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Primavera D, Fornaro M, Carrà G, Romano F, Aviles Gonzales CI, Preti A, Sancassiani F, Cossu G, Nardi AE, Scano A, Orrù G, Chessa E, Floris A, Piga M, Cauli A, Carta MG. Mood Disorder Questionnaire Positivity in Systemic Lupus Erythematosus and Other Chronic Diseases including Screen Bipolar Disorders or Rhythm and Energy Dysregulation Syndromes (DYMERS). Clin Pract Epidemiol Ment Health 2024; 20:e17450179303653. [PMID: 39135945 PMCID: PMC11318155 DOI: 10.2174/0117450179303653240705051227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Revised: 06/11/2024] [Accepted: 06/24/2024] [Indexed: 08/15/2024]
Abstract
Introduction This study explores the issue of paper-and-pencil screening tests for bipolar disorder, often leading to false positives. It discusses hypotheses that connect MDQ positivity with sleep disorders, a decline in health-related quality of life, and the impact of the COVID-19 pandemic on mood disorders. The study proposes that MDQ identifies a "Dysregulation of Mood, Energy, and Social Rhythms Syndrome" (DYMERS), indicating a stress-related condition. It aims to investigate the association between MDQ positivity and systemic lupus erythematosus (SLE) in comparison to other chronic disorders. Methods This case-control study, conducted from April 2019 to February 2020, investigated MDQ positivity in patients with SLE. Ethical approvals were obtained, and statistical analysis was used for data assessment. Results This is a case-controlled study where MDQ positivity was significantly higher in systemic lupus erythematosus cases than controls. The analysis compared gender, age, and the presence of depressive episodes between MDQ-positive and MDQ-negative cases, revealing some differences but no significant variations. Interestingly, no association with high prednisone or biologics use was observed. The frequency of MDQ positivity in systemic lupus erythematosus was compared to other chronic pathologies, revealing varying associations with each condition. Conclusion This study reveals a high rate of (MDQ) positivity in systemic lupus erythematosus (SLE), associated with the risk of bipolar disorder in SLE. Notable discrepancies in MDQ positivity risk factors between SLE and bipolar disorder are observed. The study emphasizes the ability of MDQ to identify a distinct syndrome characterized by rhythm dysregulation, posing a risk for bipolar disorder and other disorders.
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Affiliation(s)
- Diego Primavera
- Department of Medical Sciences and Public Health, University of Cagliari, Italy Section of Psychiatry, Cagliari, Italy
| | - Michele Fornaro
- Department of Neuroscience, Reproductive Science and Odontostomatology Federico II University of Naples, Naples, Italy
| | - Giuseppe Carrà
- Department of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, Monza 20900, Italy
- Division of Psychiatry, University College London, 149 Tottenham Court Road, London, W1T 7NF, UK
| | - Ferdinando Romano
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome 00185, Italy
| | - Cesar Ivan Aviles Gonzales
- Department of Medical Sciences and Public Health, University of Cagliari, Italy Section of Psychiatry, Cagliari, Italy
- Nursing Program, Faculty of Health Sciences, Universidad Popular del Cesar, Valledupar, Colombia
| | - Antonio Preti
- Laboratory Panic and Respiration, Institute of Psychiatry (Ipub), Federal University of Rio De Janeiro (Ufrj), Rio De Janeiro 22725, Brazil
| | - Federica Sancassiani
- Department of Medical Sciences and Public Health, University of Cagliari, Italy Section of Psychiatry, Cagliari, Italy
| | - Giulia Cossu
- Department of Medical Sciences and Public Health, University of Cagliari, Italy Section of Psychiatry, Cagliari, Italy
| | - Antonio Egidio Nardi
- Department of Neuroscience, University of Turin, Turin 10125, Italy
- Institute of Psychiatry, Federal University of Rio de Janeiro, Brasil
| | - Alessandra Scano
- Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | - Germano Orrù
- Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | - Elisabetta Chessa
- Department of Medical Sciences and Public Health, University of Cagliari, Monserrato 09042, Italy
- Rheumatology Unit, Azienda Ospedaliero Universitaria di Cagliari, Monserrato 09042, Italy
| | - Alberto Floris
- Department of Medical Sciences and Public Health, University of Cagliari, Monserrato 09042, Italy
- Rheumatology Unit, Azienda Ospedaliero Universitaria di Cagliari, Monserrato 09042, Italy
| | - Matteo Piga
- Department of Medical Sciences and Public Health, University of Cagliari, Monserrato 09042, Italy
- Rheumatology Unit, Azienda Ospedaliero Universitaria di Cagliari, Monserrato 09042, Italy
| | - Alberto Cauli
- Department of Medical Sciences and Public Health, University of Cagliari, Monserrato 09042, Italy
- Rheumatology Unit, Azienda Ospedaliero Universitaria di Cagliari, Monserrato 09042, Italy
| | - Mauro Giovanni Carta
- Department of Medical Sciences and Public Health, University of Cagliari, Italy Section of Psychiatry, Cagliari, Italy
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Primavera D, Cantone E, Cannizzaro GM, Sanna C, Redolfi S. Are Depressive Symptoms in Obstructive Sleep Apnea Attributable to a Syndrome of Dysregulation of Rhythms and Hyperactivity (DYMERS)? J Clin Med 2024; 13:4396. [PMID: 39124663 PMCID: PMC11312976 DOI: 10.3390/jcm13154396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2024] [Revised: 07/22/2024] [Accepted: 07/26/2024] [Indexed: 08/12/2024] Open
Abstract
Background: Obstructive sleep apnea (OSA) is characterized by repeated airway obstructions during sleep, causing hypopnea, apnea, intermittent hypoxia, and sleep fragmentation. The severity of OSA is measured using the apnea-hypopnea index (AHI), with AHI ≥ 5 indicating OSA. This study aims to assess the frequency and type of depressive disorder characteristics of OSA patients and to evaluate the impact on quality of life, also considering the presence of hyperactivity. Methods: A case-control study using OSA patients referred to Cagliari's sleep disorder center. Controls were matched by age and sex from community databases. OSA diagnoses were made with AHI > 15. Depressive episodes were identified using BDI-SF, and H-QoL (Health related Quality of Life) was measured with the SF-12, focusing on item 10 for hyper-energy. Results: The clinical sample (n = 25) had a higher frequency of depressive episodes (36%) compared to controls (7% and 4%). Depressed OSA patients had worse H-QoL and higher hyper-energy scores, but the additional burden from depression was relatively low. Conclusions: The OSA sample has a higher frequency of depressive episodes compared to the general population. Depressive episodes in OSA patients are linked to higher scores on item 10 of the SF-12, indicating hyper-energy despite lower overall quality of life scores. While OSA significantly impacts quality of life, the additional burden from depression is less severe than in other chronic diseases. These findings suggest that depressive episodes in OSA may be related to rhythm dysregulation and hyperactivity (DYMERS).
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Affiliation(s)
- Diego Primavera
- Department of Medical Sciences and Public Health, University of Cagliari, Monserrato Blocco I (CA), 09042 Cagliari, Italy; (D.P.); (S.R.)
| | - Elisa Cantone
- Department of Medical Sciences and Public Health, University of Cagliari, Monserrato Blocco I (CA), 09042 Cagliari, Italy; (D.P.); (S.R.)
| | - Gregorio Marco Cannizzaro
- Research Center of Sleep Disorders, University Hospital D. Casula Monserrato, Monserrato, 09042 Cagliari, Italy; (G.M.C.); (C.S.)
| | - Chiara Sanna
- Research Center of Sleep Disorders, University Hospital D. Casula Monserrato, Monserrato, 09042 Cagliari, Italy; (G.M.C.); (C.S.)
| | - Stefania Redolfi
- Department of Medical Sciences and Public Health, University of Cagliari, Monserrato Blocco I (CA), 09042 Cagliari, Italy; (D.P.); (S.R.)
- Research Center of Sleep Disorders, University Hospital D. Casula Monserrato, Monserrato, 09042 Cagliari, Italy; (G.M.C.); (C.S.)
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Ciaccio EJ, Lee AR, Lebovits J, Wolf RL, Lewis SK, Ciacci C, Green PHR. Psychological, Psychiatric, and Organic Brain Manifestations of Celiac Disease. Dig Dis 2024; 42:419-444. [PMID: 38861947 DOI: 10.1159/000534219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 09/07/2023] [Indexed: 06/13/2024]
Abstract
INTRODUCTION Celiac disease is an autoimmune condition that affects approximately 1% of the population worldwide. Although its main impact often concerns the small intestine, resulting in villous atrophy and nutrient malabsorption, it can also cause systemic manifestations, particularly when undiagnosed or left untreated. METHOD Attention is directed to the possible psychological, psychiatric, and organic brain manifestations of celiac disease. Specific topics related to the influence and risk of such manifestations with respect to celiac disease are defined and discussed. Overall, eighteen main topics are considered, sifted from over 500 references. RESULTS The most often studied topics were found to be the effect on quality of life, organic brain dysfunction and ataxia, epilepsy, Down syndrome, generalized psychological disorders, eating dysfunction, depression, and schizophrenia. For most every topic, although many studies report a connection to celiac disease, there are often one or more contrary studies and opinions. A bibliographic analysis of the cited articles was also done. There has been a sharp increase in interest in this research since 1990. Recently published articles tend to receive more referencing, up to as many as 15 citations per year, suggesting an increasing impact of the topics. The number of manuscript pages per article has also tended to increase, up to as many as 12 pages. The impact factor of the publishing journal has remained level over the years. CONCLUSION This compendium may be useful in developing a consensus regarding psychological, psychiatric, and organic brain manifestations that can occur in celiac disease and for determining the best direction for ongoing research focus.
