Cortisol as a Biomarker of Mental Disorder Severity

Prenatal psychological distress and 11β-HSD2 gene expression in human placentas: Systematic review and meta-analysis

BACKGROUND

The placenta acts as a buffer to regulate the degree of fetal exposure to maternal cortisol through the 11-Beta Hydroxysteroid Dehydrogenase isoenzyme type 2 (11-β HSD2) enzyme. We conducted a systematic review and meta-analysis to assess the effect of prenatal psychological distress (PPD) on placental 11-β HSD2 gene expression and explore the related mechanistic pathways involved in fetal neurodevelopment.

METHODS

We searched PubMed, Embase, Scopus, APA PsycInfo®, and ProQuest Dissertations for observational studies assessing the association between PPD and 11-β HSD2 expression in human placentas. Adjusted regression coefficients (β) and corresponding 95% confidence intervals (CIs) were pooled based on three contextual PPD exposure groups: prenatal depression, anxiety symptoms, and perceived stress.

RESULTS

Of 3159 retrieved records, sixteen longitudinal studies involving 1869 participants across seven countries were included. Overall, exposure to PPD disorders showed weak negative associations with the placental 11-β HSD2 gene expression as follows: prenatal depression (β -0.01, 95% CI 0.05-0.02, I2=0%), anxiety symptoms (β -0.02, 95% CI 0.06-0.01, I2=0%), and perceived stress (β -0.01 95% CI 0.06-0.04, I2=62.8%). Third-trimester PPD exposure was more frequently associated with lower placental 11-β HSD2 levels. PPD and placental 11-β HSD2 were associated with changes in cortisol reactivity and the development of adverse health outcomes in mothers and children. Female-offspring were more vulnerable to PPD exposures.

CONCLUSION

The study presents evidence of a modest role of prenatal psychological distress in regulating placental 11-β HSD2 gene expression. Future prospective cohorts utilizing larger sample sizes or advanced statistical methods to enhance the detection of small effect sizes should be planned. Additionally, controlling for key predictors such as the mother's ethnicity, trimester of PPD exposure, mode of delivery, and infant sex is crucial for valid exploration of PPD effects on fetal programming.

Biosensors for psychiatric biomarkers in mental health monitoring

Psychiatric disorders are associated with serve disturbances in cognition, emotional control, and/or behavior regulation, yet few routine clinical tools are available for the real-time evaluation and early-stage diagnosis of mental health. Abnormal levels of relevant biomarkers may imply biological, neurological, and developmental dysfunctions of psychiatric patients. Exploring biosensors that can provide rapid, in-situ, and real-time monitoring of psychiatric biomarkers is therefore vital for prevention, diagnosis, treatment, and prognosis of mental disorders. Recently, psychiatric biosensors with high sensitivity, selectivity, and reproducibility have been widely developed, which are mainly based on electrochemical and optical sensing technologies. This review presented psychiatric disorders with high morbidity, disability, and mortality, followed by describing pathophysiology in a biomarker-implying manner. The latest biosensors developed for the detection of representative psychiatric biomarkers (e.g., cortisol, dopamine, and serotonin) were comprehensively summarized and compared in their sensitivities, sensing technologies, applicable biological platforms, and integrative readouts. These well-developed biosensors are promising for facilitating the clinical utility and commercialization of point-of-care diagnostics. It is anticipated that mental healthcare could be gradually improved in multiple perspectives, ranging from innovations in psychiatric biosensors in terms of biometric elements, transducing principles, and flexible readouts, to the construction of 'Big-Data' networks utilized for sharing intractable psychiatric indicators and cases.

Diurnal cortisol profiles in autistic adolescents and young adults: Associations with social difficulties and internalizing mental health symptoms

Several autism-related characteristics, such as social difficulties, may contribute to high perceived stress and increased exposure to stressful life events in some autistic individuals. Repeated exposure to stress might lead to the dysfunction of the hypothalamic-pituitary-adrenocortical-axis and be a vulnerability factor for developing mental health difficulties. Previous studies show contradictory findings on salivary cortisol in autism. In the current study, we investigated diurnal cortisol profiles in autistic adolescents and young adults, as well as their associations with social difficulties, stress exposure, and mental health symptoms. Autistic (n = 48, Mage = 17.6) and nonautistic (n = 51, Mage = 18.4) participants collected salivary cortisol at home six times a day for 2 days. Social difficulties, exposure to stressful life events/bullying, and mental health symptoms were assessed with questionnaires and clinical interviews. Similar diurnal cortisol slopes (DCS) and cortisol awakening responses were observed between the groups, but autistic participants showed higher total cortisol output (AUCG, area under the curve with respect to ground) during the day (b = 19.09, p = 0.009). In the autistic group, more severe social difficulties were associated with flatter DCS (b = 0.01, p = 0.007). Finally, cortisol alterations were associated with self-reported mental health symptoms, especially in autistic females in analyses uncorrected for multiple comparisons. In conclusion, our results do not indicate autism-related group-level alterations in most diurnal cortisol measures, but autistic youth showed higher total cortisol (AUCG) compared with nonautistic peers. More detailed investigation of interindividual variability in cortisol profiles within autistic people might give us important insights into vulnerability to developing stress-related mental health difficulties.

Synergy between psychological impact and biochemical manifestation of stress among the COVID-19 pandemic-affected population

Objective

Due to the COVID-19 pandemic, many countries around the world experienced an unprecedented increase in stress in the general population. Even after normal life has been reestablished, the new normal is punctuated by severely impacted vulnerable groups. Stress-associated symptoms display an intricate relationship with biochemical modulations, which coordinate the stress response. Identifying these biochemical factors is inherent to deciphering the mode of treatment needed to diminish the health-care gap resulting from the pandemic.

Methods

We applied psychological measures using the perceived stress (PS) and COVID-19 anxiety (CA) scales and preventive health behavior (PHB) to evaluate stress in the general population. Biochemical markers of stress, that is, total antioxidant capacity (TAC), thiobarbituric acid reactive substances (TBARS), cortisol, and C-reactive protein (CRP) were tested in the serum samples of the participants. Statistical analysis was carried out using SPSS version 22.0.

Results

Stress scores for PS, CA, and PHB indicate the prevalence of moderate-to-high stress among participants, and a correlation between psychological stress and biochemical correlates, TAC, TBARS, cortisol, and CRP. Serum concentrations of TBARS, Cortisol, and CRP were found to be significantly increased, while the TAC was decreased across all stress types and levels. Our findings demonstrate a positive correlation between PS, CA, PHB TBARS, cortisol, and CRP and a strong negative correlation with TAC.

Conclusion

The results of this study will help in tailoring targeted interventions and preventive regimes to mitigate COVID-19-associated anxiety and stress disorders prevailing even after the actual pandemic has subsided.

A Bibliometric Analysis of Clinical Trials on Salivary Biomarkers for Mental Health (2003-2024)

Mental health conditions, such as depression, anxiety, and stress-related disorders, are often difficult to diagnose and monitor using traditional methods. Salivary biomarkers offer a promising alternative due to their non-invasive nature, ease of collection, and the potential to reflect real-time physiological changes associated with mental health. This bibliometric analysis examines 95 clinical trials on stress biomarkers for mental health, published between 2003 and 2024. The field is characterized by extensive collaboration and global participation, involving 593 authors and publications across 73 journals. Despite a consistent annual publication rate, notable increases in 2011, 2014, and 2018 indicate growing research interest. The United States leads in research output, followed by Australia, Germany, and Japan, with Psychoneuroendocrinology being the most prominent journal. Co-occurrence analysis identified nine research clusters, suggesting diverse directions such as the impact of stress-related hormones, circadian rhythms, mindfulness, various therapies, aging, psychological adaptation mechanisms, exercise therapy, anxiety disorders, and the autonomic nervous system on salivary biomarkers. Key terms such as "biomarkers/metabolism," AND "hydrocortisone/metabolism," AND "saliva/metabolism" were central, with significant activity from 2012 to 2018. This analysis highlights a growing focus on the metabolic processes and therapeutic applications of salivary biomarkers in mental health. This bibliometric analysis calls attention to the promising potential of salivary biomarkers to revolutionize mental health diagnostics and treatment through non-invasive methods, fostering interdisciplinary research, technological advancements, and global health improvements.

The Effect of Surgical Procedure in the Nasal Cavity on the Passive Avoidance Conditioning and the Hypothalamic Level of Monoamines in Rats

A rat biological model of septoplasty was used to study the effect of surgery on passive avoidance conditioning (PAC). Septoplasty was shown to increase anxiety and to reduce exploratory activity in rodents during PAC. A neurochemical analysis of the hypothalamus was carried out immediately after the end of the experiment and showed an increase in norepinephrine (NE) metabolism after septoplasty. The finding was tentatively associated with activation of the hypothalamic-pituitary-adrenal axis.

