miami, Coral Gables, Fla. (Dhabhar); the Department of Psychiatry, New York University School of Medicine, New York (Schultebraucks, Galatzer-Levy); Mclean Hospital, Harvard Medical School, Belmont, Mass. (Ressler); the Department of Psychiatry, Dell Medical School, and the Institute for Early Life Adversity Research, University of Texas at Austin (Nemeroff)
| | - Firdaus S Dhabhar
- The Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta (Michopoulos, Rothbaum, Ressler); the Yerkes National Primate Research Center, Atlanta (Michopoulos); the Department of Psychiatry and Behavioral Sciences (Beurel, Gould, Dhabhar), the Department of Biochemistry and Molecular Biology (Beurel), and the Sylvester Comprehensive Cancer Center (Dhabhar), University of Miami Miller School of Medicine, Miami; the Department of Psychology, University of Miami, Coral Gables, Fla. (Dhabhar); the Department of Psychiatry, New York University School of Medicine, New York (Schultebraucks, Galatzer-Levy); Mclean Hospital, Harvard Medical School, Belmont, Mass. (Ressler); the Department of Psychiatry, Dell Medical School, and the Institute for Early Life Adversity Research, University of Texas at Austin (Nemeroff)
| | - Katharina Schultebraucks
- The Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta (Michopoulos, Rothbaum, Ressler); the Yerkes National Primate Research Center, Atlanta (Michopoulos); the Department of Psychiatry and Behavioral Sciences (Beurel, Gould, Dhabhar), the Department of Biochemistry and Molecular Biology (Beurel), and the Sylvester Comprehensive Cancer Center (Dhabhar), University of Miami Miller School of Medicine, Miami; the Department of Psychology, University of Miami, Coral Gables, Fla. (Dhabhar); the Department of Psychiatry, New York University School of Medicine, New York (Schultebraucks, Galatzer-Levy); Mclean Hospital, Harvard Medical School, Belmont, Mass. (Ressler); the Department of Psychiatry, Dell Medical School, and the Institute for Early Life Adversity Research, University of Texas at Austin (Nemeroff)
| | - Isaac Galatzer-Levy
- The Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta (Michopoulos, Rothbaum, Ressler); the Yerkes National Primate Research Center, Atlanta (Michopoulos); the Department of Psychiatry and Behavioral Sciences (Beurel, Gould, Dhabhar), the Department of Biochemistry and Molecular Biology (Beurel), and the Sylvester Comprehensive Cancer Center (Dhabhar), University of Miami Miller School of Medicine, Miami; the Department of Psychology, University of Miami, Coral Gables, Fla. (Dhabhar); the Department of Psychiatry, New York University School of Medicine, New York (Schultebraucks, Galatzer-Levy); Mclean Hospital, Harvard Medical School, Belmont, Mass. (Ressler); the Department of Psychiatry, Dell Medical School, and the Institute for Early Life Adversity Research, University of Texas at Austin (Nemeroff)
| | - Barbara O Rothbaum
- The Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta (Michopoulos, Rothbaum, Ressler); the Yerkes National Primate Research Center, Atlanta (Michopoulos); the Department of Psychiatry and Behavioral Sciences (Beurel, Gould, Dhabhar), the Department of Biochemistry and Molecular Biology (Beurel), and the Sylvester Comprehensive Cancer Center (Dhabhar), University of Miami Miller School of Medicine, Miami; the Department of Psychology, University of Miami, Coral Gables, Fla. (Dhabhar); the Department of Psychiatry, New York University School of Medicine, New York (Schultebraucks, Galatzer-Levy); Mclean Hospital, Harvard Medical School, Belmont, Mass. (Ressler); the Department of Psychiatry, Dell Medical School, and the Institute for Early Life Adversity Research, University of Texas at Austin (Nemeroff)
| | - Kerry J Ressler
- The Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta (Michopoulos, Rothbaum, Ressler); the Yerkes National Primate Research Center, Atlanta (Michopoulos); the Department of Psychiatry and Behavioral Sciences (Beurel, Gould, Dhabhar), the Department of Biochemistry and Molecular Biology (Beurel), and the Sylvester Comprehensive Cancer Center (Dhabhar), University of Miami Miller School of Medicine, Miami; the Department of Psychology, University of Miami, Coral Gables, Fla. (Dhabhar); the Department of Psychiatry, New York University School of Medicine, New York (Schultebraucks, Galatzer-Levy); Mclean Hospital, Harvard Medical School, Belmont, Mass. (Ressler); the Department of Psychiatry, Dell Medical School, and the Institute for Early Life Adversity Research, University of Texas at Austin (Nemeroff)
| | - Charles B Nemeroff