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Affiliation(s)
- Edward J Ciaccio
- Department of Medicine - Celiac Disease Center, Columbia University Irving Medical Center, New York, New York, USA
| | - Anne R Lee
- Department of Medicine - Celiac Disease Center, Columbia University Irving Medical Center, New York, New York, USA
| | - Jessica Lebovits
- Department of Medicine - Celiac Disease Center, Columbia University Irving Medical Center, New York, New York, USA
| | - Randi L Wolf
- Teachers College, Columbia University, New York, New York, USA
| | - Suzanne K Lewis
- Department of Medicine - Celiac Disease Center, Columbia University Irving Medical Center, New York, New York, USA
| | - Carolina Ciacci
- Department of Medicine, Surgery, and Dentistry, Scuola Medica Salernitana, Università degli Studi di Salerno, Salerno, Italy
| | - Peter H R Green
- Department of Medicine - Celiac Disease Center, Columbia University Irving Medical Center, New York, New York, USA
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Mikulska J, Pietrzak D, Rękawek P, Siudaj K, Walczak-Nowicka ŁJ, Herbet M. Celiac disease and depressive disorders as nutritional implications related to common factors - A comprehensive review. Behav Brain Res 2024; 462:114886. [PMID: 38309373 DOI: 10.1016/j.bbr.2024.114886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 01/23/2024] [Accepted: 01/27/2024] [Indexed: 02/05/2024]
Abstract
Celiac disease (CD) is an immune-mediated disease affecting the small intestine. The only treatment strategy for CD is the gluten-free diet (GFD). One of the more common mental disorders in CD patients is major depressive disorder (MDD). The influence of GFD on the occurrence of MDD symptoms in patients with CD will be evaluated. This diet often reduces nutritional deficiencies in these patients and also helps to reduce depressive symptoms. Both disease entities are often dominated by the same deficiencies of nutrients such as iron, zinc, selenium, iodine, or B and D vitamins. Deficiencies of particular components in CD can favor MDD and vice versa. Gluten can adversely affect the mental state of patients without CD. Also, intestinal microbiota may play an important role in the described process. This work aims to comprehensively assess the common factors involved in the pathomechanisms of MDD and CD, with particular emphasis on nutrient imbalances. Given the complexity of both disease entities, and the many common links, more research related to improving mental health in these patients and the implementation of a GFD would need to be conducted, but it appears to be a viable pathway to improving the quality of life and health of people struggling with CD and MDD. Therefore, probiotics, micronutrients, macronutrients, and vitamin supplements are recommended to reduce the risk of MDD, given that they may alleviate the symptoms of both these disease entities. In turn, in patients with MDD, it is worth considering testing for CD.
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Affiliation(s)
- Joanna Mikulska
- Chair and Department of Toxicology, Faculty of Pharmacy, Medical University of Lublin, 8 Chodźki Street, 20-093 Lublin, Poland
| | - Diana Pietrzak
- Chair and Department of Toxicology, Faculty of Pharmacy, Medical University of Lublin, 8 Chodźki Street, 20-093 Lublin, Poland
| | - Paweł Rękawek
- Chair and Department of Toxicology, Faculty of Pharmacy, Medical University of Lublin, 8 Chodźki Street, 20-093 Lublin, Poland
| | - Krystian Siudaj
- Chair and Department of Toxicology, Faculty of Pharmacy, Medical University of Lublin, 8 Chodźki Street, 20-093 Lublin, Poland
| | - Łucja Justyna Walczak-Nowicka
- Chair and Department of Toxicology, Faculty of Pharmacy, Medical University of Lublin, 8 Chodźki Street, 20-093 Lublin, Poland.
| | - Mariola Herbet
- Chair and Department of Toxicology, Faculty of Pharmacy, Medical University of Lublin, 8 Chodźki Street, 20-093 Lublin, Poland
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Primavera D, Carta MG, Romano F, Sancassiani F, Chessa E, Floris A, Cossu G, Nardi AE, Piga M, Cauli A. Quality of Life in Systemic Lupus Erythematosus and Other Chronic Diseases: Highlighting the Amplified Impact of Depressive Episodes. Healthcare (Basel) 2024; 12:233. [PMID: 38255120 PMCID: PMC10815265 DOI: 10.3390/healthcare12020233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 01/12/2024] [Accepted: 01/13/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Extensive research has explored SLE's impact on health-related quality of life (H-QoL), especially its connection with mental wellbeing. Recent evidence indicates that depressive syndromes significantly affect H-QoL in SLE. This study aims to quantify SLE's impact on H-QoL, accounting for comorbid depressive episodes through case-control studies. METHODS A case-control study was conducted with SLE patients (meeting the ACR/EULAR 2019 criteria of age ≥ 18). The control group was chosen from a community database. H-QoL was measured with the SF-12 questionnaire, and PHQ-9 was used to assess depressive episodes. RESULTS SLE significantly worsened H-QoL with an attributable burden of 5.37 ± 4.46. When compared to other chronic diseases, only multiple sclerosis had a worse impact on H-QoL. Major depressive episodes had a significant impact on SLE patients' H-QoL, with an attributable burden of 9.43 ± 5.10, similar to its impact on solid cancers but greater than its impact on other diseases. CONCLUSIONS SLE has a comparable impact on QoL to serious chronic disorders. Concomitant depressive episodes notably worsened SLE patients' QoL, exceeding other conditions, similar to solid tumors. This underscores the significance of addressing mood disorders in SLE patients. Given the influence of mood disorders on SLE outcomes, early identification and treatment are crucial.
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Affiliation(s)
- Diego Primavera
- Department of Medical Sciences and Public Health, University of Cagliari, 09127 Cagliari, Italy; (M.G.C.); (F.S.); (E.C.); (G.C.); (M.P.); (A.C.)
| | - Mauro Giovanni Carta
- Department of Medical Sciences and Public Health, University of Cagliari, 09127 Cagliari, Italy; (M.G.C.); (F.S.); (E.C.); (G.C.); (M.P.); (A.C.)
| | - Ferdinando Romano
- Department of Public Health and Infectious Diseases, University of Rome La Sapienza, 00100 Rome, Italy;
| | - Federica Sancassiani
- Department of Medical Sciences and Public Health, University of Cagliari, 09127 Cagliari, Italy; (M.G.C.); (F.S.); (E.C.); (G.C.); (M.P.); (A.C.)
| | - Elisabetta Chessa
- Department of Medical Sciences and Public Health, University of Cagliari, 09127 Cagliari, Italy; (M.G.C.); (F.S.); (E.C.); (G.C.); (M.P.); (A.C.)
- UOC Reumatologia, Azienda Ospedaliero Universitaria Cagliari, 09124 Cagliari, Italy
| | - Alberto Floris
- Department of Medical Sciences and Public Health, University of Cagliari, 09127 Cagliari, Italy; (M.G.C.); (F.S.); (E.C.); (G.C.); (M.P.); (A.C.)
- UOC Reumatologia, Azienda Ospedaliero Universitaria Cagliari, 09124 Cagliari, Italy
| | - Giulia Cossu
- Department of Medical Sciences and Public Health, University of Cagliari, 09127 Cagliari, Italy; (M.G.C.); (F.S.); (E.C.); (G.C.); (M.P.); (A.C.)
| | - Antonio Egidio Nardi
- Panic and Respiration Laboratory, Federal University of Rio de Janeiro, Rio de Janeiro 22725, Brazil;
| | - Matteo Piga
- Department of Medical Sciences and Public Health, University of Cagliari, 09127 Cagliari, Italy; (M.G.C.); (F.S.); (E.C.); (G.C.); (M.P.); (A.C.)
- UOC Reumatologia, Azienda Ospedaliero Universitaria Cagliari, 09124 Cagliari, Italy
| | - Alberto Cauli
- Department of Medical Sciences and Public Health, University of Cagliari, 09127 Cagliari, Italy; (M.G.C.); (F.S.); (E.C.); (G.C.); (M.P.); (A.C.)
