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Surve TAN, Sharma DD, Khan KG, Ghanie N, Charanrak R, Sharifa M, Begum S, Auz MJ, Akbarova N, Mylavarapu M. A comprehensive review of the intersection between asthma and depression. J Asthma 2024; 61:895-904. [PMID: 38415695 DOI: 10.1080/02770903.2024.2324862] [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: 11/01/2023] [Revised: 02/16/2024] [Accepted: 02/25/2024] [Indexed: 02/29/2024]
Abstract
OBJECTIVE To emphasize the necessity for increased research in this field, incorporating depression into the preventative, diagnostic, and therapeutic considerations for asthma. Additionally, we seek to highlight upcoming advancements that can be applied to simultaneously address these comorbidities, ultimately improving the overall well-being and quality of life for individuals coping with these conditions. METHODS A rigorous search in PubMed using the MeSH terms "asthma" and "depression" was performed, and papers were screened by the authors in view of their eligibility to contribute to the study. RESULTS There exists a correlation between these two conditions, with specific biological mechanisms and genetic factors playing a crucial role in their concurrent occurrence. In this review, we present preclinical and clinical research data, shed light on the possible mechanisms contributing to the co-occurrence of symptoms associated with both asthma and depression, and explore the intricate relationship between both conditions. CONCLUSION The evidence presented here supports the existence of a correlation between asthma and depression. By acknowledging these shared biological mechanisms, genetic factors, and epidemiological trends, we can formulate more efficacious strategies for addressing the dual impact of asthma and depression.
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Affiliation(s)
| | - DhruviKumari D Sharma
- Department of Internal Medicine, Spartan Health Sciences University, Vieux Fort, Saint Lucia
| | - Kiyan Ghani Khan
- Department of Internal Medicine, Baqai Medical University, Karachi, Pakistan
| | - Neisha Ghanie
- Department of Internal Medicine, American University of Antigua, Osbourn, Antigua and Barbuda
| | - Riley Charanrak
- Department of Internal Medicine, University of Lublin, Lublin, Poland
| | - Mouhammad Sharifa
- Department of Internal Medicine, University of Aleppo Faculty of Medicine, Aleppo, Syria
| | - Samreen Begum
- Department of Internal Medicine, Deccan College of Medical Sciences, Hyderabad, India
| | - Maria Jose Auz
- Department of Internal Medicine, Pontificia Universidad Catolica Argentina, Buenos Aires, Argentina
| | - Nozima Akbarova
- Department of Internal Medicine, Tashkent Pediatric Medical Institute, Tashkent, Uzbekistan
| | - Maneeth Mylavarapu
- Graduate Research Assistant, Department of Public Health, Adelphi University, Garden City, NY, USA
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Jang S. Temporal and bidirectional association of depression and physical illnesses: Analyzing the pooled data from independently conducted cross-sectional national surveys at three distinct time points. J Psychosom Res 2024; 179:111614. [PMID: 38422716 DOI: 10.1016/j.jpsychores.2024.111614] [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: 08/26/2023] [Revised: 01/09/2024] [Accepted: 02/17/2024] [Indexed: 03/02/2024]
Abstract
OBJECTIVE Depression is a widespread mental health issue, often coexisting with physical conditions. Understanding its interplay with physical illnesses is crucial for holistic care. METHODS We analyzed the pooled data from three cross-sectional surveys of the Korea National Health and Nutrition Examination Survey (KNHANES) conducted in 2016, 2018, and 2020. Data on depression and physical illness for participants aged 19 and above were collected based on information provided by the participants. RESULTS In cases where depression and physical illnesses occur independently, the diagnosed age for depression is typically earlier than that of physical health conditions. Furthermore, when exploring scenarios where depression coexists with physical illnesses, it is observed that depression often precedes the development of these conditions in most cases. However, exceptions to this trend are found in diabetes mellitus, thyroid disorders, and asthma, where the presence of these diseases is linked to an elevated risk of depression onset. Interestingly, the study also implies that the mood state associated with depression, rather than the diagnosis itself, may influence health-related behaviors, potentially playing a role in the development of physical illnesses. CONCLUSION Depression and physical illnesses share complex associations. Early detection, interventions, and addressing lifestyle factors are vital. This study's insights underscore the need for comprehensive mental and physical health care, though further research is needed for deeper understanding. The findings emphasize the importance of considering depression as a potential risk factor for physical illnesses and highlight the interplay between depression and physical health.
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Affiliation(s)
- Saeheon Jang
- Department of Psychiatry, Bongseng Memorial Hospital, South Korea.
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Touilloux B, Casutt A, Strippoli MPF, Lenoir A, Janett S, Vollenweider P, Vaucher J, Nicod L, Preisig M, von Garnier C. Associations of Depressive and Anxiety Disorders with Pulmonary Disorders in the Community: The PneumoLaus and PsyCoLaus Studies. Respiration 2024; 103:503-512. [PMID: 38417406 PMCID: PMC11309049 DOI: 10.1159/000537918] [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: 11/29/2023] [Accepted: 02/14/2024] [Indexed: 03/01/2024] Open
Abstract
INTRODUCTION Mental health disorders figure among the many comorbidities of obstructive respiratory diseases. The multisystemic characteristics of chronic respiratory disease and its impact on quality of life could affect depressive and/or anxiety disorders. We aimed to evaluate the association of spirometric indices, ventilatory disorders, and self-reported respiratory diseases with psychiatric disorders considering potential confounders. METHODS We analysed data from CoLaus|PsyCoLaus, a Swiss population-based cohort study, consisting of 2'774 participants (56% women; mean age: 62.3 (standard deviation = ±9.9) years) who performed spirometry and completed semi-structured psychiatric interviews. We defined ventilatory disorders using GLI-2012 references. Major depressive episode (MDE) and anxiety disorders were defined using the DSM-IV (Diagnostic and Statistical Manual). RESULTS 630 subjects (22.7%) presented a recent MDE. Reversible obstructive ventilatory disorders were associated with recent MDE (OR = 1.94, 95% confidence interval (95% CI) 1.10-3.43) and recent anxiety disorders (2.21 [1.16-4.22]) only in unadjusted model. Self-reported chronic obstructive pulmonary (COPD) and asthma were associated with MDE with ORs of 2.49 (95% CI, 1.19-5.27) and 1.56 (95% CI, 1.04-2.35) after adjustment, respectively. Possible restrictive ventilatory impairment was positively associated with recent anxiety disorders (OR = 2.46, 1.10-5.51). Z-scores of FEV1, FVC, and maximal mid-expiratory flow were not associated with psychiatric disorders. There was no association between ventilatory disorders and MDE in adjusted models. CONCLUSIONS In this cross-sectional population-based study, the association between respiratory disorders and depressive disorders was observed for self-reported COPD and asthma, but not with objective diagnoses based on spirometry. Lung volumes are not associated with psychiatric disorders. Further prospective studies will be necessary to understand the significance of the association.
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Affiliation(s)
- Brice Touilloux
- Division of Pulmonology, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Division of Pulmonology, Department of Medicine and Specialties, Fribourg Hospital and University of Fribourg, Fribourg, Switzerland
| | - Alessio Casutt
- Division of Pulmonology, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Division of Pneumology, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Marie-Pierre F. Strippoli
- Psychiatric Epidemiology and Psychopathology Research Center, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Prilly, Switzerland
| | - Alexandra Lenoir
- Division of Pulmonology, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Department of Internal Medicine V, Ludwig-Maximilians-University (LMU) of Munich, Munich, Germany
| | - Simone Janett
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | - Peter Vollenweider
- Division of Internal Medicine, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Julien Vaucher
- Division of Internal Medicine, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Division of Internal Medicine, Department of Medicine and Specialties, Fribourg Hospital and University of Fribourg, Fribourg, Switzerland
| | - Laurent Nicod
- Division of Pulmonology, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Martin Preisig
- Psychiatric Epidemiology and Psychopathology Research Center, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Prilly, Switzerland
| | - Christophe von Garnier
- Division of Pulmonology, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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Nicoloro-SantaBarbara J, Majd M, Burdick KE, Dixon V, Giannetti MP. Cognitive Impairment and Depression in Mastocytosis: A Synthesis of the Literature. Curr Allergy Asthma Rep 2024; 24:53-62. [PMID: 38294589 DOI: 10.1007/s11882-024-01127-z] [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] [Accepted: 01/05/2024] [Indexed: 02/01/2024]
Abstract
PURPOSE OF REVIEW Symptoms of depression and cognitive dysfunction are commonly reported in mastocytosis. The aims of this review paper are to summarize the current literature on cognitive dysfunction and depressive symptoms, elucidate some of the mechanistic pathways underlying depressive symptoms in mastocytosis, identify gaps in the literature, and offer guidance for future research in this area. RECENT FINDINGS The study of cognition and depression in mastocytosis is in its infancy and the methodological flaws of the current literature limit interpretability. There is preliminary evidence that some individuals with mastocytosis might experience mild deficits in memory. On average, depression symptom scores fell within the mild to moderate or sub-syndromal range. Regrettably, only one study utilized a standardized diagnostic instrument to assess major depressive disorder. The authors' tendency to inaccurately equate depressive symptoms with a diagnosis of major depressive disorder presents a notable issue. The prevalence of cognitive deficits and depression appears to be similar to other chronic illnesses. Future work needs to better characterize cognition and characterize "depression" in this population.