- The Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta (Michopoulos, Rothbaum, Ressler); the Yerkes National Primate Research Center, Atlanta (Michopoulos); the Department of Psychiatry and Behavioral Sciences (Beurel, Gould, Dhabhar), the Department of Biochemistry and Molecular Biology (Beurel), and the Sylvester Comprehensive Cancer Center (Dhabhar), University of Miami Miller School of Medicine, Miami; the Department of Psychology, University of Miami, Coral Gables, Fla. (Dhabhar); the Department of Psychiatry, New York University School of Medicine, New York (Schultebraucks, Galatzer-Levy); Mclean Hospital, Harvard Medical School, Belmont, Mass. (Ressler); the Department of Psychiatry, Dell Medical School, and the Institute for Early Life Adversity Research, University of Texas at Austin (Nemeroff)
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15
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Affiliation(s)
- Joanna L Spencer-Segal
- Division of Metabolism, Endocrinology, and Diabetes, Department of Internal Medicine, Molecular and Behavioral Neuroscience Institute, Ann Arbor, Michigan
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16
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Stressing the Brain: The Immune System, Hypothalamic-Pituitary-Adrenal Axis, and Psychiatric Symptoms in Acute Respiratory Distress Syndrome Survivors. Ann Am Thorac Soc 2019; 14:839-841. [PMID: 28570150 DOI: 10.1513/annalsats.201703-203ed] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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17
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Spencer-Segal JL, Akil H. Glucocorticoids and resilience. Horm Behav 2019; 111:131-134. [PMID: 30448249 PMCID: PMC7384477 DOI: 10.1016/j.yhbeh.2018.11.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 11/09/2018] [Accepted: 11/14/2018] [Indexed: 11/17/2022]
Abstract
All organisms endure frequent challenges to homeostasis, or stressors, that require adaptation. Depending on the individual, the context, and the magnitude of stress, this active adaptation can lead to behavioral susceptibility or resilience. The latter is an under-appreciated consequence of stress, as the damaging effects of chronic stress and chronically elevated glucocorticoids have received much more attention. We suggest here that neural pathways promoting resilience are initiated at the time of stress, and that they involve glucocorticoid signaling. By focusing on the neurobiology of resilience induction and the identification of vulnerable individuals, we may be able to intervene in the future at the time of stress to promote positive adaptation.
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Affiliation(s)
- Joanna L Spencer-Segal
- Department of Internal Medicine, Division of Metabolism, Endocrinology, and Diabetes, University of Michigan, Ann Arbor, MI, United States of America; Molecular and Behavioral Neuroscience Institute, University of Michigan, Ann Arbor, MI, United States of America.
| | - Huda Akil
- Molecular and Behavioral Neuroscience Institute, University of Michigan, Ann Arbor, MI, United States of America
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18
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Bay-Richter C, Petersen E, Liebenberg N, Elfving B, Wegener G. Latent toxoplasmosis aggravates anxiety- and depressive-like behaviour and suggest a role of gene-environment interactions in the behavioural response to the parasite. Behav Brain Res 2019; 364:133-139. [PMID: 30768994 DOI: 10.1016/j.bbr.2019.02.018] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 01/23/2019] [Accepted: 02/11/2019] [Indexed: 01/11/2023]
Abstract
Toxoplasma gondii (TOX) is an intracellular parasite which infects warm-blooded animals including humans. An increasing number of clinical studies now hypothesize that latent toxoplasmosis may be a risk factor for the development of psychiatric disease. For depression, the results have been varied and we speculate that genetic background is important for the response to latent toxoplasmosis. The main objective of this study was to elucidate gene - environment interactions in the behavioural response to TOX infection by use of genetically vulnerable animals (Flinders sensitive line, FSL) compared to control animals (Flinders resistant line, FRL). Our results show that all infected animals displayed increased anxiety-like behaviour whereas only genetically vulnerable animals (FSL rats) showed depressive-like behaviour as a consequence of the TOX infection. Furthermore, peripheral cytokine expression was increased following the infection, primarily independent of strain. In the given study 14 cytokines, chemokines, metabolic hormones, and growth factors were quantified with the bead-based Luminex200 system, however, only IL-1α expression was affected differently in FSL animals compared to FRL rats. These results suggest that latent TOX infection can induce anxiety-like behaviour independent of genetic background. Intriguingly, we also report that for depressive-like behaviour only the vulnerable rat strain is affected. This could explain the discrepancy in the literature as to whether TOX infection is a risk factor for depressive symptomatology. We propose that the low grade inflammation caused by the chronic infection is related to the development of behavioural symptoms.