- UOC Reumatologia, Azienda Ospedaliero Universitaria Cagliari, 09124 Cagliari, Italy
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Giovanni Carta M, Kalcev G, Scano A, Aviles Gonzalez CI, Ouali U, Pinna S, Carrà G, Romano F, Preti A, Orrù G, Minerba L, Cossu G, Nardi AE, Primavera D. The impact of MDQ positivity on quality of life impairment: Does it support the hypothesis of "Dysregulation of Mood, Energy, and Social Rhythms Syndrome" (DYMERS)? J Public Health Res 2023; 12:22799036231208356. [PMID: 37927350 PMCID: PMC10625312 DOI: 10.1177/22799036231208356] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 09/09/2023] [Indexed: 11/07/2023] Open
Abstract
Background DSM-5 separates bipolar (BD) from depressive disorders, but some experts consider BD as part of a spectrum of mood disorders. The interpretation of numerous false positives of BD screened by the Mood Disorders Questionnaire (MDQ) is part of this debate. Recent study results suggest that the worsening of health-related quality of life (H-Qol) associated with MDQ positivity does not depend solely on mood disorders. This study aims to clarify whether the impairment may be due to other concomitant disorders, unrelated to mood disorders, leading to a worsening of H-Qol. Additionally, the study aims to explore if MDQ positivity itself observe clinical significance. Design and methods The study involved pairs of cases (MDQ+) and controls (MDQ-) matched for sex, age, and absence of DSM-IV psychiatric comorbidity. The impact of MDQ positivity on the quality of life in a sample of MDQ+ comorbid with MDD was measured and compared to impact of MDD in other chronic disorders. Results The H-Qol was significantly worse in MDQ+ than in controls (both groups without any psychiatric co-morbidity). The worsening was similar to severe chronic disorders The burden of worsening quality of life due to MDD was mild in another sample of MDQ positives with comorbid MDD. Conclusion The study hypothesizes that MDQ positivity may be related to hyperactivation and dysregulation of rhythms typical of stress disorders. In fact, MDQ+ was found strongly related to sleep disturbances. Future studies could verify if a "Dysregulation of Mood, Energy, and Social Rhythms Syndrome" (DYMERS), causes worsening the H-Qol in MDQ+.
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Affiliation(s)
- Mauro Giovanni Carta
- Department of Medical Sciences and Public Health, University of Cagliari, Monserato Blocco I (CA), Cagliari, Italy
| | - Goce Kalcev
- Department of Medical Sciences and Public Health, University of Cagliari, Monserato Blocco I (CA), Cagliari, Italy
| | - Alessandra Scano
- Department of Surgical Science, Molecular Biology Service Lab, University of Cagliari, Cagliari, Italy
| | - Cesar Ivan Aviles Gonzalez
- Faculty of Health Sciences, Nursing Program, Univesidad Popular del Cesar, Sede Sabanas, Valledupar, Colombia
| | - Uta Ouali
- Razi Hospital, La Manouba 2010, Faculty of Medicine of Tunisia, University of Tunis, El Manar, Tunisia
| | - Samantha Pinna
- Department of Medical Sciences and Public Health, University of Cagliari, Monserato Blocco I (CA), Cagliari, Italy
| | - Giuseppe Carrà
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Division of Psychiatry, University College London, Maple House, London, UK
| | - Ferdinando Romano
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Antonio Preti
- Department of Neuroscience, University of Turin, Torino, Italy
| | - Germano Orrù
- Department of Surgical Science, Molecular Biology Service Lab, University of Cagliari, Cagliari, Italy
| | - Luigi Minerba
- Department of Medical Sciences and Public Health, University of Cagliari, Monserato Blocco I (CA), Cagliari, Italy
| | - Giulia Cossu
- Department of Medical Sciences and Public Health, University of Cagliari, Monserato Blocco I (CA), Cagliari, Italy
| | - Antonio Egidio Nardi
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Diego Primavera
- Department of Medical Sciences and Public Health, University of Cagliari, Monserato Blocco I (CA), Cagliari, Italy
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Ortega MA, Álvarez-Mon MA, García-Montero C, Fraile-Martínez Ó, Monserrat J, Martinez-Rozas L, Rodríguez-Jiménez R, Álvarez-Mon M, Lahera G. Microbiota-gut-brain axis mechanisms in the complex network of bipolar disorders: potential clinical implications and translational opportunities. Mol Psychiatry 2023; 28:2645-2673. [PMID: 36707651 PMCID: PMC10615769 DOI: 10.1038/s41380-023-01964-w] [Citation(s) in RCA: 28] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 01/02/2023] [Accepted: 01/13/2023] [Indexed: 01/28/2023]
Abstract
Bipolar disorders (BD) represent a severe leading disabling mental condition worldwide characterized by episodic and often progressive mood fluctuations with manic and depressive stages. The biological mechanisms underlying the pathophysiology of BD remain incompletely understood, but it seems that there is a complex picture of genetic and environmental factors implicated. Nowadays, gut microbiota is in the spotlight of new research related to this kind of psychiatric disorder, as it can be consistently related to several pathophysiological events observed in BD. In the context of the so-called microbiota-gut-brain (MGB) axis, it is shown to have a strong influence on host neuromodulation and endocrine functions (i.e., controlling the synthesis of neurotransmitters like serotonin or mediating the activation of the hypothalamic-pituitary-adrenal axis), as well as in modulation of host immune responses, critically regulating intestinal, systemic and brain inflammation (neuroinflammation). The present review aims to elucidate pathophysiological mechanisms derived from the MGB axis disruption and possible therapeutic approaches mainly focusing on gut microbiota in the complex network of BD. Understanding the mechanisms of gut microbiota and its bidirectional communication with the immune and other systems can shed light on the discovery of new therapies for improving the clinical management of these patients. Besides, the effect of psychiatric drugs on gut microbiota currently used in BD patients, together with new therapeutical approaches targeting this ecosystem (dietary patterns, probiotics, prebiotics, and other novelties) will also be contemplated.
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Affiliation(s)
- Miguel A Ortega
- Department of Medicine and Medical Specialities, University of Alcala, Alcalá de Henares, Spain.
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), Madrid, Spain.
| | - Miguel Angel Álvarez-Mon
- Department of Medicine and Medical Specialities, University of Alcala, Alcalá de Henares, Spain
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), Madrid, Spain
- Department of Psychiatry and Mental Health, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - Cielo García-Montero
- Department of Medicine and Medical Specialities, University of Alcala, Alcalá de Henares, Spain
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), Madrid, Spain
| | - Óscar Fraile-Martínez
- Department of Medicine and Medical Specialities, University of Alcala, Alcalá de Henares, Spain
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), Madrid, Spain
| | - Jorge Monserrat
- Department of Medicine and Medical Specialities, University of Alcala, Alcalá de Henares, Spain
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), Madrid, Spain
| | - Lucia Martinez-Rozas
- Department of Medicine and Medical Specialities, University of Alcala, Alcalá de Henares, Spain
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), Madrid, Spain
| | - Roberto Rodríguez-Jiménez
- Department of Legal Medicine and Psychiatry, Complutense University, Madrid, Spain
- Institute for Health Research 12 de Octubre Hospital, (Imas 12)/CIBERSAM (Biomedical Research Networking Centre in Mental Health), Madrid, Spain
| | - Melchor Álvarez-Mon
- Department of Medicine and Medical Specialities, University of Alcala, Alcalá de Henares, Spain
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), Madrid, Spain
- Immune System Diseases-Rheumatology, Oncology Service an Internal Medicine, University Hospital Príncipe de Asturias (CIBEREHD), Alcalá de Henares, Spain
- Psychiatry Service, Center for Biomedical Research in the Mental Health Network, University Hospital Príncipe de Asturias, Alcalá de Henares, Spain
| | - Guillermo Lahera
- Department of Medicine and Medical Specialities, University of Alcala, Alcalá de Henares, Spain
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), Madrid, Spain
- Psychiatry Service, Center for Biomedical Research in the Mental Health Network, University Hospital Príncipe de Asturias, Alcalá de Henares, Spain
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Alkhiari R, Adler JR. Psychiatric and Neurological Manifestations of Celiac Disease in Adults. Cureus 2023; 15:e35712. [PMID: 36875248 PMCID: PMC9984242 DOI: 10.7759/cureus.35712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2023] [Indexed: 03/06/2023] Open
Abstract
Celiac disease (CD), a chronic inflammatory disorder of the intestines, affects 0.7% to 1.4% of the world's population. CD causes diarrhea, abdominal discomfort, bloating, flatulence, and, in rare cases, constipation in the digestive tract. Since the identification of gluten as the disease-causing antigen, CD patients have been treated with a gluten-free diet, which is advantageous but has limitations for certain patient groups. CD is associated with mood disorders, such as manic-depressive disease, schizophrenia, and bipolar disorder, as well as other disorders such as depression and anxiety. The relationship between CD and psychological issues is not entirely understood. Here, we look at the most recent psychiatric data as they pertain to CD, as well as the relevant psychiatric manifestations that have been associated with this condition. Clinicians should examine mental health factors when a CD diagnosis is established. More research is needed to understand the pathophysiology of CD's psychiatric manifestations.