Evaluating the efficacy and mechanisms of a ketogenic diet as adjunctive treatment for people with treatment-resistant depression: A protocol for a randomised controlled trial

BACKGROUND

One-third of people with depression do not respond to antidepressants, and, after two adequate courses of antidepressants, are classified as having treatment-resistant depression (TRD). Some case reports suggest that ketogenic diets (KDs) may improve some mental illnesses, and preclinical data indicate that KDs can influence brain reward signalling, anhedonia, cortisol, and gut microbiome which are associated with depression. To date, no trials have examined the clinical effect of a KD on TRD.

METHODS

This is a proof-of-concept randomised controlled trial to investigate the efficacy of a six-week programme of weekly dietitian counselling plus provision of KD meals, compared with an intervention involving similar dietetic contact time and promoting a healthy diet with increased vegetable consumption and reduction in saturated fat, plus food vouchers to purchase healthier items. At 12 weeks we will assess whether participants have continued to follow the assigned diet. The primary outcome is the difference between groups in the change in Patient Health Questionnaire-9 (PHQ-9) score from baseline to 6 weeks. PHQ-9 will be measured at weeks 2, 4, 6 and 12. The secondary outcomes are the differences between groups in the change in remission of depression, change in anxiety score, functioning ability, quality of life, cognitive performance, reward sensitivity, and anhedonia from baseline to 6 and 12 weeks. We will also assess whether changes in reward sensitivity, anhedonia, cortisol awakening response and gut microbiome may explain any changes in depression severity.

DISCUSSION

This study will test whether a ketogenic diet is an effective intervention to reduce the severity of depression, anxiety and improve quality of life and functioning ability for people with treatment-resistant depression.

Body mass index, smoking behavior, and depression mediated the effects of schizophrenia on chronic obstructive pulmonary disease: trans-ethnic Mendelian-randomization analysis

Background

Previous studies have highlighted the association between schizophrenia (SCZ) and chronic obstructive pulmonary disease (COPD), yet the causal relationship remains unestablished.

Methods

Under the genome-wide significance threshold (P<5×10-8), data from individuals of European (EUR) and East Asian (EAS) ancestries with SCZ were selected for analysis. Univariable Mendelian randomization (MR) explored the causal relationship between SCZ and COPD. Linkage disequilibrium score (LDSC) regression was used to calculate genetic correlation, while multivariable and mediation MR further investigated the roles of six confounding factors and their mediating effects. The primary method utilized was inverse-variance weighted (IVW), complemented by a series of sensitivity analyses and false discovery rate (FDR) correction.

Results

LDSC analysis revealed a significant genetic correlation between SCZ and COPD within EUR ancestry (rg = 0.141, P = 6.16×10-7), with no such correlation found in EAS ancestry. IVW indicated a significant causal relationship between SCZ and COPD in EUR ancestry (OR = 1.042, 95% CI 1.013-1.071, P = 0.003, PFDR = 0.015). Additionally, replication datasets provide evidence of consistent causal associations(P < 0.05 & PFDR < 0.05). Multivariable and mediation MR analyses identified body mass index (BMI)(Mediation effect: 50.57%, P = 0.02), age of smoking initiation (Mediation effect: 27.42%, P = 0.02), and major depressive disorder (MDD) (Mediation effect: 60.45%, P = 6.98×10-5) as partial mediators of this causal relationship. No causal associations were observed in EAS (OR = 0.971, 95% CI 0.875-1.073, P = 0.571, PFDR = 0.761) ancestry. No causal associations were found in the reverse analysis across the four ancestries (P > 0.05 & PFDR > 0.05).

Conclusions

This study confirmed a causal relationship between SCZ and the risk of COPD in EUR ancestry, with BMI, smoking, and MDD serving as key mediators. Future research on a larger scale is necessary to validate the generalizability of these findings across other ancestries.

Medical comorbidities in bipolar disorder (BIPCOM): clinical validation of risk factors and biomarkers to improve prevention and treatment. Study protocol

BACKGROUND

BIPCOM aims to (1) identify medical comorbidities in people with bipolar disorder (BD); (2) examine risk factors and clinical profiles of Medical Comorbidities (MC) in this clinical group, with a special focus on Metabolic Syndrome (MetS); (3) develop a Clinical Support Tool (CST) for the personalized management of BD and medical comorbidities.

METHODS

The BIPCOM project aims to investigate MC, specifically MetS, in individuals with BD using various approaches. Initially, prevalence rates, characteristics, genetic and non-genetic risk factors, and the natural progression of MetS among individuals with BD will be assessed by analysing Nordic registers, biobanks, and existing patient datasets from 11 European recruiting centres across 5 countries. Subsequently, a clinical study involving 400 participants from these sites will be conducted to examine the clinical profiles and incidence of specific MetS risk factors over 1 year. Baseline assessments, 1-year follow-ups, biomarker analyses, and physical activity measurements with wearable biosensors, and focus groups will be performed. Using this comprehensive data, a CST will be developed to enhance the prevention, early detection, and personalized treatment of MC in BD, by incorporating clinical, biological, sex and genetic information. This protocol will highlight the study's methodology.

DISCUSSION

BIPCOM's data collection will pave the way for tailored treatment and prevention approaches for individuals with BD. This approach has the potential to generate significant healthcare savings by preventing complications, hospitalizations, and emergency visits related to comorbidities and cardiovascular risks in BD. BIPCOM's data collection will enhance BD patient care through personalized strategies, resulting in improved quality of life and reduced costly interventions. The findings of the study will contribute to a better understanding of the relationship between medical comorbidities and BD, enabling accurate prediction and effective management of MetS and cardiovascular diseases.

TRIAL REGISTRATION

ISRCTN68010602 at https://www.isrctn.com/ISRCTN68010602 . Registration date: 18/04/2023.

Intranasal delivery of paroxetine: A preclinical study on pharmacokinetics, depressive-like behaviour, and neurochemical sex differences

Treatment of major depressive disorder remains a major unmet clinical need. Given the advantages of intranasal administration for targeted brain delivery, the present study aimed at investigating the pharmacokinetics of paroxetine, after its intranasal instillation and assessing its potential therapeutic effect on female and male mice subjected to unpredictable chronic mild stress (UCMS) protocol. IN administration revealed direct nose-to-brain paroxetine delivery but dose- and sex-dependent differences. Pharmacokinetics was nonlinear and paroxetine concentrations were consistently higher in plasma and brain of male mice. Additionally, UCMS decreased animal preference for sucrose in both male and female mice following acute (p < 0.01) and chronic stress (p < 0.05), suggesting anhedonia. Both male and female mice exhibited depressive-like behavior in the forced swimming test. UCMS females displayed a significantly longer immobility time and shorter climbing time than the control group (p < 0.05), while no differences were found between male mice. Two weeks of paroxetine intranasal administration reduced immobility time and lengthened climbing and swimming time, approaching values similar to those observed in the healthy control group. The therapeutic effect was stronger on female mice. Importantly, melatonin plasma levels were significantly decreased in female mice following UCMS (p < 0.05), while males exhibited heightened corticosterone levels. On the other hand, treatment with IN paroxetine significantly increased corticosterone and melatonin levels in both sexes compared to healthy mice (p < 0.05). Intranasal paroxetine delivery undoubtedly ameliorated the behavioral despair, characteristic of depressive-like animals. Despite its efficiency in male and female mice subjected to UCMS, females were more prone to this novel therapeutic strategy.

Exposure to topiramate and acetazolamide causes endocrine disrupting effects in female rats during estrus

BACKGROUND

Idiopathic intracranial hypertension (IIH) is a disease characterized by elevated intracranial pressure (ICP) and is a disease of young females. The first line pharmacological treatments include acetazolamide and topiramate and given the nature of IIH patients and the dosing regimen of these drugs, their effect on the endocrine system is important to evaluate. We aimed to assess the effects of acetazolamide and topiramate on steroid profiles in relevant endocrine tissues.

METHODS

Female Sprague Dawley rats received chronic clinically equivalent doses of acetazolamide or topiramate by oral gavage and were sacrificed in estrus. Tissue specific steroid profiles of lateral ventricle CP, 4th ventricle CP, CSF, serum, uterine horn and fundus, ovaries, adrenal glands and pituitary glands were assessed by quantitative targeted LC-MS/MS. We determined luteinizing hormone (LH) and follicle stimulating hormones (FSH) levels in paired serum by ELISA.

RESULTS

Topiramate increased the concentration of estradiol and decreased the concentration of DHEA in lateral choroid plexus. Moreover, it decreased the concentration of androstenediol in the pituitary gland. Topiramate increased serum LH. Acetazolamide decreased progesterone levels in serum and uterine fundus and increased corticosteroid levels in the adrenal glands.