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Affiliation(s)
- Cecilie Bay-Richter
- Translational Neuropsychiatry Unit, Department of Clinical Medicine, Aarhus University, 8240 Risskov, Denmark.
| | - Eskild Petersen
- Department of Infectious Diseases, The Royal Hospital, 111 Muscat, Oman; Institute for Clinical Medicine, 8000 Aarhus University, Denmark
| | - Nico Liebenberg
- Translational Neuropsychiatry Unit, Department of Clinical Medicine, Aarhus University, 8240 Risskov, Denmark
| | - Betina Elfving
- Translational Neuropsychiatry Unit, Department of Clinical Medicine, Aarhus University, 8240 Risskov, Denmark
| | - Gregers Wegener
- Translational Neuropsychiatry Unit, Department of Clinical Medicine, Aarhus University, 8240 Risskov, Denmark; Department of Clinical Medicine, AUGUST Centre, Aarhus University, Risskov, Denmark
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Abstract
Critical illness survivors frequently have substantial psychiatric morbidity, including posttraumatic stress, depression, and anxiety symptoms. Prior psychiatric illness is a potent predictor of postcritical illness psychiatric morbidity. Early emotional distress and memories of frightening psychotic and nightmarish intensive care unit (ICU) experiences are risk factors for longer term psychiatric morbidity. ICU diaries may be effective in decreasing psychiatric morbidity after critical illness, though these and other interventions deserve further study.
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Affiliation(s)
- Elizabeth Prince
- Department of Psychiatry, University of Maryland Medical Center, 22 South Greene Street Room P1H10, Baltimore, MD 21201, USA
| | - Ted Avi Gerstenblith
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, 600 North Wolfe Street, Meyer 106 and 115, Baltimore, MD 21287, USA
| | - Dimitry Davydow
- CHI Franciscan Health System St. Joseph Medical Center, 1717 South J Street MS 01-01, Tacoma, WA 98405, USA
| | - Oscar Joseph Bienvenu
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, 600 North Wolfe Street, Meyer 106 and 115, Baltimore, MD 21287, USA.
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21
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Reply: A New Direction: Sleep and Neuropsychological Impairment after Critical Illness. Ann Am Thorac Soc 2018; 15:114. [DOI: 10.1513/annalsats.201709-757le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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22
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Wang Z, Caughron B, Young MRI. Posttraumatic Stress Disorder: An Immunological Disorder? Front Psychiatry 2017; 8:222. [PMID: 29163241 PMCID: PMC5681483 DOI: 10.3389/fpsyt.2017.00222] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 10/23/2017] [Indexed: 12/15/2022] Open
Abstract
Patients with posttraumatic stress disorder (PTSD) exhibit an increased state of inflammation. Various animal models for PTSD have shown some of the same immune imbalances as have been shown in human subjects with PTSD, and some of these studies are discussed in this review. However, animal studies can only indirectly implicate immune involvement in PTSD in humans. This review of mainly studies with human subjects focuses on dissecting the immunological role in the pathogenesis of PTSD following initial trauma exposure. It addresses both the inflammatory state associated with PTSD and the immune imbalance between stimulatory and inhibitory immune mediators, as well as variables that can lead to discrepancies between analyses. The concept of immunological treatment approaches is proposed for PTSD, as new treatments are needed for this devastating disorder that is affecting unprecedented numbers of Veterans from the long-standing wars in the Middle East and which affects civilians following severe trauma.
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Affiliation(s)
- Zhewu Wang
- Mental Health Service, Ralph H. Johnson VA Medical Center, Charleston, SC, United States.,Department of Psychiatry, Medical University of South Carolina, Charleston, SC, United States
| | - Blaine Caughron
- Research Service, Ralph H. Johnson VA Medical Center, Charleston, SC, United States
| | - M Rita I Young
- Research Service, Ralph H. Johnson VA Medical Center, Charleston, SC, United States.,Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, United States
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