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Affiliation(s)
| | - John R Adler
- Department of Medicine, Qassim University, Qassim, SAU
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Nardi AE, Sancassiani F, Barrui V, Kalcev G, Uras V, Meloni G, Marongiu L, Tamburini G, Maleci A, Quagliato LA, La Nasa G, Carta MG. The Effects of Tyrosine Kinase Inhibitors (TKIs) in Monotherapy and with Add-on Treatments on Health-related Quality of Life of People with Chronic Myeloid Leukemia: A Systematic Review of Randomized-Controlled Trials. Clin Pract Epidemiol Ment Health 2023; 19:e1745017921112200. [PMID: 38659630 PMCID: PMC11037549 DOI: 10.2174/17450179-v17-e211118-2021-ht2-1910-12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 09/04/2021] [Accepted: 10/01/2021] [Indexed: 04/26/2024]
Abstract
Background The era of establishing tyrosine kinase inhibitors (TKIs) in the treatment of chronic myeloid leukemia (CML) changed the outcome and the course of this life-threatening malignancy. People suffering from CML have now a better prognosis and a longer life expectancy due to the development of TKIs, even if it requires long-term, often lifelong, treatments that are nonetheless associated with improved Health-related Quality of life (HRQoL). However, data on the effects of TKIs on HRQoL are not always systematic; sometimes the data have been obtained by studies different from RCTs, or without a clear definition of what HRQoL is. The main purpose of this systematic review is to summarize all randomized-controlled trials (RCTs) including HRQoL as main or secondary outcome in patients with CML treated with TKIs or with TKIs plus an add-on treatment. Methods A systematic review has been conducted by searching the relevant papers in PubMed/Medline and Web of Science with the following keywords: "quality of life" OR "health-related quality of life" OR "QoL" OR "HRQoL" OR "H-QoL" AND "chronic myeloid leukemia". Interval was set from January 2000 to December 2020. Results 40 papers were identified through the search. Out of them, 7 RCTs were included. All the studies used standardized measures to assess HRQoL, even not always specific for CML. 5 RCTs randomized subjects to 2 or 3 arms to evaluate the effects of TKIs of the first, second and third generation in monotherapy. 2 RCTs randomized subjects to TKI therapy plus an add-on treatment versus TKI therapy as usual. The results of all these trials were examined and discussed. Conclusion All the included RCTs pointed out significant findings regarding the positive effects of TKIs on HRQoL of people with CML, both when they were used in monotherapy or, notably, with an add-on treatment to enhance TKIs effects.
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Affiliation(s)
- Antonio E. Nardi
- Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Federica Sancassiani
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Vanessa Barrui
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Goce Kalcev
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Veronica Uras
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Giulia Meloni
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Luigi Marongiu
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Giorgio Tamburini
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Alberto Maleci
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Laiana A. Quagliato
- Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Giorgio La Nasa
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Mauro Giovanni Carta
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
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Abstract
Growing evidence supports a potential link between dietary gluten intake and neurodegenerative disease in susceptible populations. Observational data supporting this link are described along with interventional study data evaluating the effects of restricting gluten from the diet in patients with neurologic disorders. Suggested underlying mechanisms between gluten intake and neurodegeneration are discussed.
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Affiliation(s)
- Ashok Philip
- Ashok Philip, Director of Assessment and Professor of Pharmaceutical Sciences, University of Arkansas for Medical Sciences, College of Pharmacy 4301 W. Markham
- Little Rock, AR 72205, USA. e-mail:
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Lindert J, Sancassiani F, Massa E, Nardi AE. An Overview of the International Literature on Health-Related Quality of Life, Mental Health and Psychosocial Issues in People with Cancer. Clin Pract Epidemiol Ment Health 2021; 17:253-256. [PMID: 35444711 PMCID: PMC8985473 DOI: 10.2174/1745017902117010253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background Cancer is one of the most important leading causes of death worldwide. Early detection, screening and diagnosis have been demonstrated to significantly improve patients' survival rates and increase awareness of the benefit of prompt therapies and healthy lifestyles. In this context, Health-related Quality of Life (HRQoL) and several psychosocial difficulties are of relevance as prognostic factors for the trajectory of the diseases of people living with cancer. Methods This Special Issue aims to present a set of systematic reviews and research studies focusing on several psychosocial aspects in people suffering from hematologic and solid cancer. Results Three systematic reviews regard HRQoL, the quality of patient-physician communication, depression and other stress-related difficulties, respectively. One review pointed out the difficulties in diagnosing depression in the elderly with solid cancer; another one regards the risk of cancer in severe mental illnesses, such as schizophrenia, bipolar disorders, and severe depressive disorders. One additional review regards HRQoL in people with cancer in the present era of COVID-19 pandemic. Furthermore, some research studies pointed out the usefulness of a validated instrument to assess satisfaction with care in the oncology field, as well as of the self-reinforcing feedback loop to improve fatigue, insomnia and depression in people with cancer. Other two research studies evaluate, respectively, the attributable burden in worsening HRQoL in people suffering both from cancer and depression and the Type D personality as a risk factor for stress-related difficulties in women with breast cancer. Conclusion This Special Issue is a contribution to enhance future research mainly about such interventions useful to assess and improve HRQoL and overall well-being in people with cancer.
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Affiliation(s)
- Jutta Lindert
- University of Applied Sciences Emden/Leer, Emden, Germany; WRSC, Brandeis University, Waltham, United States
| | - Federica Sancassiani
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy,Address correspondence to this author at Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy; Tel: 0039 3493119215; E-mail:
| | - Elena Massa
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Antonio Egidio Nardi
- Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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Aviles Gonzalez CI, Angermeyer M, Deiana L, Loi C, Murgia E, Holzinger A, Cossu G, Massa E, Romano F, Scartozzi M, Carta MG. The Quality of Life of People with Solid Cancer is Less Worse than Other Diseases with better Prognosis, Except in the Presence of Depression. Clin Pract Epidemiol Ment Health 2021; 17:315-323. [PMID: 35444707 PMCID: PMC8985466 DOI: 10.2174/1745017902117010315] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 07/08/2021] [Accepted: 07/09/2021] [Indexed: 01/17/2023]
Abstract
Background: Suffering from Solid Cancer (SC) may adversely impact the Health-related Quality of Life (H-QoL). The aims of this study are to measure the H-QoL in a sample of people suffering from SC and to clarify the role of the co-occurrence of depressive episodes. Results were compared with a healthy control group and with groups of other disorders. Methods: In 151 patients with SC (mean±sd age 63.1±11.5; female 54.3%), H-QoL was assessed by SF-12, depressive episodes were identified by PHQ-9. The attributable burden of SC in impairing H-QoL was calculated as the difference between SF-12 score of a community sex and age ¼ matched healthy control group and that of the study sample. The attributable burden of SC was compared with other chronic diseases using specific diagnostic groups drawn from case-control studies that used the same database for selecting control samples. Results: H-QoL in people with SC was significantly worse than in the healthy control group (p<0.0001). The attributable burden in worsening the H-QoL due to SC was similar to those of severe chronic diseases, but lower than Multiple Sclerosis (p<0.0001) or Fibromyalgia (p<0.00001). Having a depressive episode was a strong determinant of decreasing H-QoL, regardless of the severity of cancer. Conclusion: The findings confirm a strong impact of SC but showed that H-QoL in SC was higher than in chronic diseases with better “quoad vitam” outcome. Since depression was a strong determinant, its prevention, early detection and therapy are the main objectives that must be reached in cancer patients.
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Celiac disease poses significant risk in developing depression, anxiety, headache, epilepsy, panic disorder, dysthymia: A meta-analysis. Indian J Gastroenterol 2021; 40:453-462. [PMID: 34839445 DOI: 10.1007/s12664-021-01215-2] [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: 01/26/2021] [Accepted: 06/30/2021] [Indexed: 02/04/2023]
Abstract
Celiac disease (CD) primarily affects the small intestine. Previous studies have identified higher incidences of neuropsychiatric diseases among CD patients compared to non-CD controls. Genome-wide association studies have identified >60 non-human leukocyte antigen (HLA) genes associated with CD, where estimated 15% genes have role in neurological health. We carried out a systematic review and meta-analysis to estimate the potential risk conferred by CD in developing neuropsychiatric diseases. Literature search was performed till June 2019. Incidences of neuropsychiatric diseases were compared among CD and non-CD controls. Funnel plots and Egger's tests were used to evaluate publication bias and estimate study effects. Qualities of the included studies were estimated using Newcastle-Ottawa Scale. Quality of evidence was graded using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Odds of developing neuropsychiatric diseases among CD were evaluated by computing meta-odds ratio (Manten-Haenszel method) and Z test p-value using random and fixed effect models based on the degree of study heterogeneity. Thirteen non-randomized case-control studies were found eligible. Subjects suffering from CD were found to have significantly more risk to develop depression (p<1.00E-05; OR=1.60 [1.37-1.86]), anxiety (p=0.05; OR=1.41 [1.00-1.97]), headache (p<0.1.00E-05; OR=3.27 [2.46-4.34]), epilepsy (p<1.00E-04; OR=11.90 [3.78-37.43]), panic disorder (p<1.00E-04; OR=4.64 [2.22-9.70]), and dysthymia (p=2.00E-03; OR=5.27 [1.83-15.22]). CD is a major predisposing factor in developing array of common neuropsychiatric diseases. Shared biological processes and molecular networks could play a crucial role in disease co-occurrence. Detailed molecular evidences are needed to establish the cause-effect relationship between these diseases.