CONCLUSION

These results demonstrate that both acetazolamide and topiramate have endocrine disrupting effects in rats. Topiramate primarily targeted the choroid plexus and the pituitary gland while acetazolamide had broader systemic effects. Furthermore, topiramate predominantly targeted sex hormones, whereas acetazolamide widely affected all classes of hormones. A similar effect in humans has not yet been documented but these concerning findings warrants further investigations.

Association of hair cortisol concentration with brain-derived neurotrophic factor gene methylation: The role of sex as a moderator

Hair cortisol concentration (HCC) reflects the long-term activity of the hypothalamus-pituitary-adrenal (HPA) axis in response to stress. Brain-derived neurotrophic factor DNA methylation (BDNF DNAM) may affect HCC, and sex and Val66Met may contribute to this association. Thus, the aim of this study was to investigate the associations between HCC and Brain-derived neurotrophic factor (BDNF) DNAM, and the moderating effects of Val66Met and sex. We recruited 191 healthy young participants (96 women, mean age 23.0 ± 2.6 years) and collected body samples to evaluate HCC, and to determine BDNF DNAM and Val66Met genotypes. We analyzed the effects of BDNF DNAM, sex, and Val66Met on HCC. We also evaluated the associations between BDNF DNAM and HCC in groups separated by sex and genotypes. We found a marked association of BDNF DNAM with HCC across men and women. After dividing the data by sex, a positive correlation of HCC with BDNF DNAM was found only in women. There was no substantial moderation effect of Val66Met genotypes on the association between BDNF DNAM and HCC. Therefore, BDNF DNAM was found to have positive association with HCC only in healthy young women, indicating that sex moderates the association of BDNF DNAM with long-term HPA axis activity.

Dietary acid load in health and disease

Maintaining an appropriate acid-base equilibrium is crucial for human health. A primary influencer of this equilibrium is diet, as foods are metabolized into non-volatile acids or bases. Dietary acid load (DAL) is a measure of the acid load derived from diet, taking into account both the potential renal acid load (PRAL) from food components like protein, potassium, phosphorus, calcium, and magnesium, and the organic acids from foods, which are metabolized to bicarbonate and thus have an alkalinizing effect. Current Western diets are characterized by a high DAL, due to large amounts of animal protein and processed foods. A chronic low-grade metabolic acidosis can occur following a Western diet and is associated with increased morbidity and mortality. Nutritional advice focusing on DAL, rather than macronutrients, is gaining rapid attention as it provides a more holistic approach to managing health. However, current evidence for the role of DAL is mainly associative, and underlying mechanisms are poorly understood. This review focusses on the role of DAL in multiple conditions such as obesity, cardiovascular health, impaired kidney function, and cancer.

Loneliness and the risk of type 2 diabetes

INTRODUCTION

The incidence of type 2 diabetes is increasing globally. Recent research suggests that loneliness could be a potential risk factor for the development of type 2 diabetes. We aimed to investigate the association between loneliness and type 2 diabetes and the modifying effect of mental disorders.

RESEARCH DESIGN AND METHODS

We conducted a prospective study including 465 290 adults (aged ≥16 years) who participated in either the Danish Health and Morbidity Survey or the Danish National Health Survey between 2000 and 2017. Loneliness was based on self-report, while type 2 diabetes was measured using an algorithm combining several health registers including type 2 diabetes patients treated both within the hospital sector and general practice. Cox proportional hazards regressions were used to estimate hazard ratios (HRs) and 95% confidence intervals (95% CIs).

RESULTS

During a mean follow-up time of 6.3 years, 13 771 individuals (3%) developed type 2 diabetes. Feeling lonely once in a while was associated with a 14% increased risk of type 2 diabetes (95% CI 1.09 to 1.20), while feeling lonely often was associated with a 24% increased risk (95% CI 1.14 to 1.34), independent of sociodemographic factors and body mass index. The association was stronger among individuals without a mental disorder (HR 1.21, 95% CI 1.10 to 1.34 among those feeling lonely often) compared with those with a mental disorder (HR 1.07, 95% CI 0.93 to 1.23).

CONCLUSIONS

Loneliness independently increased the risk of type 2 diabetes. The effect was more pronounced in individuals without a mental disorder, as having a mental disorder itself likely increases the risk of type 2 diabetes. These findings emphasize the importance of addressing loneliness as a modifiable risk factor in preventing type 2 diabetes.

Moderating Effect of Muscular Strength in the Association between Cardiovascular Events and Depressive Symptoms in Middle-Aged and Older Adults-A Cross Sectional Study

BACKGROUND

Depression and cardiovascular diseases are two main health conditions contributing to the global disease burden. Several studies indicate a reciprocal association between them. It is still unclear how changes in overall muscle strength may impact this association. This study aimed to analyse how muscular strength moderates the relationship between cardiovascular events and depressive symptoms among middle-aged and older adults.

METHODS

Wave 8 of the population-based Survey of Health, Ageing, and Retirement in Europe (2019/2020) cross-sectional data, which included 41,666 participants (17,986 men) with a mean age of 70.65 (9.1) years old, was examined. Grip strength was measured twice on each hand using a dynamometer. The 12-item EURO-D scale was employed to gauge depressive symptoms.

RESULTS

Grip strength negatively moderates the link between cardiovascular events and depressive symptoms (male: B = -0.03, 95% CI = -0.04, -0.03; female: B = -0.06, 95% CI = -0.06, -0.05). Additionally, the grip strength moderation values in the significant zone for males and females were less than 63.2 kg and 48.3 kg, respectively.

CONCLUSIONS

Muscular strength modifies depressive symptoms and lessens their correlation with cardiovascular diseases. Muscle-strengthening activities could be incorporated into primary and secondary preventive strategies to reduce the burden of depression in people with CVD.

Examining the association of breakfast skipping with sleep disturbance, mental health, and health-related quality of life: data from the 2018 Korean community health survey

Objectives: This study aimed to explore the relationship between breakfast skipping and its effects on sleep disorders, mental health, and health-related quality of life among Korean adults.Methods: Utilizing data from the 2018 Korea Community Health Survey, this cross-sectional analysis included 173,272 adults aged 19 years and older. Instruments used for assessment included the Patient Health Questionnaire-9 for depression, the EuroQol 5-dimension (EQ-5D) for health-related quality of life, and the Pittsburgh Sleep Quality Index for sleep disorders. The complex sample logistic regression analysis was employed to adjust for potential confounders.Results: Breakfast skipping was found to be significantly associated with delayed mid-sleep time, an increased propensity for daytime sleepiness, and a notable decline in sleep quality. Additionally, it was linked to a significant increase in depression risk, compromised health-related quality of life, and elevated stress levels across both genders. All five dimensions of the EQ-5D were negatively impacted by breakfast skipping.Discussion: The findings highlight the detrimental effects of skipping breakfast on sleep patterns, mental health, and overall quality of life, stressing the importance of regular breakfast consumption for enhancing these health outcomes. The study suggests the need for further research to uncover the mechanisms behind these associations and to devise targeted interventions to mitigate the negative impacts of breakfast skipping.

Blood Markers Show Neural Consequences of LongCOVID-19

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) persists throughout the world with over 65 million registered cases of survivors with post-COVID-19 sequelae, also known as LongCOVID-19 (LongC). LongC survivors exhibit various symptoms that span multiple organ systems, including the nervous system. To search for neurological markers of LongC, we investigated the soluble biomolecules present in the plasma and the proteins associated with plasma neuronal-enriched extracellular vesicles (nEVs) in 33 LongC patients with neurological impairment (nLongC), 12 COVID-19 survivors without any LongC symptoms (Cov), and 28 pre-COVID-19 healthy controls (HC). COVID-19 positive participants were infected between 2020 and 2022, not hospitalized, and were vaccinated or unvaccinated before infection. IL-1β was significantly increased in both nLongC and Cov and IL-8 was elevated in only nLongC. Both brain-derived neurotrophic factor and cortisol were significantly elevated in nLongC and Cov compared to HC. nEVs from people with nLongC had significantly elevated protein markers of neuronal dysfunction, including amyloid beta 42, pTau181 and TDP-43. This study shows chronic peripheral inflammation with increased stress after COVID-19 infection. Additionally, differentially expressed nEV neurodegenerative proteins were identified in people recovering from COVID-19 regardless of persistent symptoms.