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Affiliation(s)
- Jennifer Nicoloro-SantaBarbara
- Department of Psychiatry, Brigham and Women's Hospital, 221 Longwood Ave, Boston, MA, 02115, USA.
- Harvard Medical School, Boston, MA, USA.
| | - Marzieh Majd
- Department of Psychiatry, Brigham and Women's Hospital, 221 Longwood Ave, Boston, MA, 02115, USA
- Harvard Medical School, Boston, MA, USA
| | - Katherine E Burdick
- Department of Psychiatry, Brigham and Women's Hospital, 221 Longwood Ave, Boston, MA, 02115, USA
- Harvard Medical School, Boston, MA, USA
| | - Victoria Dixon
- Department of Psychology, Northeastern University, Boston, MA, USA
| | - Matthew P Giannetti
- Harvard Medical School, Boston, MA, USA
- Division of Allergy and Clinical Immunology, Brigham and Women's Hospital, Boston, MA, USA
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Jenkins CR, Boulet LP, Lavoie KL, Raherison-Semjen C, Singh D. Personalized Treatment of Asthma: The Importance of Sex and Gender Differences. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:963-971.e3. [PMID: 35150902 DOI: 10.1016/j.jaip.2022.02.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 01/18/2022] [Accepted: 02/03/2022] [Indexed: 12/19/2022]
Abstract
An individual's sex (nominally male or female, based on biological attributes) and gender (a complex term referring to socially constructed roles, behaviors, and expressions of identity) influence the clinical course of asthma in several ways. The physiologic development of the lungs and effects of sex hormones may explain why more boys than girls have asthma, and after puberty, more women than men have asthma. Female sex hormones have an impact throughout the life span and are associated with poor asthma control. Gender may influence exposure to asthma triggers, and sex and gender can influence the prevalence of comorbidities and interactions with health care professionals. Despite widely reported sex- and gender-based differences in asthma and asthma management, these issues frequently are not considered by health care professionals. There is also inconsistency regarding the use of "sex" and "gender" in scientific discourse; research is needed to define sex- and gender-based differences better and how they might interact to influence asthma outcomes. This review outlines the impact an individual's sex and gender can have on the pathogenesis, clinical course, diagnosis, treatment, and management of asthma.
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Affiliation(s)
| | | | - Kim L Lavoie
- Department of Psychology, University of Québec at Montreal and Montreal Behavioural Medicine Centre, CIUSSS-NIM, Hôpital du Sacré-Cœur de Montréal, Montreal, Canada
| | - Chantal Raherison-Semjen
- Centre Hospitalier Universitaire de Guadeloupe, Guadeloupe, France; INSERM U1219, EpiCene Team, University of Bordeaux, Bordeaux, France
| | - Dave Singh
- University of Manchester, Manchester University NHS Foundation Trust, Manchester, United Kingdom
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Stubbs MA, Clark VL, Gibson PG, Yorke J, McDonald VM. Associations of symptoms of anxiety and depression with health-status, asthma control, dyspnoea, dysfunction breathing and obesity in people with severe asthma. Respir Res 2022; 23:341. [PMID: 36510255 PMCID: PMC9743554 DOI: 10.1186/s12931-022-02266-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 11/29/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Anxiety and depression are comorbidities of severe asthma. However, clinical characteristics associated with coexisting severe asthma and anxiety/depression are poorly understood. The study objective is to determine clinical characteristics associated with anxiety and depressive symptoms in severe asthma. METHODS Severe asthma participants (N = 140) underwent a multidimensional assessment. Categorization of symptoms of anxiety and depression were based on HADS scale sub-scores and divided into four groups (< 8 on both subscales; ≥ 8 on one subscale; ≥ 8 on both subscales). Clinical characteristics were compared between subgroups. Multivariate logistic regression determined associations of clinical characteristics and anxiety and/or depressive symptoms in people with severe asthma. RESULTS Participants were (mean ± SD) 59.3 ± 14.7 years old, and 62% female. There were 74 (53%) severe asthma participants without symptoms of anxiety/depression, 11 (7%) with symptoms of anxiety, 37 (26%) with symptoms of depression and 18 (13%) with symptoms of anxiety and depression. Quality of life impairment was greater in participants with symptoms of depression (4.4 ± 1.2) and combined symptoms of anxiety and depression (4.4 ± 1.1). Asthma control was worse in those with symptoms of depression (2.9 ± 1.1) and combined anxiety and depression (2.6 ± 1.0). In multivariate models, dysfunctional breathing was associated with symptoms of anxiety (OR = 1.24 [1.01, 1.53]). Dyspnoea was associated with symptoms of depression (OR = 1.90 [1.10, 3.25]). Dysfunctional breathing (OR 1.16 [1.04, 1.23]) and obesity (OR 1.17 [1.00, 1.35]) were associated with combined symptoms of anxiety and depression. CONCLUSION People with severe asthma and anxiety and/or depressive symptoms have poorer QoL and asthma control. Dyspnoea, dysfunctional breathing and obesity are associated with these symptoms. These key clinical characteristics should be targeted in severe asthma management.
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Affiliation(s)
- Michelle A. Stubbs
- National Health and Medical Research Council Centre for Research Excellence in Severe Asthma, Level 2 West Wing, 1 Kookaburra Circuit, New Lambton Heights, NSW 2305 Australia ,grid.413648.cAsthma and Breathing Research Centre, Hunter Medical Research Institute, Lot 1, Kookaburra Circuit, New Lambton Heights, NSW 2305 Australia ,grid.266842.c0000 0000 8831 109XSchool of Nursing and Midwifery, College of Health, Medicine and Wellbeing, The University of Newcastle, University Drive, Callaghan, NSW 2308 Australia
| | - Vanessa L. Clark
- National Health and Medical Research Council Centre for Research Excellence in Severe Asthma, Level 2 West Wing, 1 Kookaburra Circuit, New Lambton Heights, NSW 2305 Australia ,grid.413648.cAsthma and Breathing Research Centre, Hunter Medical Research Institute, Lot 1, Kookaburra Circuit, New Lambton Heights, NSW 2305 Australia ,grid.266842.c0000 0000 8831 109XSchool of Nursing and Midwifery, College of Health, Medicine and Wellbeing, The University of Newcastle, University Drive, Callaghan, NSW 2308 Australia
| | - Peter G. Gibson
- National Health and Medical Research Council Centre for Research Excellence in Severe Asthma, Level 2 West Wing, 1 Kookaburra Circuit, New Lambton Heights, NSW 2305 Australia ,grid.413648.cAsthma and Breathing Research Centre, Hunter Medical Research Institute, Lot 1, Kookaburra Circuit, New Lambton Heights, NSW 2305 Australia ,grid.414724.00000 0004 0577 6676Department of Respiratory and Sleep Medicine, John Hunter Hospital, New Lambton Heights, NSW 2305 Australia
| | - Janelle Yorke
- grid.5379.80000000121662407School of Health Sciences, University of Manchester, Oxford Road, Manchester, M13 9PL UK ,grid.412917.80000 0004 0430 9259Christie Patient Centred Research, The Christie NHS Foundation Trust, Wilmslow Road, Manchester, M20 4BX UK
| | - Vanessa M. McDonald
- National Health and Medical Research Council Centre for Research Excellence in Severe Asthma, Level 2 West Wing, 1 Kookaburra Circuit, New Lambton Heights, NSW 2305 Australia ,grid.413648.cAsthma and Breathing Research Centre, Hunter Medical Research Institute, Lot 1, Kookaburra Circuit, New Lambton Heights, NSW 2305 Australia ,grid.266842.c0000 0000 8831 109XSchool of Nursing and Midwifery, College of Health, Medicine and Wellbeing, The University of Newcastle, University Drive, Callaghan, NSW 2308 Australia
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Hou A, Silverberg JI. Predictors and age-dependent pattern of psychologic problems in childhood atopic dermatitis. Pediatr Dermatol 2021; 38:606-612. [PMID: 33890299 DOI: 10.1111/pde.14588] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 02/07/2021] [Accepted: 03/07/2021] [Indexed: 01/02/2023]
Abstract
BACKGROUND/OBJECTIVES Little is known about the predictors and trends of psychological comorbidities in childhood atopic dermatitis (AD), or whether they occur in an age-dependent pattern. We hypothesized racial/ethnic and socioeconomic disparities lead to increased psychological problems among children with AD and psychological comorbidities occur in an age-dependent manner. METHODS We analyzed cross-sectional data on 228 898 children aged 2-17 years from the 1997-2018 National Health Interview Survey. RESULTS Children with AD had higher proportions of depression/sadness (17.2% vs 12.6%; odds ratio [95% confidence interval]: 1.44 [1.37-1.51]), attention deficit (hyperactivity) disorder (ADD/ADHD) (10.0% vs 7.1%; 1.46 [1.38-1.55]), emotional/behavioral difficulties (29.9% vs 23.5%; 1.77 [1.69-1.84]), feelings of frequent worry (38.8% vs 23.5%; 1.66 [1.58-1.74]), and autism (1.9% vs 0.9%; 2.00 [1.75-2.29]). Among children with AD, psychologic comorbidity was associated with atopic comorbidities and multimorbidity and white race, households with lower income and education, and no insurance coverage. In children with or without AD, the prevalence of autism peaked during pre-adolescence; ADD/ADHD and emotional/behavioral difficulties peaked in adolescence; and depression/sadness and feelings of frequent worry increased steadily throughout childhood without plateau. CONCLUSION Atopic dermatitis was associated with multiple psychologic disorders, particularly among those with atopic comorbidities, white race, and low household income. Psychologic comorbidities increased in an age-dependent pattern, though similar to children without AD.