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Preti A, Piras M, Cossu G, Pintus E, Pintus M, Kalcev G, Cabras F, Moro MF, Romano F, Balestrieri M, Caraci F, Dell'Osso L, Sciascio GD, Drago F, Hardoy MC, Roncone R, Faravelli C, Musu M, Finco G, Nardi AE, Carta MG. The Burden of Agoraphobia in Worsening Quality of Life in a Community Survey in Italy. Psychiatry Investig 2021; 18:277-283. [PMID: 33849246 PMCID: PMC8103017 DOI: 10.30773/pi.2020.0342] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 12/11/2020] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE Current nosology redefined agoraphobia as an autonomous diagnosis distinct from panic disorder. We investigated the lifetime prevalence of agoraphobia, its association with other mental disorders, and its impact on the health-related quality of life (HR-QoL). METHODS Community survey in 2,338 randomly selected adult subjects. Participants were interviewed with the Advanced Neuropsychiatric Tools and Assessment Schedule (ANTAS), administered by clinicians. The diagnoses were based on the ICD-10 criteria. The Short-Form Health Survey (SF-12) was used to quantify HR-QoL. RESULTS In the sample, 35 subjects met the criteria for agoraphobia (1.5%), with greater prevalence among women (2.0%) than men (0.9%): odds ratio (OR) 2.23; 95% CI: 1.0-5-2. Agoraphobia was more often seen among those with (n=26; 1.1%) than without (n=9; 0.4%) panic disorder: OR=8.3; 2.9-24.4. Co-morbidity with other mental disorders was substantial. The mean score of SF-12 in people with agoraphobia was 35.2±7.8, with similar levels of HR-QoL in people with (35.3±7.9) or without (34.8±7.3) panic disorder: ANOVA: F(1;33)=0.0; p=1.00. CONCLUSION One out of seventy people may suffer from agoraphobia in their lifetime. The attributable burden in terms of HR-QoL is substantial and comparable to the one observed for chronic mental disorders such as major depression, post-traumatic stress disorder, or obsessive-compulsive disorder.
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Affiliation(s)
- Antonio Preti
- Department of Neuroscience, University of Turin, Torino, Italy
| | - Martina Piras
- PhD Programme Innovation Sciences and Technologies, University of Cagliari, Cagliari, Italy
| | - Giulia Cossu
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Elisa Pintus
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Mirra Pintus
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Goce Kalcev
- PhD Programme Innovation Sciences and Technologies, University of Cagliari, Cagliari, Italy
| | - Federico Cabras
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | | | | | | | - Filippo Caraci
- Department of Drug Sciences, University of Catania, Catania, Italy.,Oasi Research Institute-IRCCS, Troina, Italy
| | | | | | - Filippo Drago
- Department of Drug Sciences, University of Catania, Catania, Italy
| | | | | | | | - Mario Musu
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Gabriele Finco
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | | | - Mauro Giovanni Carta
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
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15
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La Nasa G, Caocci G, Morelli E, Massa E, Farci A, Deiana L, Pintus E, Scartozzi M, Sancassiani F. Health Related Quality of Life in Patients with Onco-hematological Diseases. Clin Pract Epidemiol Ment Health 2020; 16:174-179. [PMID: 32874192 PMCID: PMC7431682 DOI: 10.2174/1745017902016010174] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 06/03/2020] [Accepted: 06/06/2020] [Indexed: 11/22/2022]
Abstract
Background HRQoL is generally conceptualized as a broad multidimensional construct that refers to patients' perceptions of the impact of disease and its treatment on their physical, psychological, and social functioning and well-being. Little is known in patients with onco-hematological cancer in comparison with the general population and other chronic diseases. Objective We assessed HRQoL in patients diagnosed with haematological cancers in comparison with the general population and other chronic diseases. Methods The questionnaire Short Form (SF)-12 was administered to 62 patients with onco-hematological disease and results were compared with 702 controls (184 healthy people, 37 Major Depression, 201 Multiple Sclerosis; 23 Wilson disease; 46 Carotidal Atherosclerosis; 60 Celiac disease; 151 solid tumours). Results HRQoL in patients diagnosed with a haematological cancer was significantly worse in comparison with the general population (F= 43.853, p <0.00001) but similar when compared with solid tumour and other chronic diseases such as Major Depression and Carotid Atherosclerosis. In addition, HRQoL in patients diagnosed with a haematological cancer was significantly higher than that due to Celiac disease (p <0.00001) and Wilson's disease (p= 0.02), and lower than that due to Multiple Sclerosis (p= 0.032). Conclusion This study confirmed that haematological cancers negatively affects overall HRQoL. The results showed an impact of haematological cancers on HRQoL that is similar to what found in patients with solid tumors, Major Depression and Carotid Atherosclerosis. Current successful therapeutic strategy achieved in the treatment of haematological cancers not only positively impact on survival rate but also could improve the overall HRQoL.
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Affiliation(s)
- Giorgio La Nasa
- Ematologia e CTMO, Ospedale Businco, Azienda Ospedaliera Brotzu, Cagliari, Italy
| | - Giovanni Caocci
- Ematologia e CTMO, Ospedale Businco, Azienda Ospedaliera Brotzu, Cagliari, Italy
| | - Emanuela Morelli
- Ematologia e CTMO, Ospedale Businco, Azienda Ospedaliera Brotzu, Cagliari, Italy
| | - Elena Massa
- Dipartimento di Scienze Mediche e Sanita Pubblica, Universita di Cagliari, Cagliari, Italy
| | - Antonio Farci
- Dipartimento di Scienze Mediche e Sanita Pubblica, Universita di Cagliari, Cagliari, Italy
| | - Laura Deiana
- Dipartimento di Scienze Mediche e Sanita Pubblica, Universita di Cagliari, Cagliari, Italy
| | - Elisa Pintus
- Dipartimento di Scienze Mediche e Sanita Pubblica, Universita di Cagliari, Cagliari, Italy
| | - Mario Scartozzi
- Dipartimento di Scienze Mediche e Sanita Pubblica, Universita di Cagliari, Cagliari, Italy
| | - Federica Sancassiani
- Dipartimento di Scienze Mediche e Sanita Pubblica, Universita di Cagliari, Cagliari, Italy
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Pender MP. Hypothesis: bipolar disorder is an Epstein-Barr virus-driven chronic autoimmune disease - implications for immunotherapy. Clin Transl Immunology 2020; 9:e1116. [PMID: 32257210 PMCID: PMC7133420 DOI: 10.1002/cti2.1116] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 01/09/2020] [Accepted: 02/10/2020] [Indexed: 01/29/2023] Open
Abstract
Bipolar disorder (BD) is a chronic disease characterised by episodes of major depression and episodes of mania or hypomania, with a worldwide prevalence of 2.4%. The cause of BD is unknown. Here, I propose the hypothesis that BD is a chronic autoimmune disease caused by Epstein–Barr virus (EBV) infection of autoreactive B cells. It is postulated that EBV‐infected autoreactive B cells accumulate in the brain where they provide costimulatory survival signals to autoreactive T cells and differentiate into plasma cells producing pathogenic autoantibodies targeting brain components such as the N‐methyl‐D‐aspartate receptor. It is also proposed that the accumulation of EBV‐infected autoreactive B cells in the brain is a consequence of a genetically determined defect in the ability of CD8+ T cells to control EBV infection. The theory is supported by studies indicating that autoimmunity, EBV infection and CD8+ T‐cell deficiency all have roles in the pathogenesis of BD. According to the hypothesis, BD should be able to be treated by EBV‐specific T‐cell therapy and to be prevented by vaccination against EBV in early childhood. Exposure to sunlight or appropriate artificial light should also be beneficial in BD by augmenting CD8+ T‐cell control of EBV infection.