Redox-Concatenated Aptamer Integrated Skin Mimicking Electrochemical Patch for Noninvasive Detection of Cortisol

This research focuses on developing and validating a wearable electrochemical biosensor called the concatenated aptamer integrated skin patch, also known as the Captain Patch. The main objective is to detect cortisol levels in sweat, which can provide valuable insights into an individual's health. The biosensor utilizes a corrugated surface that mimics the skin, allowing for better attachment and an improved electrochemical performance. The study demonstrates the successful application of Captain Patch on the human body by using artificially spiked sweat samples. The results indicate good measurement accuracy and conformity when the patch is worn on the body. However, for long-term usage, the patch needs to be changed every 3-4 h or worn three times a day to enable monitoring of cortisol levels. Despite the need for frequent patch changes, the cost-effectiveness and ease of operation make these skin patches suitable for longitudinal cortisol monitoring and other sweat analytes. By customization of the biorecognition probe, the developed biowearable can be used to monitor a variety of vital biomarkers. Overall, Captain Patch, with its capability of detecting specific health markers such as cortisol, hints at the future potential of wearables to offer valuable data on various other biomarkers. Our approach presents the first step in integrating a cost-effective wearable electrochemical patch integrated with a redox-concatenated aptamer for noninvasive biomarker detection. This personalized approach to monitoring can lead to improved patient outcomes and increased patient engagement in managing their health.

Understanding Mental Health Challenges in Cardiovascular Care

There is a profound link between cardiovascular health and mental well-being. This narrative review shows that heart and mental health are not isolated domains but deeply interconnected, influencing each other. It describes how cardiovascular diseases (CVDs) can cause mental health issues such as stress, anxiety, and depression. It also explains how these mental conditions can, in turn, worsen or raise the risk of CVDs. In addition, it emphasizes the necessity of a holistic approach to healthcare that integrates the treatment of physical symptoms of CVDs with interventions aimed at addressing mental health issues. This approach advocates for comprehensive care strategies that include psychotherapy, pharmacological treatments, lifestyle modifications, and digital health technologies. It also highlights the significant role of family and social support in recovery and discusses barriers to integrating mental health care in cardiovascular treatment. The article argues for a paradigm shift in healthcare towards more inclusive and integrated care models. The authors hope to foster a healthcare environment that prioritizes holistic care by increasing awareness about the connection between heart and mind. The call to action includes policy changes and healthcare system reforms aimed at facilitating the integration of mental health services into cardiovascular care, ultimately leading to improved outcomes for patients with CVDs and associated mental health issues.

In Vitro Assessment of Cortisol Release Inhibition, Bioaccessibility and Bioavailability of a Chemically Characterized Scutellaria lateriflora L. Hydroethanolic Extract

Excess cortisol release is associated with numerous health concerns, including psychiatric issues (i.e., anxiety, insomnia, and depression) and nonpsychiatric issues (i.e., osteoporosis). The aim of this study was to assess the in vitro inhibition of cortisol release, bioaccessibility, and bioavailability exerted by a chemically characterized Scutellaria lateriflora L. extract (SLE). The treatment of H295R cells with SLE at increasing, noncytotoxic, concentrations (5-30 ng/mL) showed significant inhibition of cortisol release ranging from 58 to 91%. The in vitro simulated gastric, duodenal, and gastroduodenal digestions, induced statistically significant reductions (p < 0.0001) in the bioactive polyphenolic compounds that most represented SLE. Bioavailability studies on duodenal digested SLE, using Caco-2 cells grown on transwell inserts and a parallel artificial membrane permeability assay, indicated oroxylin A glucuronide and oroxylin A were the only bioactive compounds able to cross the Caco-2 cell membrane and the artificial lipid membrane, respectively. The results suggest possible applications of SLE as a food supplement ingredient against cortisol-mediated stress response and the use of gastroresistant oral dosage forms to partially prevent the degradation of SLE bioactive compounds. In vivo studies and clinical trials remain necessary to draw a conclusion on the efficacy and tolerability of this plant extract.

Exploring the short-term influence of a proprietary oil extract of black cumin (Nigella sativa) on non-restorative sleep: a randomized, double-blinded, placebo-controlled actigraphy study

Background

Nigella sativa (black cumin, or black seed) is popularly known as the seed of blessings in the Arab system of medicine. Though not widely recommended for sleep, a unique proprietary black cumin extract (BlaQmax®/ThymoDream™; BCO-5) has been shown to be helpful in the management of stress and sleep issues.

Methods

This randomized, double-blind, placebo-controlled trial aimed to investigate the efficacy of BCO-5 on the sleep quality of volunteers characterized with a self-reported non-restorative sleep disorder. Healthy male and female participants (n = 70), aged 18-65 years (BMI 22-28 Kg/m2) were randomized to either placebo or BCO-5 (n = 35/group). Both interventions were supplemented at 200 mg/day for seven days. Actigraphy and a validated restorative sleep questionnaire (RSQ-W) were used to monitor the influence of BCO-5 on sleep.

Results

Compared to placebo, BCO-5 significantly improved sleep quality, as evidenced by both intra-group and inter-group analyses of the actigraphy data. The relative improvements observed were sleep efficiency (7.8%, p < 0.001), total sleep time (19.1%, p < 0.001), sleep onset latency (35.4%; p < 0.001), and wake-after-sleep-onset (22.5%; p < 0.001) compared with placebo. BCO-5 also improved sleep by 75.3% compared to baseline (p < 0.001) and by 68.9% compared to placebo (p < 0.001), when monitored by RSQ-W. BCO-5 was well-tolerated with no reports of side effects or toxicity.

Conclusion

BCO-5 significantly improved non-restorative sleep in seven days, indicating its potential role as a natural sleep aid.

Effects of Physical Exercise and Motor Activity on Depression and Anxiety in Post-Mastectomy Pain Syndrome

BACKGROUND

Chronic post-surgical pain is a condition persisting for not less than 3 months after surgical intervention. It is evaluated that 25-60% of women who underwent breast cancer excision suffer from post-mastectomy pain syndrome, and anxiety, depression, sleep disturbance, and catastrophizing. Physical activity can reduce the risk of chronic diseases and has a good impact on mood and cognitive function. The aim of this study was to estimate the influence of physical activity on the intensity of pain, depression, and anxiety in women who underwent mastectomy for breast cancer removal.

METHODS

A prospective observational unicentric cohort study was performed. Patients were females who underwent unilateral or bilateral mastectomy. The Numerical Rating Scale (NRS) was used to measure pain intensity, Beck's Depression Inventory (BDI) for depression, and Generalized Anxiety Disorders-7 (GAD-7) for anxiety evaluation. Physical activity was assessed by the International Physical Activity Questionnaire (IPAQ). Interleukin (IL)-17, IL-1β, cortisol, adrenocorticotropic hormone (ACTH), and brain-derived neurotrophic factor (BDNF) were also evaluated in the blood of patients. All evaluations were assessed 3 and 6 months after the surgery.

RESULTS

Adequate physical activity reduced the intensity of pain, depression, and anxiety symptoms in women affected by post-mastectomy pain syndrome. Moreover, adequately active women showed a reduction in biomarkers of inflammation, cortisol, ACTH, and an increase of BDNF.

CONCLUSIONS

Our results suggest that physical activity can improve the quality of life, reduce the intensity of pain and inflammatory markers, and be useful in the reduction of associated anxiety and depression.

Bioinspired nanoplatforms for human-machine interfaces: Recent progress in materials and device applications

The panoramic characteristics of human-machine interfaces (HMIs) have prompted the needs to update the biotechnology community with the recent trends, developments, and future research direction toward next-generation bioelectronics. Bioinspired materials are promising for integrating various bioelectronic devices to realize HMIs. With the advancement of scientific biotechnology, state-of-the-art bioelectronic applications have been extensively investigated to improve the quality of life by developing and integrating bioinspired nanoplatforms in HMIs. This review highlights recent trends and developments in the field of biotechnology based on bioinspired nanoplatforms by demonstrating recently explored materials and cutting-edge device applications. Section 1 introduces the recent trends and developments of bioinspired nanomaterials for HMIs. Section 2 reviews various flexible, wearable, biocompatible, and biodegradable nanoplatforms for bioinspired applications. Section 3 furnishes recently explored substrates as carriers for advanced nanomaterials in developing HMIs. Section 4 addresses recently invented biomimetic neuroelectronic, nanointerfaces, biointerfaces, and nano/microfluidic wearable bioelectronic devices for various HMI applications, such as healthcare, biopotential monitoring, and body fluid monitoring. Section 5 outlines designing and engineering of bioinspired sensors for HMIs. Finally, the challenges and opportunities for next-generation bioinspired nanoplatforms in extending the potential on HMIs are discussed for a near-future scenario. We believe this review can stimulate the integration of bioinspired nanoplatforms into the HMIs in addition to wearable electronic skin and health-monitoring devices while addressing prevailing and future healthcare and material-related problems in biotechnologies.