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Affiliation(s)
- Alexander Hou
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Jonathan I Silverberg
- Department of Dermatology, George Washington University School of Medicine, Washington, DC, USA
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von Fingerhut G, Mizukami K, Yam D, Makarov K, Kim Y, Kondyurina E, Yakovleva L. Social and physical factors related to depression in the older population of Siberia, Russia: a cross-sectional study. BMC Geriatr 2021; 21:272. [PMID: 33892638 PMCID: PMC8066855 DOI: 10.1186/s12877-021-02225-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 04/14/2021] [Indexed: 11/21/2022] Open
Abstract
Background Depression and suicide rates are relatively high in the colder regions of Russia. Older individuals in these regions are especially susceptible to these issues and are understudied in this regard. This study aims to better understand the current depression prevalence, and the factors related to depression, among the older individuals in these colder regions of Russia by studying a population in Novosibirsk oblast. Methods A questionnaire survey was administered to 422 older individuals, assessing basic attributes and health status, and employing the following standardized scales: 8-item Short-Form Health Survey, Pittsburgh Sleep Quality Index, and 15-item Geriatric Depression Scale (GDS). Participants were divided in two groups (GDS ≤ 6, GDS > 6) and compared, using Student’s t test, χ2 test, and logistic regression analysis. Results Young old (YO) adults showed significant correlation of depression with asthma (P = 0.005, OR = 6.40, 95%CI: 1.74–23.5), having a spouse (P = 0.016, OR = 1.99, 95%CI: 1.14–3.48), and daily communication with others (P < 0.001, OR = 0.336, 95%CI: 0.197–0.572). Among old old (OO) adults, significant correlation with depression was found for the variables work status (P = 0.047, OR = 0.115, 95%CI: 0.014–0.974), and weekly walking (P = 0.014, OR = 0.288, 95%CI: 0.106–0.778). Conclusions Twenty eight percent of the participants have depression. In YO adults, frequent communication and social ties with individuals outside of the family can mitigate depression prevalence. As for OO adults, the factors that have the highest impact on mitigating depression are related to daily activity, including both frequent walking and working or self-employment. Asthma patients are one of the more sensitive groups towards depression, but further research on this topic is needed. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02225-7.
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Affiliation(s)
- Georg von Fingerhut
- Department of Gerontological Nursing and Caring, Human Care Science, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Comprehensive Research Building D-310, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8577, Japan.
| | - Katsuyoshi Mizukami
- Faculty of Health and Sport Sciences, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Comprehensive Research Building D-311, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8577, Japan
| | - Dorothy Yam
- Department of Neuroscience, Brown University, 185 Meeting St, Providence, RI, 02912, USA
| | - Konstantin Makarov
- Department of Obstetrics and Gynecology, Novosibirsk State Medical University, 52, Krasny Prospect, Novosibirsk, Russian Federation, 630091
| | - Yuriy Kim
- Department of Nursing, Novosibirsk State Medical University, 52, Krasny Prospect, Novosibirsk, Russian Federation, 630091
| | - Elena Kondyurina
- Department of Pediatrics, Novosibirsk State Medical University, 52, Krasny Prospect, Novosibirsk, Russian Federation, 630091
| | - Lyudmila Yakovleva
- Department of Nursing, Novosibirsk State Medical University, 52, Krasny Prospect, Novosibirsk, Russian Federation, 630091
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Khaw SM, Li SC, Mohd Tahir NA. A systematic review of the cost-effectiveness of medicationadherence-enhancing intervention for asthma. J Asthma 2021; 59:697-711. [PMID: 33435775 DOI: 10.1080/02770903.2021.1875483] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Objective: This systematic review aimed to evaluate the cost-effectiveness of medication adherence-improving interventions in patients with asthma.Data source: Search engines including PubMed, Scopus and EBSCOhost were used to locate relevant studies from the inception of the databases to 19 October 2018. Drummond's checklist was used to appraise the quality of the economic evaluation.Study selection: Economic studies evaluating the cost-effectiveness of medication adherence enhancing interventions for asthmatic patients were selected. Relevant information including study characteristics, quality assessment, health outcomes and costs of intervention were narratively summarized. The primary outcome of interest was cost-effectiveness (CE) values and the secondary outcomes were costs, medication adherence and clinical consequences.Results: Twenty studies including 11 randomized controlled trials, 6 comparative studies and 3 modeled studies using Markov models were included in the review. Among these, 15 studies evaluated an educational intervention with 13 showing cost-effectiveness in improving health outcomes. The CE of an internet-based intervention showed similar results between groups, while 3 studies of simplified drug regimens and adding a technology-based training program achieved the desirable cost-effectiveness outcome.Conclusion: Overall, our results would support that all of the identified medication adherence-enhancing interventions were cost-effective considering the increased adherence rate, improved clinical effectiveness and the reduced costs of asthma care. However, it was not possible to identify the most cost-effective intervention. More economic studies with sound methodological conduct will be needed to provide stronger evidence in deciding the best approach to improve medication adherence.
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Affiliation(s)
- Sin Mei Khaw
- Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala, Lumpur, Malaysia
| | - Shu Chuen Li
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, NSW, Australia
| | - Nurul Ain Mohd Tahir
- Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala, Lumpur, Malaysia
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Underner M, Peiffer G, Perriot J, Jaafari N. [Smoking cessation in asthmatic patients and its impact]. Rev Mal Respir 2021; 38:87-107. [PMID: 33414027 DOI: 10.1016/j.rmr.2020.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 06/18/2020] [Indexed: 02/08/2023]
Abstract
INTRODUCTION The prevalence of smoking in asthmatic patients is similar to, or even higher than in the general population. OBJECTIVES This systematic review addresses (1) the effects of smoking on asthma, (2) smoking cessation strategies in asthmatic patients, and (3) the consequences of smoking cessation for people with asthma. RESULTS Active or passive smoking can promote the development of asthma. The few studies on smoking cessation in asthma confirm the efficacy of validated smoking cessation strategies in these patients (nicotine replacement therapy, varenicline, bupropion, cognitive and behavioural therapies). Smoking cessation in parents with asthmatic children is essential and is based on the same strategies. Electronic cigarettes may be a useful help to quit smoking in some patients. Smoking cessation is beneficial in asthmatic smokers and associated with (1) a reduction of asthma symptoms, acute exacerbations, bronchial hyperresponsiveness, and bronchial inflammation, (2) decreased use of rescue medications and in doses of inhaled corticosteroids, (3) improved asthma control, quality of life, and lung function. CONCLUSION In asthmatic patients, it is essential to assess smoking status and health professionals must assist them to quit smoking.