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Affiliation(s)
- Michael P Pender
- Faculty of Medicine The University of Queensland Brisbane QLD Australia.,Department of Neurology Royal Brisbane and Women's Hospital Brisbane QLD Australia
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17
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Sancassiani F, Carmassi C, Romano F, Balestrieri M, Caraci F, Di Sciascio G, Drago F, Faravelli C, Hardoy MC, Moro MF, Roncone R, Preti A, Dell'Osso L. Impairment of Quality of Life Associated With Lifetime Diagnosis of Post-traumatic Stress Disorder in Women - A National Survey in Italy. Clin Pract Epidemiol Ment Health 2019; 15:38-43. [PMID: 30972141 PMCID: PMC6416466 DOI: 10.2174/1745017901915010038] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 01/28/2019] [Accepted: 02/02/2019] [Indexed: 12/16/2022]
Abstract
Introduction The aim of the study was to measure the lifetime prevalence of Post-Traumatic Stress Disorder (PTSD) among women of an Italian community sample, the comorbidity of PTSD with mood and anxiety disorders and the burden attributable to PTSD in worsening the Quality of Life (QoL). Methods Community survey on a sample of 1961 adult women randomly selected. Tools: psychiatric clinical interview ANTAS partially derived from the SCID-DSM-IV, administered by psychologists or medical doctors; Short Form Health Survey (SF-12); Mood Disorder Questionnaire (MDQ). Results Lifetime prevalence of PTSD in women was 1.3%, (1.4% in<45 years aged, 1.3% in >44 years aged; p=0.8). In order of risk of comorbidity, PTSD was associated with: Bipolar Spectrum Disorders (MDQ+), Panic Disorders (PD) and Major Depressive Disorder (MDD). People with PTSD showed an SF-12 mean score lower than women of the same sample without PTSD (standardized by gender and age), with a mean difference (attributable burden) of 3.9±0.9 similarly to MDD and Eating Disorders and higher than PD. Among the analyzed nonpsychiatric diseases, Multiple Sclerosis and Carotid Atherosclerosis showed a higher burden in impairing QoL than PTSD; Wilson's Disease showed a similar burden and Celiac Disease was found less impairing on QoL than PTSD. Conclusion The attributable burden in worsening women' perceived QoL due to a lifetime diagnosis of PTSD was found comparable to those caused by MDD, Eating Disorders or by neurological condition such as Wilson's Disease. The comorbidity of PTSD with Bipolar Spectrum Disorders was remarkable, even further studies are needed to clarify the direction of causality.
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Affiliation(s)
- Federica Sancassiani
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | | | | | | | | | | | | | | | - Maria Carolina Hardoy
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Maria Francesca Moro
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Mailman School of Public Health Columbia University, New York, NY 10027, USA
| | | | - Antonio Preti
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
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Sancassiani F, Romano F, Balestrieri M, Caraci F, Di Sciascio G, Drago F, Hardoy MC, Moro MF, Roncone R, Piras M, Preti A, Dell’Osso L, Faravelli C, Carta MG. The Prevalence of Specific Phobia by Age in an Italian Nationwide Survey: How Much Does it Affect the Quality of Life? Clin Pract Epidemiol Ment Health 2019; 15:30-37. [PMID: 30972140 PMCID: PMC6407652 DOI: 10.2174/1745017901915010030] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 01/24/2019] [Accepted: 01/24/2019] [Indexed: 02/07/2023]
Abstract
INTRODUCTION The study aimed to see if a community survey conducted by clinical interviewers with semi-structured psychiatric interviews shows lifetime prevalence rates of Specific Phobia (SP) similar to those found by surveys carried out by lay interviewers and if the high level of impairment found in SP may be confirmed. METHODS This is a community survey on an Italian nationwide sample randomly selected from registers of municipalities. Tools: semi-structured ANTAS psychiatric interview derived from the SCID-DSM-IV, carried out by clinicians (psychologists or physicians); Short Form Health Survey (SF-12) as a measure of Quality of Life (QoL). Analyses: means of the χ 2 test odds ratios were adopted to test several associations regarding SP prevalence. One-way ANOVA was used to compare different groups on attributable burden due to SP and/or other disorders in worsening QoL. RESULTS The lifetime prevalence of SP was 2.3%. No difference was found by age class. Females showed more than twice the frequency of males (p<0.0001). The disorders showing the closest association with SP were: social phobia (OR=17.53); general anxiety disorder (OR=11.57); anorexia (OR=11.13) and agoraphobia (OR=10.03), but also obsessive compulsive disorders (OR=8.8), eating disorders (OR=7.2), panic disorder (OR=5.9), post-traumatic stress disorder (OR=5.8), and major depressive disorder (OR=4.8) presented an association that achieved statistical significance. The QoL of people with SP and at least one disorder of anxiety, mood or eating in comorbidity, measured as a score at SF12, was worse than controls without SP (p <0.001) but that of people with SP without co-morbidity was not (p = 0.809). CONCLUSION An epidemiological study conducted by clinical interviewers through semi-structured interviews appears to re-dimension the impact of SP, at least from the public health perspective. Future prospective studies will better clarify the role of SP in the context of anxiety disorders.
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Affiliation(s)
| | | | | | - Filippo Caraci
- University of Catania,Catania,Italy
- I.R.C.C.S. Associazione Oasi Maria SS. ONLUS-Troina, Troina, Italy
| | | | | | | | - Maria Francesca Moro
- University of Cagliari,Cagliari,Italy
- Mailman School of Public Health Columbia University,Columbia, NY, US
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Subki AH, Mukhtar AM, Al-Harbi RS, Alotaibi AK, Mosaad FG, Alsallum MS, Jan MMS. The Impact of Pediatric Epilepsy on Children and Families: A Multicenter Cross-Sectional Study. Clin Pract Epidemiol Ment Health 2018; 14:323-333. [PMID: 30972132 PMCID: PMC6407654 DOI: 10.2174/1745017901814010323] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 10/02/2018] [Accepted: 11/19/2018] [Indexed: 11/22/2022]
Abstract
Background and Objectives: Epilepsy is considered one of the most prevalent causes of morbidity in children. The aim of this study is to determine how epilepsy impacts the lives of children with epilepsy and their families. Methods: A translated version of the “Impact of Pediatric Epilepsy Scale” (IPES) questionnaire was completed by the 80 mothers of children with epilepsy, recruited at three hospitals in Jeddah, Saudi Arabia This is a validated self-administered questionnaire used to assess the impact of epilepsy on the lives of the child and family, as well as the quality of life (QoL) of the child. Results: The mean age of children epilepsy was 6.32 years (SD = 3.22). The mean IPES score was 6.28 (SD = 8.42) and the mean child’s QoL was 2.85 (SD= 0.83). 87.5% of the mothers rated their child’s QoL as low. IPES score was significantly associated with cause of seizure (β=0.259; 95%-CI= 0.263 - 10.334; p = 0.039). Child’s QoL was significantly associated with frequency of seizure (β=0.251; 95%-CI= 0.016 - 0.568; p= 0.039) and child’s nationality (β=-0.270; 95%-CI -0.252, -0.013; p= 0.031). Conclusions: Pediatric epilepsy may have a greater impact on the lives of the child and the family when it is not comorbid with cerebral palsy. Quality of life tends to be lower for non-Saudi children, and children with more frequent seizures. Therefore, these groups may need more support in managing the impact that epilepsy has on their daily functioning and quality of life.
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Affiliation(s)
- Ahmed Hussein Subki
- Department of Pediatrics, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Abdel Moniem Mukhtar
- Department of Family and Community Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Rakan Salah Al-Harbi
- Department of Pediatrics, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | | | - Faisal Ghazi Mosaad
- Department of Pediatrics, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Mohammed Saad Alsallum
- Department of Pediatrics, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Mohammed M S Jan
- Department of Pediatrics, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
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Slim M, Rico-Villademoros F, Calandre EP. Psychiatric Comorbidity in Children and Adults with Gluten-Related Disorders: A Narrative Review. Nutrients 2018; 10:E875. [PMID: 29986423 PMCID: PMC6073457 DOI: 10.3390/nu10070875] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 06/26/2018] [Accepted: 07/04/2018] [Indexed: 12/22/2022] Open
Abstract
Gluten-related disorders are characterized by both intestinal and extraintestinal manifestations. Previous studies have suggested an association between gluten-related disorder and psychiatric comorbidities. The objective of our current review is to provide a comprehensive review of this association in children and adults. A systematic literature search using MEDLINE, Embase and PsycINFO from inception to 2018 using terms of ‘celiac disease’ or ‘gluten-sensitivity-related disorders’ combined with terms of ‘mental disorders’ was conducted. A total of 47 articles were included in our review, of which 28 studies were conducted in adults, 11 studies in children and eight studies included both children and adults. The majority of studies were conducted in celiac disease, two studies in non-celiac gluten sensitivity and none in wheat allergy. Enough evidence is currently available supporting the association of celiac disease with depression and, to a lesser extent, with eating disorders. Further investigation is warranted to evaluate the association suggested with other psychiatric disorders. In conclusion, routine surveillance of potential psychiatric manifestations in children and adults with gluten-related disorders should be carried out by the attending physician.