Relationship between mid-sleep time and depression, health-related quality of life, and sleep deprivation in the 2018 Korea Community Health Survey

This cross-sectional study examined the relationship of mid-sleep time (MST) with depression, quality of life, and sleep deprivation. This study included 173 284 adults aged ≥ 19 years who participated in the 2018 Korea Community Health Survey. The Patient Health Questionnaire-9 for depression, EuroQol-5 dimension for health-related quality of life, and the Pittsburgh Sleep Quality Index for MST, daytime sleepiness, and sleep quality were used. Regression and logistic regression analysis was used for complex sample analysis. The results showed that individuals with later MST had a higher risk of depression, poor quality of life, poor sleep quality, and excessive daytime sleepiness than intermediate-type individuals, whereas earlier MST was associated with good sleep quality in the total population. This association was significant in both men and women. The later type was associated with all items of health-related quality of life in both men and women. These findings suggest that the later type is a significant predictor of mental health, quality of life, sleep quality, and daytime sleepiness. Identifying an individual's mid-sleep time may help tailor interventions and treatment strategies that optimize sleep, mental health outcomes, and quality of life.

Cortisol as a Target for Treating Mental Disorders: A Promising Avenue for Therapy

Cortisol, commonly known as the "stress hormone," plays a critical role in the body's response to stress. Elevated cortisol levels have been associated with various mental disorders, including anxiety, depression, and post-traumatic stress disorder. Consequently, researchers have explored cortisol modulation as a promising avenue for treating these conditions. However, the availability of research on cortisol as a therapeutic option for mental disorders is limited, and existing studies employ diverse methodologies and outcome measures. This review article aimed to provide insights into different treatment approaches, both pharmacological and non-pharmacological, which can effectively modulate cortisol levels. Pharmacological interventions involve the use of substances, such as somatostatin analogs, dopamine agonists, corticotropin-releasing hormone antagonists, and cortisol synthesis inhibitors. Additionally, non-pharmacological techniques, including cognitivebehavioral therapy, herbs and supplements, transcranial magnetic stimulation, lifestyle changes, and surgery, have been investigated to reduce cortisol levels. The emerging evidence suggests that cortisol modulation could be a promising treatment option for mental disorders. However, more research is needed to fully understand the effectiveness and safety of these therapies.

The effects of prolonged stress exposure on the brain of rats and insights to understand the impact of work-related stress on caregivers

Introduction

Stress exposure is a significant concern in the healthcare sector. This animal model study aims to reproduce caregivers' working conditions and determine their impact on the brain.

Method

Twenty-four healthy male rats of the Wistar strain were divided into four groups. Three groups were submitted each to one stressor for 21 days, while the fourth group was used as a control. Stressors were food and water deprivation (FW), permanent illumination (PI), and forced swimming (FS). At the end of the experiment, rats were euthanized, and stress biomarkers, biological parameters, and DNA damage were measured.

Results

Prooxidant biomarker rates increased in the different groups (+50 to +75%) compared to the control (p < 0.0001). Urinary corticosterone rates increased in all stressed animals, mainly in the PI group, with changes of up to +50% compared to the control group. Acetylcholinesterase levels decreased to -50% (p < 0.0001 for the three exposed groups). Total ATPase, (Na+/K+)-ATPase, and Mg2+-ATPase activities decreased in all stressed groups. The percentage of brain cell congestion and apoptosis was 3% for the FW group (p < 0.0001), 2% for the PI group (p < 0.0001), and 4% for the FS group (p < 0.0001) compared to the control (0.8%). DNA damage was observed in all exposed groups. Finally, we noticed behavioral changes and a depression-like syndrome in all stressed rats.

Conclusion

Stressful conditions such as the working environment of caregivers can trigger several pathophysiological processes leading to oxidative, neurochemical, and hypothalamic-pituitary-adrenal disorders. These changes can progress to cell damage and apoptosis in the brain and trigger psychological and physical disorders.

The relationship between neutrophil lymphocyte ratio, platelet lymphocyte ratio, and depression in dialysis patients

Chronic kidney disease is a worldwide public health issue with rising incidence, morbidity/mortality, and cost. Depression and chronic renal disease often coexist, and psychological illnesses are associated with poor results. Early identification of depression reduces morbidity and death. Neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) are reported as practical biomarkers of inflammation and immune system activation. In this study, we aimed to determine the association of NLR and PLR with depression in dialysis patients. This study included 71 adults over 18 without known hematologic or oncologic disease, drug use, or chronic inflammatory diseases. Comorbid chronic diseases, laboratory data, and Beck depression inventory scores were prospectively recorded. A comparison of 2 groups according to the existence of depression was made, and a binomial logistic regression test was used to determine the association between the variables and the presence of depression after adjusting for confounding factors. A receiver operating curve analysis was used to differentiate groups with and without severe depression. Seventy-one patients met the study criteria, with 46 hemodialysis and 25 peritoneal dialysis patients. The majority had hypertension and diabetes mellitus, with 47.89% having minimal-minor depression and 52.11% having moderate-major depression. The 2 groups were similar regarding chronic diseases, with no significant differences in serum creatinine levels, glucose, lipid profiles, or electrolytes. However, when the NLR of the 2 groups was compared, the median was higher in patients with moderate or major depression. Multivariate analysis showed no significant differences between the groups in PLR, triglyceride to glucose ratio, and C-reactive peptide to albumin ratio. The best NLR cutoff value was 3.26, with 48.6% sensitivity, 88.2% specificity, 81.8% positive predictive value, 61.2% negative predictive value, and 67.6% test accuracy. Depression is one of the most common psychiatric conditions in dialysis patients and is linked to increased morbidity, mortality, treatment failure, expense, and hospitalization. NLR helped predict moderate-to-major depression in dialysis patients, even after controlling for confounding factors in multivariate analysis. This study indicated that an NLR successfully identified depressive groups, and patients with an NLR value >3.26 were 6.1 times more likely to have moderate or major depression.

A cross-sectional study on resilience, anxiety, depression, and psychoactive substance use among heterosexual and sexual minority adolescents in Nigeria

BACKGROUND

Mental health-related problems predispose alcohol and other psychoactive substances use as coping strategies. We assessed associations between resilience and anxiety symptoms, depressive symptoms, problematic alcohol, and multiple psychoactive substance use among sexual minority and heterosexual adolescents in Nigeria.

METHODS

This was a secondary analysis of a subset of data generated through an online cross-sectional study conducted between 16th and 31st of October 2020. Data extracted for adolescents in Nigeria age 13-19 years were: dependent variables (alcohol use using the CAGE test, multiple psychoactive substance use, depressive symptoms using the Patient Health Questionnaire-9, and anxiety symptoms using the Generalized Anxiety Disorder-7 measure); independent variables (resilience using the Connor-Davidson resilience scale and sexual identity), and confounding factors (age and sex). Associations between dependent and independent variables were determined using multivariable logistic regression analyses after controlling for confounders.

RESULTS

Of the 1419 adolescent participants, 593 (42%) were sexual minority individuals, 533 (37.6%) had high depressive symptoms, 381 (26.8%) had high anxiety symptoms, 177 (12.5%) had problematic alcohol use and 389 (27.4%) used multiple psychoactive substances. Resilience was significantly associated with lower odds of anxiety (AOR:0.96, 95% CI: 0.94-0.97, p < 0.001) and depressive (AOR:0.94, 95% CI: 0.92-0.96, p < 0.001) symptoms, problematic alcohol use (AOR:0.97, 95% CI: 0.95-0.99, p = 0.002), and multiple psychoactive substance use (AOR:0.95, 95% CI: 0.93-0.96, p < 0.001). Sexual minority adolescents had significantly higher odds of anxiety (AOR:4.14, 95% CI: 3.16-5.40, p < 0.001) and depressive symptoms (AOR:4.79; 95% CI: 3.73-6.15, p < 0.001), problematic alcohol use (AOR:2.48, 95% CI: 1.76-3.49, p < 0.001), and multiple psychoactive substance use (AOR:5.69, 95% CI: 4.34-7.47, p < 0.001).

CONCLUSION

Sexual minority adolescents and adolescents with low resilience have a higher need for interventions to reduce the risk of anxiety, depression, and the use of alcohol and other psychoactive substances.

Targeting inflammatory pathways for treatment of the major depressive disorder

Current treatments modalities for major depressive disorder (MDD) mainly target the monoaminergic neurotransmission. However, the therapeutic inadequacy and adverse effects confine the use of these conventional antidepressants to a limited subset of MDD patients. The classical antidepressants are increasingly proving unsatisfactory in tackling the treatment-resistant depression (TRD). Hence, the focus of treatment is shifting to alternative pathogenic pathways involved in depression. Preclinical and clinical evidences accumulated across the last decades have unequivocally affirmed the causative role of immuno-inflammatory pathways in the progression of depression. There is an upsurge in the clinical evaluations of the drugs having anti-inflammatory effects as antidepressants. This review highlights the molecular mechanisms connecting the inflammatory pathways to the MDD and current clinical status of inflammation modulating drugs in the treatment of MDD.