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Affiliation(s)
- M Underner
- Unité de recherche clinique, centre hospitalier Henri-Laborit, université de Poitiers, 86021 Poitiers, France.
| | - G Peiffer
- Service de pneumologie, hôpital de Mercy, CHR Metz-Thionville, 57085 Metz cedex 3, France
| | - J Perriot
- Dispensaire Émile-Roux, CLAT 63, centre de tabacologie, 63100 Clermont-Ferrand, France
| | - N Jaafari
- Unité de recherche clinique, centre hospitalier Henri-Laborit, université de Poitiers, 86021 Poitiers, France
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Cameron L, Palikhe NS, Laratta C, Vliagoftis H. Elevated Circulating Th2 Cells in Women With Asthma and Psychological Morbidity: A New Asthma Endotype? Clin Ther 2020; 42:1015-1031. [PMID: 32482491 DOI: 10.1016/j.clinthera.2020.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 05/01/2020] [Accepted: 05/02/2020] [Indexed: 12/31/2022]
Abstract
PURPOSE Psychological stress shifts the immune system toward the production of T-helper (Th)-2-mediated cytokines and eosinophilia, increases the risks for both asthma and depression, and can precipitate asthma exacerbations. Th2-mediated inflammation is a characteristic of allergic asthma. We have shown that the levels of CD4+ Th2 cells in the peripheral blood of patients with asthma are associated with severity and/or control of the disease. To improve our understanding of the interactions between stress and asthma symptoms, we evaluated the effects of psychological comorbidity on Th2-mediated inflammation in patients with asthma. METHODS Sixty-six asthmatic patients were recruited from the University of Alberta Asthma Clinic after they gave informed consent. Stress-related effects on asthma and psychological morbidity were assessed using the Asthma Control Questionnaire, completed by the patients at recruitment. Venous blood was collected at recruitment and Th2-mediated immunity evaluated by flow cytometry, quantitative real-time reverse-transcription polymerase chain reaction and enzyme-linked immunosorbent assay. FINDINGS Patients with stress-triggered asthma (n = 12) had higher percentage of CD4+ T cells (P = 0.006) and Th2 cells (CD4+CRTh2+ T cells; P = 0.002) in peripheral blood compared to patients with asthma who did not experience stress-related worsening of disease (n = 54). The same was true when we analyzed patients with any form of psychological comorbidity (n = 19) compared to those without psychological comorbidities (n = 47). These differences were evident among women, but not among men. Women with psychological comorbidity also required higher doses of inhaled and oral corticosteroids compared to those without psychological comorbidity. IMPLICATIONS Asthma involving psychological morbidity associates with an elevated level of circulating Th2 cells and increased corticosteroid usage, and may be more prevalent in women. Larger-scale prospective studies are required for assessing whether these women constitute a new endotype of Th2-high asthma responsive to treatments aimed to improve psychological comorbidities.
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Affiliation(s)
- Lisa Cameron
- Department of Pathology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; Division of Pulmonary Medicine, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada; Alberta Respiratory Centre, University of Alberta, Edmonton, Alberta, Canada.
| | - Nami Shrestha Palikhe
- Division of Pulmonary Medicine, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada; Alberta Respiratory Centre, University of Alberta, Edmonton, Alberta, Canada
| | - Cheryl Laratta
- Division of Pulmonary Medicine, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada; Alberta Respiratory Centre, University of Alberta, Edmonton, Alberta, Canada
| | - Harissios Vliagoftis
- Division of Pulmonary Medicine, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada; Alberta Respiratory Centre, University of Alberta, Edmonton, Alberta, Canada
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12
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Depression and anxiety in children with epilepsy and other chronic health conditions: National estimates of prevalence and risk factors. Epilepsy Behav 2020; 103:106828. [PMID: 31870808 PMCID: PMC7241646 DOI: 10.1016/j.yebeh.2019.106828] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 11/20/2019] [Accepted: 11/24/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This study estimates the national prevalence of depression and anxiety among children with epilepsy and determines which demographic variables and comorbidities increase the risk of these psychopathologies. We also compare the rates of depression and anxiety in pediatric epilepsy with those of other chronic health conditions in childhood. METHODS We used the 2009-2010 National Survey of Children with Special Health Care Needs to identify children with epilepsy with and without depression and anxiety. We assessed demographic factors and comorbidities associated with depression and anxiety using weighted multivariable logistic regressions. The rates of psychiatric comorbidity in children with chronic conditions other than epilepsy were also determined. RESULTS The final sample included 1042 children over the age of five with epilepsy. After applying the sampling weights, we estimated that 283,000 children between 5 and 17 years of age have epilepsy in the United States (U.S.). Among these children, 25% have depression and/or anxiety. This figure was not significantly different from the rates seen among children with asthma (16.5%) or allergies (21.6%) but was significantly lower than the rate seen among children with migraines (43.2%). In our analyses of children with epilepsy, low-income children (regardless of race) and children whose needs for specialist care were unmet (relative to those whose needs were met) were more likely to have depression. Low-income black children were less likely to have anxiety than high-income white children. Gender, age, and epilepsy severity were unrelated to depression or anxiety. CONCLUSIONS One in four U.S. children with epilepsy has depression and/or anxiety. Therefore, physicians should consider the various factors that are related to depression and anxiety in children with epilepsy so that at-risk children can be screened and managed appropriately.
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Τhe Co-Existence of Obstructive Sleep Apnea and Bronchial Asthma: Revelation of a New Asthma Phenotype? J Clin Med 2019; 8:jcm8091476. [PMID: 31527545 PMCID: PMC6780801 DOI: 10.3390/jcm8091476] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 08/26/2019] [Accepted: 09/05/2019] [Indexed: 12/15/2022] Open
Abstract
Bronchial asthma (BA) and obstructive sleep apnea (OSA) are common respiratory obstructive diseases that may coexist. It would be interesting to study the possible influence of that coexistence on both diseases. Until now, reviews focused mainly on epidemiology. The aim of this study was to review the literature in relation to epidemiology, pathophysiology, consequences, screening of patients, and treatment of the coexistence of OSA and BA. We pooled studies from the PubMed database from 1986 to 2019. OSA prevalence in asthmatics was found to be high, ranging from19% to 60% in non-severe BA, reaching up to 95% in severe asthma. Prevalence was correlated with the duration and severity of BA, and increased dosage of steroids taken orally or by inhalation. This high prevalence of the coexistence of OSA and BA diseases could not be a result of just chance. It seems that this coexistence is based on the pathophysiology of the diseases. In most studies, OSA seems to deteriorate asthma outcomes, and mainly exacerbates them. CPAP (continuous positive airway pressure) treatment is likely to improve symptoms, the control of the disease, and the quality of life in asthmatics with OSA. However, almost all studies are observational, involving a small number of patients with a short period of follow up. Although treatment guidelines cannot be released, we could recommend periodic screening of asthmatics for OSA for the optimal treatment of both the diseases.