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Affiliation(s)
- Mahmoud Slim
- Division of Neurology, The Hospital for Sick Children, The Peter Gilgan Centre for Research and Learning, 686 Bay St., Toronto, ON M5G 0A4, Canada.
| | - Fernando Rico-Villademoros
- Instituto de Neurociencias, Universidad de Granada, Avenida del Conocimiento s/n, 18100 Armilla, Granada, Spain.
| | - Elena P Calandre
- Instituto de Neurociencias, Universidad de Granada, Avenida del Conocimiento s/n, 18100 Armilla, Granada, Spain.
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Abstract
PURPOSE OF REVIEW Bipolar disorder (BD) medical comorbidity presents significant clinical and public health concerns with serious impact on health. The aim of this article is to present an updated narrative review of original research articles (case control, longitudinal cohort, and cross-sectional studies) and meta-analyses published in English language journals from January 2013 to May 2017 focusing on general medical comorbidity in BD, including the added risks of iatrogenic factors relevant to the treatment of BD. RECENT FINDINGS We found numerous patterns of association between BD and various medical disorders involving multiple organ systems. One pattern indicated reciprocal increase in the rate of each comorbid condition, such as an increased rate of BD in asthma or migraine, and likewise an increase in the rate of asthma or migraine in patients with BD. A second pattern was a predominantly unidirectional increase in the rate of BD in patients with certain medical disorders, such as multiple sclerosis or cerebellar diseases. A third pattern was a predominantly unidirectional increased rate of medical disorders in patients with BD. One study suggested the potential involvement of genetic mechanisms for the association between BD and migraine. Most of the studies had cross-sectional or retrospective designs, and many relied on analysis of large administrative databases inviting multiple potential biases. Our review highlights the association between BD and a variety of medical disorders. Further research is needed to elucidate the potential underlying etiopathological mechanisms that contribute to observed comorbidities. The results of this review also emphasize the need for comprehensive screening for medical disorders in BD and for adoption of an integrated model of care to address these complex comorbidities.
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Affiliation(s)
- Aktriti Sinha
- Department of Psychiatry, University of Missouri School of Medicine, Columbia, MO, 65212, USA
| | - Anam Shariq
- Division of Alcohol and Substance Abuse, Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, 1120 NW 14th Street, Miami, FL, 33136, USA
| | - Khaled Said
- Division of Alcohol and Substance Abuse, Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, 1120 NW 14th Street, Miami, FL, 33136, USA
| | - Abhinav Sharma
- Homewood Health Center, Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, ON, L8S 4L8, Canada
| | - D Jeffrey Newport
- Division of Alcohol and Substance Abuse, Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, 1120 NW 14th Street, Miami, FL, 33136, USA
| | - Ihsan M Salloum
- Division of Alcohol and Substance Abuse, Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, 1120 NW 14th Street, Miami, FL, 33136, USA.
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22
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Joelson AM, Geller MG, Zylberberg HM, Green PHR, Lebwohl B. The Effect of Depressive Symptoms on the Association between Gluten-Free Diet Adherence and Symptoms in Celiac Disease: Analysis of a Patient Powered Research Network. Nutrients 2018; 10:nu10050538. [PMID: 29701659 PMCID: PMC5986418 DOI: 10.3390/nu10050538] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 04/16/2018] [Accepted: 04/23/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The prevalence of depression in celiac disease (CD) is high, and patients are often burdened socially and financially by a gluten-free diet. However, the relationship between depression, somatic symptoms and dietary adherence in CD is complex and poorly understood. We used a patient powered research network (iCureCeliac®) to explore the effect that depression has on patients' symptomatic response to a gluten-free diet (GFD). METHODS We identified patients with biopsy-diagnosed celiac disease who answered questions pertaining to symptoms (Celiac Symptom Index (CSI)), GFD adherence (Celiac Dietary Adherence Test (CDAT)), and a 5-point, scaled question regarding depressive symptoms relating to patients' celiac disease. We then measured the correlation between symptoms and adherence (CSI vs. CDAT) in patients with depression versus those without depression. We also tested for interaction of depression with regard to the association with symptoms using a multiple linear regression model. RESULTS Among 519 patients, 86% were female and the mean age was 40.9 years. 46% of patients indicated that they felt "somewhat," "quite a bit," or "very much" depressed because of their disorder. There was a moderate correlation between worsened celiac symptoms and poorer GFD adherence (r = 0.6, p < 0.0001). In those with a positive depression screen, there was a moderate correlation between worsening symptoms and worsening dietary adherence (r = 0.5, p < 0.0001) whereas in those without depression, the correlation was stronger (r = 0.64, p < 0.0001). We performed a linear regression analysis, which suggests that the relationship between CSI and CDAT is modified by depression. CONCLUSIONS In patients with depressive symptoms related to their disorder, correlation between adherence and symptoms was weaker than those without depressive symptoms. This finding was confirmed with a linear regression analysis, showing that depressive symptoms may modify the effect of a GFD on celiac symptoms. Depressive symptoms may therefore mask the relationship between inadvertent gluten exposure and symptoms. Additional longitudinal and prospective studies are needed to further explore this potentially important finding.
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Affiliation(s)
- Andrew M Joelson
- Department of Internal Medicine, New York Presbyterian Hospital, New York, NY 10032, USA.
| | | | - Haley M Zylberberg
- Celiac Disease Center, Department of Medicine, Columbia University Medical Center, 180 Fort Washington Avenue, Suite 936, New York, NY 10032, USA.
| | - Peter H R Green
- Celiac Disease Center, Department of Medicine, Columbia University Medical Center, 180 Fort Washington Avenue, Suite 936, New York, NY 10032, USA.
| | - Benjamin Lebwohl
- Celiac Disease Center, Department of Medicine, Columbia University Medical Center, 180 Fort Washington Avenue, Suite 936, New York, NY 10032, USA.
- Deartment of Epidemiology, Mailman School of Public Health, Columbia University Medical Center, New York, NY 10032, USA.
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23
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Zylberberg HM, Ludvigsson JF, Green PHR, Lebwohl B. Psychotropic medication use among patients with celiac disease. BMC Psychiatry 2018; 18:76. [PMID: 29580225 PMCID: PMC5870752 DOI: 10.1186/s12888-018-1668-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 03/19/2018] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Celiac disease is a multi-system disorder with manifestations that may result in psychiatric disorders. We assessed the prevalence of medication use to treat psychiatric disorders in celiac disease patients. METHODS We conducted a cross-sectional study of patients undergoing esophagogastroduodenoscopy over 9-years at a celiac disease referral center. We compared the prevalence of psychotropic medication use among celiac disease patients (n = 1293) to a control group (n = 1401) with abdominal pain or reflux. RESULTS Among all patients the mean age was 48.4 years, most were female (69.5%), and 22.7% used any psychotropic medication. There was no difference between overall psychotropic medication use among celiac disease patients and controls (23.9% vs 21.8%, OR 1.16; 95% CI 0.96-1.39, p = 0.12). However, those with celiac disease were more likely to use antidepressants on univariate (16.4% vs 13.4%, p = 0.03) and multivariate analysis (OR 1.28; 95% CI 1.03-1.59; p = 0.03). Use of psychotropic medications was not associated with disease duration or mode of presentation of celiac disease. CONCLUSIONS Celiac disease patients use psychotropic medications at similar rates as those with other gastrointestinal diseases, though subgroup analysis suggests they may use more antidepressants. Future studies should investigate whether celiac disease is associated with mood disorders that are not treated with medications.
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Affiliation(s)
- Haley M. Zylberberg
- 0000000419368729grid.21729.3fDivision of Digestive and Liver Diseases, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, USA ,0000000419368729grid.21729.3fThe Celiac Disease Center at Columbia University, 180 Fort Washington Avenue, Suite 936, New York, NY 10032 USA
| | - Jonas F. Ludvigsson
- 0000000419368729grid.21729.3fDivision of Digestive and Liver Diseases, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, USA ,0000 0000 9241 5705grid.24381.3cDepartment of Medical Epidemiology and Biostatistics, Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden ,0000 0001 0123 6208grid.412367.5Department of Pediatrics, Örebro University Hospital, Örebro, Sweden
| | - Peter H. R. Green
- 0000000419368729grid.21729.3fDivision of Digestive and Liver Diseases, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, USA ,0000000419368729grid.21729.3fThe Celiac Disease Center at Columbia University, 180 Fort Washington Avenue, Suite 936, New York, NY 10032 USA
| | - Benjamin Lebwohl
- Division of Digestive and Liver Diseases, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, USA. .,Department of Medical Epidemiology and Biostatistics, Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden. .,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA. .,The Celiac Disease Center at Columbia University, 180 Fort Washington Avenue, Suite 936, New York, NY, 10032, USA.