An Okinawan-Based Nordic Diet Leads to Profound Effects on Gut Microbiota and Plasma Metabolites Linked to Glucose and Lipid Metabolism

Dietary interventions modify gut microbiota and clinical outcomes. Weight reduction and improved glucose and lipid homeostasis were observed after adopting an Okinawan-based Nordic diet (O-BN) in individuals with type 2 diabetes. The aim of the present study was to explore changes in metabolomics and gut microbiota during O-BN and correlate changes with clinical outcomes. A total of 30 patients (17 women), aged 57.5 ± 8.2 years, diabetes duration 10.4 ± 7.6 years, 90% over-weight, were included. Participants were provided an O-BN for 12 weeks. Before and after intervention, and 16 weeks afterwards, anthropometry and clinical data were estimated and questionnaires were collected, as well as samples of blood and stool. Plasma metabolomics were determined by gas- (GC-MS) or liquid- (LC-MS) chromatography-based mass spectrometry and fecal microbiota determination was based on 16S rRNA amplicons from regions V1-V2. During the intervention, weight (6.8%), waist circumference (6.1%), and levels of glucose, HbA1c, insulin, triglycerides, and cholesterol were decreased. Of 602 metabolites, 323 were changed for any or both periods; 199 (101 lipids) metabolites were decreased while 58 (43 lipids) metabolites were increased during the intervention. Changes in glucose homeostasis were linked to changes in, e.g., 1,5-anhydroglucitol, thyroxine, and chiro-inositol. Changes of microbe beta diversity correlated positively with food components and negatively with IL-18 (p = 0.045). Abundance differences at phylum and genus levels were found. Abundances of Actinobacteria, Bacteroidetes, Firmicutes, and Verrucomicrobia correlated with anthropometry, HbA1c, lipids, inflammation, and food. Changes in metabolites and microbiota were reversed after the intervention. The O-BN-induced changes in metabolomics and gut microbiota correspond to clinical outcomes of reduced weight and inflammation and improved glucose and lipid metabolism.

A Prospective Biopsychosocial Repeated Measures Study of Stress and Dropout from Substance Addiction Treatment

Introduction

This prospective, repeated-measures observational study tested biopsychosocial variables as risk factors for dropping out of inpatient substance addiction treatment. Substance use disorder (SUD) is viewed as a chronic relapsing disease caused by an interaction between biological, psychological, and social factors. However, there is a lack of prospective studies that combine biopsychosocial variables when assessing dropout. The aims of this study were to investigate whether there was 1) An association between biopsychosocial factors and dropping out of inpatient substance addiction treatment, 2) An interaction with SUD diagnosis and cortisol, and 3) Different dropout rates between short-term and long-term institutions.

Materials and Methods

Patients (n = 173) were recruited from two inpatient treatment centers in Norway between 2018 and 2021. The following biopsychosocial variables were measured at four timepoints: ward atmosphere (Ward Atmosphere Scale, WAS), psychological distress (Hopkins Symptom Checklist 10, HSCL-10), motivation (M-scale of the Circumstances, Motivation, Readiness, and Suitability questionnaire), and concentration of salivary cortisol (CORT- nmol/L). Cortisol levels were measured for two consecutive days at each timepoint and calculated by two cortisol indices, daytime cortisol slope (DCS) and area under the curve with respect to the ground (AUC_G). A multivariate logistic regression analysis was performed to find an association between dropout rates and the biopsychosocial variables.

Results

The results suggest a lower dropout odds for patients with high motivation (OR = 0.76, p = 0.022) and patients admitted to short-term treatment (OR = 0.06, p = 0.005). An interaction with stimulant SUD and DCS (OR = 13.74, p = 0.024) also revealed higher dropout odds. No statistical significance was found for psychological distress, WAS, and cortisol AUC_G.

Conclusion

The results support monitoring motivation during treatment and further investigating biopsychosocial variables when assessing dropout risk together with SUD diagnosis.

Mental Stress Detection and Mitigation using Machine Learning and Binaural Beat Stimulation

Stress is an inevitable problem experienced by people worldwide. Continuous exposure to stress can greatly impact mental activity as well as physical health thereby leading to several diseases. In this study, we investigate the effectiveness of audio binaural beat stimulation (BBs) in mitigating mental stress. We developed an experimental protocol to induce four mental states: rest, control, stress, and stress mitigation. The stress was induced by utilizing Stroop Color Word Test (SCWT) with time constraints and mitigated, by listening to 16 Hz of BBs. The four mental states were assessed using behavioral responses (accuracy of target detection), a perceived stress state questionnaire (PSS-10), and electroencephalography (EEG). The mean spectral power of four frequency bands was estimated using Power Spectral Density (PSD), and five different machine learning classifiers were used to classify the four mental states. Our results show that SCWT reduced the detection accuracy by 59.58% while listening to 16-Hz BBs significantly increased the accuracy of detection by 27.08%, (p = .00392). Furthermore, the support vector machine (SVM) significantly outperformed other classifiers achieving the highest accuracy of 82.5 ± 2.0 % using the beta band information. Similarly, the PSD topographical maps showed different patterns between the four mental states, where the temporal region's PSD was mostly affected by stress. Nevertheless, under mitigation, there was a noticeable restoration in the temporal activity. Overall, our results demonstrate that BBs at 16 Hz can be used to mitigate stress levels.

Aerobic Fitness as an Important Moderator Risk Factor for Loneliness in Physically Trained Older People: An Explanatory Case Study Using Machine Learning

BACKGROUND

Loneliness in older people seems to have emerged as an increasingly prevalent social problem.

OBJECTIVE

To apply a machine learning (ML) algorithm to the task of understanding the influence of sociodemographic variables, physical fitness, physical activity levels (PAL), and sedentary behavior (SB) on the loneliness feelings of physically trained older people.

MATERIALS AND METHODS

The UCLA loneliness scale was used to evaluate loneliness, the Functional Fitness Test Battery was used to evaluate the correlation of sociodemographic variables, physical fitness, PAL, and SB in the loneliness feelings scores of 23 trained older people (19 women and 4 men). For this purpose, a naive Bayes ML algorithm was applied.

RESULTS

After analysis, we inferred that aerobic fitness (AF), hand grip strength (HG), and upper limb strength (ULS) comprised the most relevant variables panel to cause high participant loneliness with 100% accuracy and F-1 score.

CONCLUSIONS

The naive Bayes algorithm with leave-one-out cross-validation (LOOCV) predicted loneliness in trained older with a high precision. In addition, AF was the most potent variable in reducing loneliness risk.

A fatal alliance: Glial connexins, myelin pathology and mental disorders

Mature oligodendrocytes are myelin forming glial cells which are responsible for myelination of neuronal axons in the white matter of the central nervous system. Myelin pathology is a major feature of severe neurological disorders. Oligodendrocyte-specific gene mutations and/or white matter alterations have also been addressed in a variety of mental disorders. Breakdown of myelin integrity and demyelination is associated with severe symptoms, including impairments in motor coordination, breathing, dysarthria, perception (vision and hearing), and cognition. Furthermore, there is evidence indicating that myelin sheath defects and white matter pathology contributes to the affective and cognitive symptoms of patients with mental disorders. Oligodendrocytes express the connexins GJC2; mCx47 [human (GJC2) and mouse (mCx47) connexin gene nomenclature according to Söhl and Willecke (2003)], GJB1; mCx32, and GJD1; mCx29 in both white and gray matter. Preclinical findings indicate that alterations in connexin expression in oligodendrocytes and astrocytes can induce myelin defects. GJC2; mCx47 is expressed at early embryonic stages in oligodendrocyte precursors cells which precedes central nervous system myelination. In adult humans and animals GJC2, respectively mCx47 expression is essential for oligodendrocyte function and ensures adequate myelination as well as myelin maintenance in the central nervous system. In the past decade, evidence has accumulated suggesting that mental disorders can be accompanied by changes in connexin expression, myelin sheath defects and corresponding white matter alterations. This dual pathology could compromise inter-neuronal information transfer, processing and communication and eventually contribute to behavioral, sensory-motor, affective and cognitive symptoms in patients with mental disorders. The induction of myelin repair and remyelination in the central nervous system of patients with mental disorders could help to restore normal neuronal information propagation and ameliorate behavioral and cognitive symptoms in individuals with mental disorders.