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Lal C, Kumbhare S, Strange C. Prevalence of self-reported sleep problems amongst adults with obstructive airway disease in the NHANES cohort in the United States. Sleep Breath 2019; 24:985-993. [PMID: 31520299 DOI: 10.1007/s11325-019-01941-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 08/21/2019] [Accepted: 09/07/2019] [Indexed: 10/26/2022]
Abstract
RATIONALE Sleep and respiratory problems are common in adults in the USA. However, sleep problems often remain undiagnosed in patients with obstructive airway diseases (OADs). This study was designed to examine the association between sleep problems and different categories of OAD amongst US adults. METHODS We conducted an observational, cross-sectional study using a nationally representative sample of the US civilian non-institutionalized population from 2007 to 2008 National Health and Nutritional Examination Survey (NHANES). A total of 3204 study participants aged ≥35 years were stratified into four groups, using a self-reported history of asthma and data from spirometry: asthma-COPD overlap (ACO) (n = 70, 2.2%), asthma (n = 168, 5.2%), chronic obstructive pulmonary disease (COPD) (n = 412, 12.8%), and those without any OAD (normal) (n = 2554, 79.7%). After characterizing the baseline demographics and health status of the four groups, multivariate logistic regression analysis was performed to estimate the likelihood of sleep problems in adults after adjusting for age, gender, body mass index, smoking, alcohol, obstructive sleep apnea syndrome (OSAS), depression, and diabetes. The index sample was the normal group. Sleep problems were defined as any complaints which affect or involve sleep. RESULTS The participants with COPD were older (62.0 ± 11.7 years) as compared to ACO (59.1 ± 11.3 years), asthma (53.6 ± 11.3), and normal groups (53.8 ± 12.1) (p < 0.0001). Comparing baseline characteristics between the four groups, there were significant associations between OAD status and sleep problems including inadequate sleep, sleep-onset insomnia, snoring, frequent trouble sleeping, nocturnal arousals, early morning awakenings, fatigue, daytime sleepiness, use of prescription medication for sleep, leg jerks, leg cramps, difficulty in concentration, and difficulty in remembering things when tired. The multivariate logistic regression models evaluating the prevalence of sleep problems in individual OADs showed a stronger association between asthma and sleep problems as compared to COPD and ACO and sleep disorders. CONCLUSION All OADs are associated with a higher prevalence of sleep problems. There is a stronger association between asthma and sleep problems as compared to COPD and ACO. We speculate that the nocturnal burden of asthma contributes to sleep problems. Our results suggest that adults with OAD should be aggressively screened for sleep problems.
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Affiliation(s)
- Chitra Lal
- Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, Department of Medicine, Medical University of South Carolina, 96 Jonathan Lucas Street, CSB 816, MSC 630, Charleston, SC, 29425, USA.
| | - Suchit Kumbhare
- Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, Department of Medicine, Medical University of South Carolina, 96 Jonathan Lucas Street, CSB 816, MSC 630, Charleston, SC, 29425, USA
| | - Charlie Strange
- Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, Department of Medicine, Medical University of South Carolina, 96 Jonathan Lucas Street, CSB 816, MSC 630, Charleston, SC, 29425, USA
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15
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Abstract
PURPOSE OF REVIEW Breathlessness debilitates countless people with a wide range of common diseases. For some people, the experience of breathlessness is poorly explained by the findings of medical tests. This disparity complicates diagnostic and treatment options and means that disease-modifying treatments do not always have the expected effect upon symptoms. These observations suggest that brain processing of respiratory perceptions may be somewhat independent of disease processes. This may help to explain the dissonance observed in some patients between physical disease markers and the lived experience of breathlessness. RECENT FINDINGS A body of breathlessness research using functional neuroimaging has identified a relatively consistent set of brain areas that are associated with breathlessness. These areas include the insula, cingulate and sensory cortices, the amygdala and the periaqueductal gray matter. We interpret these findings in the context of new theories of perception that emphasize the importance of distributed brain networks. Within this framework, these perceptual networks function by checking an internal model (a set of expectations) against peripheral sensory inputs, instead of the brain acting as a passive signal transducer. Furthermore, other factors beyond the physiology of breathlessness can influence the system. SUMMARY A person's expectations and mood are major contributors to the function of the brain networks that generate perceptions of breathlessness. Breathlessness, therefore, arises from inferences made by the brain's integration of both expectations and sensory inputs. By better understanding individual differences across these contributing perceptual factors, we will be better poised to develop targeted and individualized treatments for breathlessness that could complement disease-modifying therapies.
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Affiliation(s)
- Lucy L. Marlow
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Olivia K. Faull
- Translational Neuromodeling Unit, Institute for Biomedical Engineering, University of Zurich and ETH Zurich, Zurich, Switzerland
| | - Sarah L. Finnegan
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Kyle T.S. Pattinson
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
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16
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Withers ALI, Green R. Transition for Adolescents and Young Adults With Asthma. Front Pediatr 2019; 7:301. [PMID: 31396495 PMCID: PMC6664046 DOI: 10.3389/fped.2019.00301] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 07/08/2019] [Indexed: 11/13/2022] Open
Abstract
Asthma is a complex, heterogenous medical condition which is very common in children and adults. The transition process from pediatric to adult health care services can be a challenge for young people with chronic medical conditions. The significant changes in physical and mental health during this time, as well as the many unique developmental and psychosocial challenges that occur during adolescence can complicate and impede transition if not adequately addressed and managed. The transition period can also be a challenging time for health professionals to assess readiness for transition and manage some of the complications which are particularly common during this time, including poor adherence to therapy, smoking, drug use, and emerging mental health conditions. The natural history, presentation, symptoms, and management of asthma is often significantly different when comparing pediatric and adult practice. In addition, management in infants, toddlers, school aged children, and adolescents differs significantly, offering an additional challenge to pediatric physicians managing asthmatic children and young people. Despite these challenges, if the transition process for young people with asthma is planned and performed in a formalized manner, many of these issues can be addressed, allowing the transition to occur smoothly despite changes that may occur in medical and psychosocial domains.
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Affiliation(s)
| | - Ruth Green
- Glenfield Hospital, Leicester, United Kingdom
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17
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Al-Rawashdeh BM, Saleh MYN, Mustafa RB, Alkhoujah MF, Elkhatib AH, Alsghaireen H, Hubaishy LZ. Prevalence of depression and anxiety among otolaryngology outpatients at Jordan University Hospital. Perspect Psychiatr Care 2019; 55:383-395. [PMID: 30171688 DOI: 10.1111/ppc.12320] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Revised: 07/02/2018] [Accepted: 07/14/2018] [Indexed: 12/11/2022] Open
Abstract
PURPOSE To determine the prevalence of depression and anxiety among otolaryngology outpatients at Jordan University Hospital. METHODS A cross-sectional observational study was conducted between January 2017 and February 2018. The sample included 1328 otolaryngology adult outpatients, who completed (PHQ-9) and (GAD-7) questionnaires for depression and anxiety. Sociodemographic and clinical data were recorded. RESULTS Depression and anxiety prevalence rates were 36.1% and 22.9%. The significant risk factors found for them were: age range 30 to 50 years, female sex, divorced status, smoking, alcohol drinking, asthma, family history of psychiatric illness, chronic illnesses, negative life events, secondary education, unemployment, low income, globus pharyngeus, tinnitus, and dizziness. PRACTICE IMPLICATIONS Healthcare providers should have the vigilance to suspect and treat these disorders to improve patients' symptoms and quality of life.
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Affiliation(s)
| | - Mohammad Y N Saleh
- Department of Clinical Nursing, Nursing Faculty, University of Jordan, Amman, Jordan
| | | | | | - Ahmad H Elkhatib
- Department of Otolaryngology-Head & Neck Surgery, Jordan University Hospital, Amman, Jordan
| | - Hadil Alsghaireen
- 5th Year Student, School of Medicine, University of Jordan, Amman, Jordan
| | - Lana Z Hubaishy
- 5th Year Student, School of Medicine, University of Jordan, Amman, Jordan
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18
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Ovsyannikov ES, Avdeev SN, Budnevsky AV, Shkatova YS. Influence of Anxiety/Depression on the Subjective Evaluation of Cough in Patients with Chronic Obstructive Pulmonary Disease and Obesity. ACTA ACUST UNITED AC 2019; 55:medicina55050134. [PMID: 31091811 PMCID: PMC6572558 DOI: 10.3390/medicina55050134] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 03/12/2019] [Accepted: 05/10/2019] [Indexed: 12/03/2022]
Abstract
Background and objectives: Obesity and anxiety and/or depression are common comorbidities in patients with chronic obstructive pulmonary disease (COPD). For doctors treating COPD, cough has a certain importance as a symptom. The purpose of this study was to figure out how obesity and anxiety/depression may influence the subjective assessment of cough. Materials and Methods: 110 patients with COPD participated in the study. The patients were divided into two groups, one including obese patients, and the other including patients with normal body weight. All patients filled out the hospital anxiety and depression scale (HADS) questionnaire, evaluated the severity of their cough by using visual analogue scale (VAS) on the 1st and 10th day of treatment, and underwent a 12 h cough monitoring with a special cough monitoring device both on the 1st and the 10th day of treatment. Results: The severity of anxiety according to the HADS in patients with COPD and normal body weight was significantly higher than in patients with COPD and obesity, corresponding to 9.25 ± 1.37 and 8.20 ± 1.18 points, respectively (p = 0.0063). The patients with normal body weight and obesity, but without anxiety and depression, subjectively noted an improvement in their well-being on the 10th day of treatment (p = 0.0022, p = 0.0021, respectively). In subgroups with normal body weight and obesity with anxiety and/or depression, the mean values for VAS on day 10 did not change significantly (p = 0.1917, p = 0.1921, respectively). Also, patients from the subgroup with normal body weight and anxiety/depression had a significantly higher assessment of their cough on day 10 than obese patients with anxiety/depression (p = 0.0411). The VAS values correlated positively with the actual amount of cough (r = 0.42, p = 0.0122 and r = 0.44, p = 0.0054, respectively) in patients without anxiety and/or depression, while in patients with anxiety and/or depression, there was an inverse correlation between VAS values and cough (r = −0.38, p = 0.0034 and r = −0.40, p = 0.0231). Conclusions: It is important to diagnose and treat anxiety and depression in patients with COPD for a better prognosis and higher efficacy of medical treatments. While treating such patients, it is preferable to use a cough monitoring device for objective assessments, since the patients may exaggerate or underestimate their symptoms.