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Sancassiani F, Carta MG, Montisci R, Preti A, Machado S, Moro MF, Marchetti MF, Meloni L. Takotsubo Syndrome is Associated with Mood Disorders and Antidepressants Use, not with Anxiety and Impairment of Quality of Life Due to the Psychiatric Disorder. Clin Pract Epidemiol Ment Health 2018; 14:26-32. [PMID: 29541148 PMCID: PMC5838620 DOI: 10.2174/1745017901814010026] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 01/14/2018] [Accepted: 02/06/2018] [Indexed: 01/20/2023]
Abstract
BACKGROUND The aim was to study the association between mood and anxiety disorders and the Tako-Tsubo Syndrome (TTS) and to determine the role of antidepressants and the impairment of quality of life due the comorbid psychiatric disorder. METHODS Case-control study: 19 consecutive patients (17 female) with TTS compared to 76 controls without TTS, were randomly selected from the database of a nationwide epidemiological study after matching (gender, age and residence) by controls. Psychiatric diagnoses were carried out according to the ICD-10 using semi-structured interview tools (ANTAS-SCID) administered by clinical staff. Quality of Life (Qol) was assessed by means of SF-12. RESULTS Only Major Depressive Disorders (MDD) showed higher frequencies in cases with statistical significance difference (p=0.014) as well as at least one Mood Disorder Diagnosis [MDD or BD] (p=0.002). The lifetime prevalence of at least one anxiety disorder with no comorbid mood disorder did not show a higher frequency in cases (p=0.57).The score at SF-12 in the TTS group was similar to those of controls (p=0.71)In the TTS group, the score at SF-12 in people with one mood or anxiety diagnosis (N=7) was similar to those without mood or anxiety diagnosis (p=0.75). The use of antidepressants was higher in TTS group (15.79% vs 1.31%; p=0.030). CONCLUSION The study shows an association between TTS with depressive disorders and antidepressants use and does not confirm the association with anxiety syndromes. The study suggests the need to investigate the possible interactions between antidepressants use and mood disorders in studies with appropriate design and sample size.
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Affiliation(s)
- F. Sancassiani
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Mauro G. Carta
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Roberta Montisci
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Antonio Preti
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Sergio Machado
- Laboratory of Panic and Respiration, Institute of Psychiatry of Federal University of Rio de Janeiro (IPUB/UFRJ), Rio de Janeiro, Brazil
- Physical Activity Neuroscience, Physical Activity Sciences Postgraduate Program - Salgado de Oliveira University, Niterói, Brazil
| | - Maria F. Moro
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Maria F. Marchetti
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Luigi Meloni
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
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25
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Cossu G, Carta MG, Contu F, Mela Q, Demelia L, Elli L, Dell'Osso B. Coeliac disease and psychiatric comorbidity: epidemiology, pathophysiological mechanisms, quality-of-life, and gluten-free diet effects. Int Rev Psychiatry 2017; 29:489-503. [PMID: 28681625 DOI: 10.1080/09540261.2017.1314952] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Coeliac Disease (CD) is an autoimmune disease in which an environmental factor, gluten, triggers a pathological reaction. It results in intra- and entra-intestinal manifestations of disease, including, most frequently, diarrhoea, weight loss, and anaemia. CD occurs in ∼1% of the western population, being one of the most common autoimmune lifelong disorders, and may present with a variety of psychiatric comorbidities. Psychiatric comorbidity in CD often complicates the diagnosis, reduces the quality-of-life, and worsens the prognosis of affected patients. This review summarizes the epidemiological studies that underline this connection, and focuses on the potential mechanisms related to this comorbility, such as nutritional deficiencies, immune responses, interference in brain processes, and dysfunctions in the gut-brain axis. Factors that play a central role on patients' quality of life, psychological well-being and adherence are presented. Finally, evidence of regression in psychiatric symptoms following the introduction of a gluten-free diet is underlined as well.
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Affiliation(s)
- Giulia Cossu
- a Department of Medical Science and Public Health , University of Cagliari , Cagliari , Italy
| | - Mauro Giovanni Carta
- a Department of Medical Science and Public Health , University of Cagliari , Cagliari , Italy
| | - Federico Contu
- a Department of Medical Science and Public Health , University of Cagliari , Cagliari , Italy
| | - Quirico Mela
- a Department of Medical Science and Public Health , University of Cagliari , Cagliari , Italy
| | - Luigi Demelia
- a Department of Medical Science and Public Health , University of Cagliari , Cagliari , Italy
| | - Luca Elli
- b Center for the Prevention and Diagnosis of Celiac Disease, Gastroenterology and Endoscopy Unit , Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico , Milan , Italy
| | - Bernardo Dell'Osso
- c Department of Pathophysiology and Transplantation , University of Milan, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico , Milan , Italy.,d Department of Psychiatry and Behavioral Sciences , Bipolar Disorders Clinic, Stanford University , CA , USA
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26
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Pennisi M, Bramanti A, Cantone M, Pennisi G, Bella R, Lanza G. Neurophysiology of the "Celiac Brain": Disentangling Gut-Brain Connections. Front Neurosci 2017. [PMID: 28928632 DOI: 10.3389/fnins.2017.00498.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Celiac disease (CD) can be considered a complex multi-organ disorder with highly variable extra-intestinal, including neurological, involvement. Cerebellar ataxia, peripheral neuropathy, seizures, headache, cognitive impairment, and neuropsychiatric diseases are complications frequently reported. These manifestations may be present at the onset of the typical disease or become clinically evident during its course. However, CD subjects with subclinical neurological involvement have also been described, as well as patients with clear central and/or peripheral nervous system and intestinal histopathological disease features in the absence of typical CD manifestations. Based on these considerations, a sensitive and specific diagnostic method that is able to detect early disease process, progression, and complications is desirable. In this context, neurophysiological techniques play a crucial role in the non-invasive assessment of central nervous system (CNS) excitability and conductivity. Moreover, some of these tools are known for their valuable role in early diagnosis and follow-up of several neurological diseases or systemic disorders, such as CD with nervous system involvement, even at the subclinical level. This review provides an up-to-date summary of the neurophysiological basis of CD using electroencephalography (EEG), multimodal evoked potentials, and transcranial magnetic stimulation (TMS). The evidence examined here seems to converge on an overall profile of "hyperexcitable celiac brain," which partially recovers after institution of a gluten-free diet (GFD). The main translational correlate is that in case of subclinical neurological involvement or overt unexplained symptoms, neurophysiology could contribute to the diagnosis, assessment, and monitoring of a potentially underlying CD.
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Affiliation(s)
| | | | | | - Giovanni Pennisi
- Department of Surgery and Medical-Surgical Specialties, University of CataniaCatania, Italy
| | - Rita Bella
- Section of Neurosciences, Department of Medical and Surgical Sciences and Advanced Technology, University of CataniaCatania, Italy
| | - Giuseppe Lanza
- Department of Neurology IC, Oasi Maria SS (IRCCS)Troina, Italy
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27
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Pennisi M, Bramanti A, Cantone M, Pennisi G, Bella R, Lanza G. Neurophysiology of the "Celiac Brain": Disentangling Gut-Brain Connections. Front Neurosci 2017; 11:498. [PMID: 28928632 PMCID: PMC5591866 DOI: 10.3389/fnins.2017.00498] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 08/23/2017] [Indexed: 02/05/2023] Open
Abstract
Celiac disease (CD) can be considered a complex multi-organ disorder with highly variable extra-intestinal, including neurological, involvement. Cerebellar ataxia, peripheral neuropathy, seizures, headache, cognitive impairment, and neuropsychiatric diseases are complications frequently reported. These manifestations may be present at the onset of the typical disease or become clinically evident during its course. However, CD subjects with subclinical neurological involvement have also been described, as well as patients with clear central and/or peripheral nervous system and intestinal histopathological disease features in the absence of typical CD manifestations. Based on these considerations, a sensitive and specific diagnostic method that is able to detect early disease process, progression, and complications is desirable. In this context, neurophysiological techniques play a crucial role in the non-invasive assessment of central nervous system (CNS) excitability and conductivity. Moreover, some of these tools are known for their valuable role in early diagnosis and follow-up of several neurological diseases or systemic disorders, such as CD with nervous system involvement, even at the subclinical level. This review provides an up-to-date summary of the neurophysiological basis of CD using electroencephalography (EEG), multimodal evoked potentials, and transcranial magnetic stimulation (TMS). The evidence examined here seems to converge on an overall profile of "hyperexcitable celiac brain," which partially recovers after institution of a gluten-free diet (GFD). The main translational correlate is that in case of subclinical neurological involvement or overt unexplained symptoms, neurophysiology could contribute to the diagnosis, assessment, and monitoring of a potentially underlying CD.
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Affiliation(s)
| | | | | | - Giovanni Pennisi
- Department of Surgery and Medical-Surgical Specialties, University of CataniaCatania, Italy
| | - Rita Bella
- Section of Neurosciences, Department of Medical and Surgical Sciences and Advanced Technology, University of CataniaCatania, Italy
| | - Giuseppe Lanza
- Department of Neurology IC, Oasi Maria SS (IRCCS)Troina, Italy
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