Outrunning a bad diet: interactions between exercise and a Western-style diet for adolescent mental health, metabolism and microbes

Adolescence is a period of biological, psychological and social changes, and the peak time for the emergence of mental health problems. During this life stage, brain plasticity including hippocampal neurogenesis is increased, which is crucial for cognitive functions and regulation of emotional responses. The hippocampus is especially susceptible to environmental and lifestyle influences, mediated by changes in physiological systems, resulting in enhanced brain plasticity but also an elevated risk for developing mental health problems. Indeed, adolescence is accompanied by increased activation of the maturing hypothalamic-pituitary-adrenal axis, sensitivity to metabolic changes due to increased nutritional needs and hormonal changes, and gut microbiota maturation. Importantly, dietary habits and levels of physical activity significantly impact these systems. In this review, the interactions between exercise and Western-style diets, which are high in fat and sugar, on adolescent stress susceptibility, metabolism and the gut microbiota are explored. We provide an overview of current knowledge on implications of these interactions for hippocampal function and adolescent mental health, and speculate on potential mechanisms which require further investigation.

Association between testosterone levels and mood disorders: A minireview

BACKGROUND

Although many studies reported the neuropsychiatric involvement of testosterone (T) levels in the development of mood disorders, its role in this disabling disorder is still not well understood. Therefore, in this review, we aim to summarize the current literature exploring serum testosterone levels in both major depressive disorder (MDD) and bipolar disorder (BD), with particular attention given to the possible causal relationship between pathological mood alterations and T levels.

METHODS

We selected 9 original studies from a bibliographic search on PubMed, excluding studies on hormonal therapy and other psychiatric disorders other than mood disorders.

RESULTS

The results reported by the reviewed studies were conflicting especially with regards to the presence of dysfunctional levels of T in patients with BD. Specifically, while MDD was found to be associated with low levels of T compared to healthy controls (HC), in BD the results were highly heterogeneous, with a mixed picture of reduced, increased or no difference in T levels in BD patients compared to HC.

LIMITATIONS

Studies were highly heterogeneous in terms of samples employed, psychometric scales used for assessing depressive symptoms, T assay methods and therapeutic regimens.

CONCLUSIONS

Overall, T levels were shown to be reduced in both MDD and BD patients, ultimately suggesting that T could be useful as a biomarker in mood disorders and provide guidance for future research.

Effects of Tele-Pilates and Tele-Yoga on Biochemicals, Physical, and Psychological Parameters of Females with Multiple Sclerosis

BACKGROUND

People with multiple sclerosis (PwMS) suffer from some comorbidities, including physical and psychiatric disorders, low quality of life (QoL), hormonal dysregulation, and hypothalamic-pituitary-adrenal axis dysfunction. The current study aimed to investigate the effects of eight weeks of tele-yoga and tele-Pilates on the serum levels of prolactin and cortisol and selected physical and psychological factors.

METHODS

Forty-five females with relapsing remitting multiple sclerosis, based on age (18-65), expanded disability status scale (0-5.5), and body mass index (20-32), were randomly assigned to tele-Pilates, tele-yoga, or control groups (n = 15). Serum blood samples and validated questionnaires were collected before and after interventions.

RESULTS

Following online interventions, there was a significant increase in the serum levels of prolactin (p = 0.004) and a significant decrease in cortisol (p = 0.04) in the time × group interaction factors. In addition, significant improvements were observed in depression (p = 0.001), physical activity levels (p < 0.001), QoL (p ≤ 0.001), and the speed of walking (p < 0.001).

CONCLUSION

Our findings suggest that tele-yoga and tele-Pilates training could be introduced as patient-friendly, non-pharmacological, add-on therapeutic methods for increasing prolactin and decreasing cortisol serum levels and achieving clinically relevant improvements in depression, walking speed, physical activity level, and QoL in female MS patients.

Persisting neuropsychiatric symptoms, Alzheimer's disease, and cerebrospinal fluid cortisol and dehydroepiandrosterone sulfate

INTRODUCTION

Neuropsychiatric symptoms are important treatment targets in the management of dementia and can be present at very early clinical stages of neurodegenerative diseases. Increased cortisol has been reported in Alzheimer's disease (AD) and has been associated with faster cognitive decline. Elevated cortisol output has been observed in relation to perceived stress, depression, and anxiety. Dehydroepiandrosterone sulfate (DHEAS) has known anti-glucocorticoid effects and may counter the effects of cortisol.

OBJECTIVES

We aimed to examine whether CSF cortisol and DHEAS levels were associated with (1) neuropsychiatric symptoms at baseline, (2) changes in neuropsychiatric symptoms over 3 years, and (3) whether these associations were related to or independent of AD pathology.

METHODS

One hundred and eighteen participants on a prospective study in a memory clinic setting, including patients with cognitive impairment (n = 78), i.e., mild cognitive impairment or mild dementia, and volunteers with normal cognition (n = 40), were included. Neuropsychiatric symptoms were assessed using the Neuropsychiatric Inventory Questionnaire (NPI-Q). CSF cortisol and DHEAS, as well as CSF AD biomarkers, were obtained at baseline. Neuropsychiatric symptoms were re-assessed at follow-up visits 18 and 36 months from baseline. We constructed linear regression models to examine the links between baseline neuropsychiatric symptoms, the presence of AD pathology as indicated by CSF biomarkers, and CSF cortisol and DHEAS. We used repeated-measures mixed ANCOVA models to examine the associations between the neuropsychiatric symptoms' changes over time, baseline CSF cortisol and DHEAS, and AD pathology.

RESULTS

Higher CSF cortisol was associated with higher NPI-Q severity scores at baseline after controlling for covariates including AD pathology status (B = 0.085 [0.027; 0.144], p = 0.027; r = 0.277). In particular, higher CSF cortisol was associated with higher baseline scores of depression/dysphoria, anxiety, and apathy/indifference. Elevated CSF cortisol was also associated with more marked increase in NPI-Q scores over time regardless of AD status (p = 0.036, η² = 0.207), but this association was no longer significant after controlling for BMI and the use of psychotropic medications. CSF DHEAS was associated neither with NPI-Q scores at baseline nor with their change over time. Cortisol did not mediate the association between baseline NPI-Q and changes in clinical dementia rating sum of boxes over 36 months.

CONCLUSION

Higher CSF cortisol may reflect or contribute to more severe neuropsychiatric symptoms at baseline, as well as more pronounced worsening over 3 years, independently of the presence of AD pathology. Our findings also suggest that interventions targeting the HPA axis may be helpful to treat neuropsychiatric symptoms in patients with dementia.

Social isolation exacerbates acute ozone inhalation induced pulmonary and systemic health outcomes

Psychosocially-stressed individuals might have exacerbated responses to air pollution exposure. Acute ozone exposure activates the neuroendocrine stress response leading to systemic metabolic and lung inflammatory changes. We hypothesized chronic mild stress (CS) and/or social isolation (SI) would cause neuroendocrine, inflammatory, and metabolic phenotypes that would be exacerbated by an acute ozone exposure. Male 5-week-old Wistar-Kyoto rats were randomly assigned into 3 groups: no stress (NS) (pair-housed, regular-handling); SI (single-housed, minimal-handling); CS (single-housed, subjected to mild unpredicted-randomized stressors [restraint-1 h, tilted cage-1 h, shaking-1 h, intermittent noise-6 h, and predator odor-1 h], 1-stressor/day*5-days/week*8-weeks. All animals then 13-week-old were subsequently exposed to filtered-air or ozone (0.8-ppm) for 4 h and immediately necropsied. CS, but not SI animals had increased adrenal weights. However, relative to NS, both CS and SI had lower circulating luteinizing hormone, prolactin, and follicle-stimulating hormone regardless of exposure (SI > CS), and only CS demonstrated lower thyroid-stimulating hormone levels. SI caused more severe systemic inflammation than CS, as evidenced by higher circulating cytokines and cholesterol. Ozone exposure increased urine corticosterone and catecholamine metabolites with no significant stressor effect. Ozone-induced lung injury, and increases in lavage-fluid neutrophils and IL-6, were exacerbated by SI. Ozone severely lowered circulating thyroid-stimulating hormone, prolactin, and luteinizing hormone in all groups and exacerbated systemic inflammation in SI. Ozone-induced increases in serum glucose, leptin, and triglycerides were consistent across stressors; however, increases in cholesterol were exacerbated by SI. Collectively, psychosocial stressors, especially SI, affected the neuroendocrine system and induced adverse metabolic and inflammatory effects that were exacerbated by ozone exposure.

Effect of Whole-Body Vibration on Serum Levels of Brain Derived Neurotrophic Factor and Cortisol in Young, Healthy Women

Vibration exercises on a platform (whole-body vibration, WBV), widely used in rehabilitation, sports medicine, and fitness, is an alternative to strength effort. The presented study assessed the effect of a 12-week cycle of vibration training on the serum concentrations of brain-derived neurotrophic factor (BDNF) and cortisol in young women (trial ID: ACTRN 12621000114842). Volunteers were assigned to three groups: performing exercises on a vibrating platform (n = 17), performing identical exercises without a platform (n = 12), and passive control group (n = 17). The concentration of BDNF and cortisol was assessed four times: before the first training session, 5 min after it, also before, and 5 min after the last training session. There were no statistically significant changes in the groups or among groups for both substances. WBV in the presented form did not increase the secretion of BDNF and is not a stressful stimulus.