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Affiliation(s)
- Evgeniy S Ovsyannikov
- oronezh State Medical University; Department of Faculty Therapy, 394036 Voronezh, Russia.
| | - Sergey N Avdeev
- .M. Sechenov First Moscow State Medical University; Pulmonology Department, 119992 Moscow, Russia.
| | - Andrey V Budnevsky
- oronezh State Medical University; Department of Faculty Therapy, 394036 Voronezh, Russia.
| | - Yanina S Shkatova
- oronezh State Medical University; Department of Faculty Therapy, 394036 Voronezh, Russia.
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19
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McLeish AC, Kraemer KM, O’Bryan EM. Discomfort Intolerance in Relation to Asthma Outcomes. COGNITIVE THERAPY AND RESEARCH 2019; 43:24-31. [PMID: 31511753 PMCID: PMC6738939 DOI: 10.1007/s10608-018-9965-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Anxiety symptoms and disorders are common among those with asthma and contribute to poorer health outcomes. Building on work examining anxiety-related cognitive-affective risk factors in asthma, the current study sought to explore associations between discomfort intolerance (i.e., the inability to withstand or tolerate unpleasant bodily sensations) in relation to lung function, asthma control, and quality of life. Participants were 61 adults with asthma (61.9% female; 54.8% African American; M age = 34.72, SD = 13.58) who were administered a self-report assessment battery and a lung function assessment. We found that, above and beyond the effects of anxiety sensitivity-physical concerns, greater discomfort intolerance was significantly associated with poorer lung function (9.5% variance), asthma control (9.9% variance), and overall asthma-related quality of life (11.7% variance) as well as the specific quality of life domains of activity limitations (12.6% variance) and asthma symptoms (6.8% variance). Thus, individuals with asthma who are unable to tolerate physical discomfort may be at risk for poor asthma outcomes and interventions to reduce discomfort intolerance could potentially be useful in this population.
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Affiliation(s)
- Alison C. McLeish
- Department of Psychology, University of Cincinnati, Cincinnati, OH, USA
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, KY, USA
| | - Kristen M. Kraemer
- Department of Psychology, University of Cincinnati, Cincinnati, OH, USA
- Division of General Medicine and Primary Care Section for Research, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA, USA
| | - Emily M. O’Bryan
- Department of Psychology, University of Cincinnati, Cincinnati, OH, USA
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20
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Sliwka A, Pilinski R, Przybyszowski M, Pieniazek M, Marciniak K, Wloch T, Sladek K, Bochenek G, Nowobilski R. The influence of asthma severity on patients' music preferences:Hints for music therapists. Complement Ther Clin Pract 2018; 33:177-183. [PMID: 30396618 DOI: 10.1016/j.ctcp.2018.10.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 10/04/2018] [Accepted: 10/07/2018] [Indexed: 12/21/2022]
Affiliation(s)
- Agnieszka Sliwka
- Institute of Physiotherapy, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland.
| | - Rafal Pilinski
- Institute of Physiotherapy, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | - Marek Przybyszowski
- II Department of Internal Medicine, Faculty of Medicine, Jagiellonian University Medical College, Poland
| | - Magdalena Pieniazek
- Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | | | - Tomasz Wloch
- Unit of Rehabilitation in Internal Diseases, Department of Clinical Rehabilitation, University School of Physical Education, Krakow, Poland
| | - Krzysztof Sladek
- II Department of Internal Medicine, Faculty of Medicine, Jagiellonian University Medical College, Poland
| | - Grazyna Bochenek
- II Department of Internal Medicine, Faculty of Medicine, Jagiellonian University Medical College, Poland
| | - Roman Nowobilski
- Institute of Physiotherapy, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
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21
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Alsaid-Habia T, McLeish AC, Kraemer KM. Associations between distress tolerance and asthma symptoms and quality of life. J Asthma 2018; 56:1120-1127. [PMID: 30285494 DOI: 10.1080/02770903.2018.1520862] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Objective: Given the robust associations between anxiety and asthma, the purpose of the current study was to explore associations between asthma outcomes and tolerance for negative affective states (i.e. distress tolerance) as well as tolerance for the specific negative emotional states of anxiety and fear. Methods: Participants were 61 nonsmoking adults with asthma (61.9% female, 54.8% African-American, Mage = 34.72, SD = 13.58) who underwent spirometry and completed self-report measures. Results: After controlling for the effects of age, race and the physical concerns domain of anxiety sensitivity, poorer global distress tolerance and tolerance for fear and anxiety each significantly predicted poorer lung function (8.7-13.8% variance), asthma control (4.9-8.8% variance) and asthma-related quality of life (6.7-8.9%). Conclusions: These findings suggest that targeting distress tolerance, specifically tolerance of fear and anxiety, may be helpful in improving asthma outcomes.
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Affiliation(s)
| | - Alison C McLeish
- Department of Psychology, University of Cincinnati, Cincinnati, OH, USA.,Department of Psychological and Brain Sciences, University of Louisville, Louisville, KY, USA
| | - Kristen M Kraemer
- Division of General Medicine and Primary Care Section for Research, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA, USA
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22
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Soria-Saucedo R, Lopez-Ridaura R, Lajous M, Wirtz VJ. The prevalence and correlates of severe depression in a cohort of Mexican teachers. J Affect Disord 2018. [PMID: 29525351 DOI: 10.1016/j.jad.2018.02.036] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Depression is among the 10 major causes of disability in Mexico. Yet, local contextual factors associated to the disorder remain poorly understood. We measured the impact of several factors on severe depression such as demographics, pharmacotherapy, multimorbidity, and unhealthy behaviors in Mexican teachers. METHODS A total of 43,845 Mexican female teachers from 12 Mexican states answered the Patient Health Questionnaire (PHQ9). Data were part the Mexican Teacher's Cohort prospective study, the largest ongoing cohort study in Latin America. Unadjusted and adjusted estimates assessed the impact of several contextual factors between severe versus mild-no depression cases. RESULTS In total 7026 teachers (16%) had a PHQ9 score compatible with severe depression. From them, only 17% received psychotropics, compared to 60% for those with a formal diagnosis. Less than 5% of teachers with PHQ9 scores compatible with severe depression had a formal diagnosis. Adjusted analysis reported higher odds of pharmacotherapy, having ≥ 3 comorbidities, higher levels of couple, family and work stress, fewer hours of vigorous physical activity, higher alcohol consumption, and smoking as risk factors for severe depression. Also, rural residents of northern and center states appeared more severely depressed compared to their urban counterparts. On average, the PHQ9 scores differed by ~ 10 points between severe and mild-no depressed teachers. LIMITATIONS A cross-sectional design. Also, the study focused on female teachers between ages 25 and 74 years old, reducing the generalizability of the estimates. CONCLUSION Under-diagnosis of clinical depression in Mexican teachers is concerning. Unhealthy behavior is associated with severe depression. The information collected in this study represents an opportunity to build prevention mechanisms of depression in high-risk subgroups of female educators and warrants improving access to mental care in Mexico.