Psychological trauma as a transdiagnostic risk factor for mental disorder: an umbrella meta-analysis

This umbrella review is the first to systematically examine psychological trauma as a transdiagnostic risk factor across psychiatric conditions. We searched Pubmed, Scopus, and PsycNET databases from inception until 01/05/2021 for systematic reviews/meta-analyses evaluating the association between psychological trauma and at least one diagnosed mental disorder. We re-calculated the odds ratio (OR), then classified the association as convincing, highly suggestive, suggestive, or weak, based on the number of cases and controls with and without psychological trauma, random-effects p value, the 95% confidence interval of the largest study, heterogeneity between studies, 95% prediction interval, small-study effect, and excess significance bias. Additional outcomes were the association between specific trauma types and specific mental disorders, and a sensitivity analysis for childhood trauma. Transdiagnosticity was assessed using TRANSD criteria. The review was pre-registered in Prospero CRD42020157308 and followed PRISMA/MOOSE guidelines. Fourteen reviews met inclusion criteria, comprising 16,277 cases and 77,586 controls. Psychological trauma met TRANSD criteria as a transdiagnostic factor across different diagnostic criteria and spectra. There was highly suggestive evidence of an association between psychological trauma at any time-point and any mental disorder (OR = 2.92) and between childhood trauma and any mental disorder (OR = 2.90). Regarding specific trauma types, convincing evidence linked physical abuse (OR = 2.36) and highly suggestive evidence linked sexual abuse (OR = 3.47) with a range of mental disorders, and convincing evidence linked emotional abuse to anxiety disorders (OR = 3.05); there were no data for emotional abuse with other disorders. These findings highlight the importance of preventing early traumatic events and providing trauma-informed care in early intervention and psychiatric services.

Intimate partner violence: psycho-physio-pathological sequelae for defining a holistic enriched treatment

Intimate partner violence (IPV) is a health priority, which worldwide, mainly affects women. The consequences of IPV include several psychophysiological effects. These range from altered levels of hormones and neurotrophins to difficulties in emotion regulation and cognitive impairment. Mounting evidence from preclinical studies has shown that environmental enrichment, a form of sensory-motor, cognitive, and social stimulation, can induce a wide range of neuroplastic processes in the brain which consistently improve recovery from a wide variety of somatic and psychiatric diseases. To support IPV survivors, it is essential to ensure a safe housing environment, which can serve as a foundation for environmental enrichment-based interventions. However, some concerns have been raised when supportive housing interventions focus on the economic aspects of survivors’ lives instead of the emotional ones. We thus propose a holistic intervention in which supportive housing is integrated with evidenced-based psychotherapies which could constitute an enriched therapeutic approach for IPV survivors.

Cytokine Imbalance as a Biomarker of Treatment-Resistant Schizophrenia

Treatment-resistant schizophrenia (TRS) is an important and unresolved problem in biological and clinical psychiatry. Approximately 30% of cases of schizophrenia (Sch) are TRS, which may be due to the fact that some patients with TRS may suffer from pathogenetically “non-dopamine” Sch, in the development of which neuroinflammation is supposed to play an important role. The purpose of this narrative review is an attempt to summarize the data characterizing the patterns of production of pro-inflammatory and anti-inflammatory cytokines during the development of therapeutic resistance to APs and their pathogenetic and prognostic significance of cytokine imbalance as TRS biomarkers. This narrative review demonstrates that the problem of evaluating the contribution of pro-inflammatory and anti-inflammatory cytokines to maintaining or changing the cytokine balance can become a new key in unlocking the mystery of “non-dopamine” Sch and developing new therapeutic strategies for the treatment of TRS and psychosis in the setting of acute and chronic neuroinflammation. In addition, the inconsistency of the results of previous studies on the role of pro-inflammatory and anti-inflammatory cytokines indicates that the TRS biomarker, most likely, is not the serum level of one or more cytokines, but the cytokine balance. We have confirmed the hypothesis that cytokine imbalance is one of the most important TRS biomarkers. This hypothesis is partially supported by the variable response to immunomodulators in patients with TRS, which were prescribed without taking into account the cytokine balance of the relation between serum levels of the most important pro-inflammatory and anti-inflammatory cytokines for TRS.

Possible Stress-Neuroendocrine System-Psychological Symptoms Relationship in Pregnant Women during the COVID-19 Pandemic

The COVID-19 pandemic induced long-term damages that weigh on the national health systems of various countries in terms of support and care. This review aimed to highlight the mental health impact of the COVID-19 pandemic in pregnant women. We first report data on the immune system physiopathology and the main viral infections in pregnancy, including COVID-19. Then, the attention is focused on the main factors that affect the mental health of pregnant women during the COVID-19 pandemic, such as (1) the fear of being infected and transmitting the infection to the fetus, (2) the cancellation of checkups and pre-child courses, and (3) confinement and the inability to have close friends or a partner at the time of delivery or in the first days after delivery, as well as family tensions. Because of all this, pregnant women find themselves in a stressful condition independent of the pregnancy, and thus experience anxiety, depression, insomnia, hostility, delirium, and an alteration of the mother-baby relationship. Several studies have shown an involvement of the hypothalamic-pituitary-adrenal axis and the hypothalamic-pituitary-thyroid axis in response to the pandemic. We propose a possible involvement of the neuroendocrine system as a mediator of the psychological symptoms of pregnant women induced by COVID-19-related stress.

Elevated Serum Cortisol Levels in Patients with Focal Epilepsy, Depression, and Comorbid Epilepsy and Depression

Background: The hypothalamic-pituitary-adrenal (HPA) axis, inflammatory processes and neurotrophic factor systems are involved in pathogenesis of both epilepsy and depressive disorders. The study aimed to explore these systems in patients with focal epilepsy (PWE, n = 76), epilepsy and comorbid depression (PWCED n = 48), and major depressive disorder (PWMDD, n = 62) compared with healthy controls (HC, n = 78). Methods: Parameters of the HPA axis, neurotrophic factors, and TNF-α were measured in blood serum along with the hemogram. Results: Serum cortisol level was augmented in PWE, PWCED, and PWMDD compared with HC and was higher in PWMDD than in PWE. Serum cortisol negatively correlated with Mini–Mental State Examination (MMSE) score in PWE, and positively with depression inventory–II (BDI-II) score in PWMDD. Only PWMDD demonstrated elevated plasma ACTH. Serum TNF-α, lymphocytes, and eosinophils were augmented in PWMDD; monocytes elevated in PWE and PWCED, while neutrophils were reduced in PWE and PWMDD. Serum BDNF was decreased in PWE and PWCED, CNTF was elevated in all groups of patients. In PWE, none of above indices depended on epilepsy etiology. Conclusions: The results confirm the involvement of HPA axis and inflammatory processes in pathogenesis of epilepsy and depression and provide new insights in mechanisms of epilepsy and depression comorbidity.

How psychosocial stress profile influences the subsequent occurrence of neuropsychiatric comorbidities: A longitudinal population-based cohort study

BACKGROUND

The role of psychosocial stressors in psychiatric disorders and executive dysfunction has been reported, separately. The literature has also suggested the involvement of social support and coping strategies in these relationships. However, there is a lack of research conducted to examine the relationships among multiple stressors and neuropsychiatric comorbidities while considering the presence of social support and coping strategies. This study aims to articulate the roles of multiple psychosocial stressors, social support, and coping strategies in the subsequent occurrence of neuropsychiatric comorbidities.

METHODS

Data analyzed were from the 6th data collection of a large-scale, longitudinal population-based cohort from Southwest Montreal in Canada. The cumulative effects of multiple stressors were separately examined by a composite score and latent profile analysis. Multinomial logistic regression models were used to test the relationship between cumulative stressors and neuropsychiatric comorbidities.

RESULTS

A total of 210 participants were included in the analyses. The LPA identified a 2-class model for psychosocial stressors (low and high) and executive function (executive dysfunction and no executive dysfunction), respectively. There were 11.8% of participants with neuropsychiatric comorbidities. Both the composite stress score (RR = 1.08, 95%CI = 1.01-1.15) and latent stress groups (RR = 3.65, 95%CI = 1.15-11.57) were associated with neuropsychiatric comorbidities after adjusting for social support and coping strategies. The risk of developing neuropsychiatric comorbidities decreased when the level of social support was high (P < 0.05).

CONCLUSIONS

Exposures to multiple stressors increased the risk of subsequent neuropsychiatric comorbidities, but the risk can be modified by a higher level of social support.