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Affiliation(s)
- Rene Soria-Saucedo
- Department of Pharmaceutical Outcomes and Policy, University of Florida, United States
| | - Ruy Lopez-Ridaura
- Center for Population Research, National Institute of Public Health, 7a. Cerrada de Fray Pedro de Gante #50, Col. Sección XVI Tlalpan, C.P. 14080 México D.F., Mexico
| | - Martin Lajous
- Center for Population Research, National Institute of Public Health, 7a. Cerrada de Fray Pedro de Gante #50, Col. Sección XVI Tlalpan, C.P. 14080 México D.F., Mexico; Department of Global Health and Population, Harvard T.H. Chan School of Public Health, United States.
| | - Veronika J Wirtz
- Department of Global Health, Boston University School of Public Health, United States; Center of Health Systems Research, National Institute of Public Health, Mexico
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Weatherburn CJ, Heath CA, Mercer SW, Guthrie B. Physical and mental health comorbidities of epilepsy: Population-based cross-sectional analysis of 1.5 million people in Scotland. Seizure 2017; 45:125-131. [DOI: 10.1016/j.seizure.2016.11.013] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 11/16/2016] [Accepted: 11/18/2016] [Indexed: 01/18/2023] Open
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Kew KM, Nashed M, Dulay V, Yorke J. Cognitive behavioural therapy (CBT) for adults and adolescents with asthma. Cochrane Database Syst Rev 2016; 9:CD011818. [PMID: 27649894 PMCID: PMC6457695 DOI: 10.1002/14651858.cd011818.pub2] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND People with asthma have a higher prevalence of anxiety and depression than the general population. This is associated with poorer asthma control, medication adherence, and health outcomes. Cognitive behavioural therapy (CBT) may be a way to improve the quality of life of people with asthma by addressing associated psychological issues, which may lead to a lower risk of exacerbations and better asthma control. OBJECTIVES To assess the efficacy of CBT for asthma compared with usual care. SEARCH METHODS We searched the Cochrane Airways Group Specialised Register, ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP). We also searched reference lists of all primary studies and review articles and contacted authors for unpublished data. The most recent searches were conducted in August 2016. SELECTION CRITERIA We included parallel randomised controlled trials (RCTs) comparing any cognitive behavioural intervention to usual care or no intervention. We included studies of adults or adolescents with asthma, with or without comorbid anxiety or depression. We included studies reported as full text, those published as abstract only, and unpublished data. DATA COLLECTION AND ANALYSIS Two or more review authors independently screened the search results, extracted data, and assessed included studies for risk of bias. We analysed dichotomous data as odds ratios (ORs) and continuous data as mean differences (MDs) or standardised mean differences (SMD) where scales varied across studies, all using a random-effects model. The primary outcomes were asthma-related quality of life and exacerbations requiring at least a course of oral steroids. We rated all outcomes using GRADE and presented our confidence in the results in a 'Summary of findings' table. MAIN RESULTS We included nine RCTs involving 407 adults with asthma in this review; no studies included adolescents under 18. Study size ranged from 10 to 94 (median 40), and mean age ranged from 39 to 53. Study populations generally had persistent asthma, but severity and diagnostic measures varied. Three studies recruited participants with psychological symptomatology, although with different criteria. Interventions ranged from 4 to 15 sessions, and primary measurements were taken at a mean of 3 months (range 1.2 to 12 months).Participants given CBT had improved scores on the Asthma Quality of Life Questionnaire (AQLQ) (MD 0.55, 95% confidence interval (CI) 0.17 to 0.93; participants = 214; studies = 6; I2 = 53%) and on measures of asthma control (SMD -0.98, 95% CI -1.76 to -0.20; participants = 95; studies = 3; I2 = 68%) compared to people getting usual care. The AQLQ effect appeared to be sustained up to a year after treatment, but due to its low quality this evidence must be interpreted with caution. As asthma exacerbations requiring at least a course of oral steroids were not consistently reported, we could not perform a meta-analysis.Anxiety scores were difficult to pool but showed a benefit of CBT compared with usual care (SMD -0.38, 95% CI -0.73 to -0.03), although this depended on the analysis used. The confidence intervals for the effect on depression scales included no difference between CBT and usual care when measured as change from baseline (SMD -0.33, 95% CI -0.70 to 0.05) or endpoint scores (SMD -0.41, 95% CI -0.87 to 0.05); the same was true for medication adherence (MD -1.40, 95% CI -2.94 to 0.14; participants = 23; studies = 1; I2 = 0%).Subgroup analyses conducted on the AQLQ outcome did not suggest a clear difference between individual and group CBT, baseline psychological status, or CBT model. The small number of studies and the variation between their designs, populations, and other intervention characteristics limited the conclusions that could be drawn about these possibly moderating factors.The inability to blind participants and investigators to group allocation introduced significant potential bias, and overall we had low confidence in the evidence. AUTHORS' CONCLUSIONS For adults with persistent asthma, CBT may improve quality of life, asthma control, and anxiety levels compared with usual care. Risks of bias, imprecision of effects, and inconsistency between results reduced our confidence in the results to low, and evidence was lacking regarding the effect of CBT on asthma exacerbations, unscheduled contacts, depression, and medication adherence. There was much variation between studies in how CBT was delivered and what constituted usual care, meaning the most optimal method of CBT delivery, format, and target population requires further investigation. There is currently no evidence for the use of CBT in adolescents with asthma.
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Affiliation(s)
- Kayleigh M Kew
- St George's, University of LondonPopulation Health Research InstituteCranmer TerraceLondonUKSW17 0RE
| | - Marina Nashed
- Faculty of Medicine, Ain Shams University10 Abdeer streetEL ZietonCairoEgypt11724
| | - Valdeep Dulay
- University of SouthamptonPrimary Care ResearchSouthamptonUK
| | - Janelle Yorke
- Jean McFarlane Building, University of ManchesterSchool of Nursing, Midwifery & Social WorkOxford RoadManchesterUKM13 9PL
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Moghaddas F, Smith C, Pilcher D, O'Hehir R, Hew M, Dabscheck E. Need for intensive care in patients admitted for asthma: Red flags from the social history. Respirology 2016; 21:1251-4. [PMID: 27321760 DOI: 10.1111/resp.12831] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 03/03/2016] [Accepted: 03/13/2016] [Indexed: 01/16/2023]
Abstract
BACKGROUND AND OBJECTIVE Asthma deaths in Australia are associated with illicit substance abuse, mental health problems and social issues. However, a large proportion of these deaths occurs out of hospital and is difficult to avert by the time the individuals seek medical attention. We hypothesized that these characteristics may also increase the risk for a patient to require intensive care admission when they present to emergency departments. METHODS We studied consecutive patients admitted to a tertiary metropolitan hospital with a primary diagnosis of asthma between January 2010 and January 2014. Clinical and demographical data were obtained from chart review. The patient's postcode was used as a surrogate for socioeconomic status. RESULTS There were 482 asthma patients admitted during the study period, of which 39 required intensive care. Ten patients admitted to intensive care (26%) used illicit drugs compared with 29 (7%) of those admitted to the ward (adjusted odds ratio: 3.6, P = 0.012). For illicit users, nonadherence to preventer therapy was associated with an even higher risk of intensive care unit admission. Socioeconomic index was lower in the group requiring intensive care admission. The frequency of psychiatric diagnoses was similar in both groups. CONCLUSION Among patients admitted to hospital for asthma, illicit substance abuse is a strong independent risk factor for intensive care requirement. Preventer therapy nonadherence further increases this risk. Lower socioeconomic status is also associated with increased risk. These historical features should be actively sought on admission and may serve as useful 'red flags' to prompt consideration of intensive monitoring.
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Affiliation(s)
- Fiona Moghaddas
- Allergy, Asthma and Clinical Immunology Service, The Alfred Hospital, Melbourne, Victoria, Australia.
| | - Catherine Smith
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - David Pilcher
- Intensive Care Unit, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Robyn O'Hehir
- Allergy, Asthma and Clinical Immunology Service, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Mark Hew
- Allergy, Asthma and Clinical Immunology Service, The Alfred Hospital, Melbourne, Victoria, Australia.,Department of Medicine, Monash University, Melbourne, Victoria, Australia
| | - Eli Dabscheck
- Allergy, Asthma and Clinical Immunology Service, The Alfred Hospital, Melbourne, Victoria, Australia.,Department of Medicine, Monash University, Melbourne, Victoria, Australia
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Binagwaho A, Fawzi MCS, Agbonyitor M, Nsanzimana S, Karema C, Remera E, Mutabazi V, Shyirambere C, Cyamatare P, Nutt C, Wagner C, Condo J, Misago N, Kayiteshonga Y. Validating the Children's Depression Inventory in the context of Rwanda. BMC Pediatr 2016; 16:29. [PMID: 26898199 PMCID: PMC4762156 DOI: 10.1186/s12887-016-0565-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 02/16/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Depression is often co-morbid with chronic conditions, and when combined with HIV it can increase progression and reduce survival. A brief and accurate screening tool for depression among children living with HIV is necessary to increase access to mental health care and improve HIV-related outcomes in the long-term. METHODS A validation study was conducted, comparing the Children's Depression Inventory (CDI) with a structured clinical assessment as the gold standard among children living with HIV ages 7-14 years in Rwanda. The response rate was 87 % and the analysis was performed among 100 study participants. RESULTS Twenty-five percent of children had a diagnosis of depression based on the clinical interview. Sensitivity of the CDI ranged from 44 to 76 % and specificity was 92 to 100 % for cut-off scores from 5 to 9. The area under the curve (AUC) for receiver operating characteristic analysis, an estimate of overall accuracy, was 0.87 (95 % confidence interval: 0.77 - 0.97). CONCLUSIONS The significant prevalence of depression among children living with HIV in Rwanda reflects a critical need to advance mental health care in this population. Although overall accuracy of the CDI is reasonable in this context, further research needs to be done to develop a more sensitive measure of depression in this vulnerable population. Development of a highly sensitive screening measure will be a fundamental step towards improving access to mental health care among children living with HIV, potentially improving health outcomes and quality of life in the long-term as this vulnerable population transitions into adulthood.
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Affiliation(s)
- Agnes Binagwaho
- Ministry of Health of Rwanda, P.O. Box 84, Kigali, Rwanda. .,Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Avenue, Boston, MA, 02115, USA. .,University of Global Health Equity, 260 Blvd de l'Umuganda, P.O. Box 6955, Kigali, Rwanda. .,Geisel School of Medicine at Dartmouth, 1 Rope Ferry Road, Hanover, NH, 03755, USA.
| | - Mary C Smith Fawzi
- Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Avenue, Boston, MA, 02115, USA
| | - Mawuena Agbonyitor
- University of Maryland School of Medicine, 685 W Baltimore St., Baltimore, MD, 21201, USA
| | | | - Corine Karema
- Rwanda Biomedical Center, P.O. Box 83, Kigali, Rwanda
| | - Eric Remera
- Rwanda Biomedical Center, P.O. Box 83, Kigali, Rwanda
| | | | | | | | - Cameron Nutt
- Partners In Health, 641 Huntington Avenue, Boston, MA, 02115, USA
| | - Claire Wagner
- Dana-Farber Cancer Institute Center for Global Cancer Medicine, 450 Brookline Avenue, Boston, MA, 02115, USA
| | - Jeanine Condo
- School of Public Health, University of Rwanda, P.O. Box 5229, Kigali, Rwanda
| | - Nancy Misago
- Rwanda Biomedical Center, P.O. Box 83, Kigali, Rwanda
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Gupte-Singh K, Kim G, Barner JC. Impact of comorbid depression on medication adherence and asthma-related healthcare costs in Texas Medicaid patients with asthma. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2015. [DOI: 10.1111/jphs.12111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Abstract
Objectives
To compare: (1) rates of adherence to asthma controllers (ACs) between patients with asthma alone (A) and patients with asthma and comorbid depression (A + D); (2) rates of adherence to AC between patients who adhere to antidepressants and patients who do not adhere to antidepressants; and (3) asthma-related healthcare costs between the A and A + D groups.
Methods
Texas Medicaid insurance claims from 1 January 2007 to 31 October 2011 were extracted for adults (18–63 years) diagnosed with asthma with at least two fills of the same AC (inhaled corticosteroids, long-acting beta agonists, fixed-dose combinations (FDC) and leukotriene modifiers) in the A group, and at least two antidepressant claims in the A + D group. Proportion of days covered (PDC) was used to assess adherence to antidepressants and AC, while controlling for demographics, chronic disease score (CDS) and AC therapy type (monotherapy, FDC, dual therapy). Asthma-related healthcare costs included asthma-related prescriptions, inpatient and outpatient costs. Descriptive statistics, Wilcoxon test and regression analyses were used.
Key findings
The patients (n = 3626) were 40.1 ± 14.0 years, primarily women (75.0%), Caucasians (37.3%), FDC therapy users (56.3%), with CDS = 0 (74.2%). Results showed that compared to the A group (n = 3400), patients in the A + D group (n = 226) were 1.6 times more likely to adhere (PDC ≥50%) to their AC (odds ratio (OR) = 1.596; 95% confidence interval (CI) = 1.198–2.128; P < 0.001). Compared to patients who do not adhere to antidepressants (PDC < 80%) (n = 140), patients who adhered to antidepressants (PDC ≥80%) (n = 86) were 2.5 times more likely to adhere (PDC ≥50%) to AC, while controlling for covariates (OR = 2.517; 95% CI = 1.304–4.855; P = 0.006). After controlling for covariates, compared to the A group, the A + D disorder group had significantly lower total asthma-related healthcare costs (P < 0.001).
Conclusions
In the A + D group, the higher costs of asthma-related prescriptions was offset by the lower costs of inpatient and outpatient claims. Patients in the A + D group should be encouraged to adhere to both their ACs and antidepressants.
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Affiliation(s)
- Komal Gupte-Singh
- Health Outcomes and Pharmacy Practice, College of Pharmacy, The University of Texas at Austin, Austin, TX, USA
| | - Gilwan Kim
- Health Outcomes and Pharmacy Practice, College of Pharmacy, The University of Texas at Austin, Austin, TX, USA
| | - Jamie C Barner
- Health Outcomes and Pharmacy Practice, College of Pharmacy, The University of Texas at Austin, Austin, TX, USA
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Manning J, Kulbida R, Rai P, Jensen L, Bouma J, Singh SP, O'Malley D, Yilmazer-Hanke D. Amitriptyline is efficacious in ameliorating muscle inflammation and depressive symptoms in the mdx mouse model of Duchenne muscular dystrophy. Exp Physiol 2014; 99:1370-86. [PMID: 24972834 DOI: 10.1113/expphysiol.2014.079475] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Mutations in the structural protein dystrophin underlie muscular dystrophies characterized by progressive deterioration of muscle function. Dystrophin-deficient mdx mice are considered a model for Duchenne muscular dystrophy (DMD). Individuals with DMD are also susceptible to mood disorders, such as depression and anxiety. Therefore, the study objectives were to investigate the effects of the tricyclic antidepressant amitriptyline on mood, learning, central cytokine expression and skeletal muscle inflammation in mdx mice. Amitriptyline-induced effects (10 mg kg(-1) daily s.c. injections, 25 days) on the behaviour of mdx mice were investigated using the open field arena and tail suspension tests. The effects of chronic amitriptyline treatment on inflammatory markers were studied in the muscle and plasma of mdx mice, and mood-associated monoamine and cytokine concentrations were measured in the amygdala, hippocampus, prefrontal cortex, striatum, hypothalamus and midbrain. The mdx mice exhibited increased levels of anxiety and depressive-like behaviour compared with wild-type mice. Amitriptyline treatment had anxiolytic and antidepressant effects in mdx mice associated with elevations in serotonin levels in the amygdala and hippocampus. Inflammation in mdx skeletal muscle tissue was also reduced following amitriptyline treatment as indicated by decreased immune cell infiltration of muscle and lower levels of the pro-inflammatory cytokines tumour necrosis factor-α and interleukin-6 in the forelimb flexors. Interleukin-6 mRNA expression was remarkably reduced in the amygdala of mdx mice by chronic amitriptyline treatment. Positive effects of amitriptyline on mood, in addition to its anti-inflammatory effects in skeletal muscle, may make it an attractive therapeutic option for individuals with DMD.
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Affiliation(s)
- Jennifer Manning
- Department of Physiology, University College Cork, Cork, Ireland Department of Anatomy & Neuroscience, University College Cork, Cork, Ireland
| | - Rebecca Kulbida
- Department of Anatomy & Neuroscience, University College Cork, Cork, Ireland
| | - Prerana Rai
- Department of Biomedical Sciences, Creighton University, School of Medicine, Omaha, NE, USA Department of Neurology, Creighton University, School of Medicine, Omaha, NE, USA
| | - Lindsay Jensen
- Department of Neurology, Creighton University, School of Medicine, Omaha, NE, USA
| | - Judith Bouma
- Department of Biomedical Sciences, Creighton University, School of Medicine, Omaha, NE, USA
| | - Sanjay P Singh
- Department of Neurology, Creighton University, School of Medicine, Omaha, NE, USA
| | - Dervla O'Malley
- Department of Physiology, University College Cork, Cork, Ireland
| | - Deniz Yilmazer-Hanke
- Department of Anatomy & Neuroscience, University College Cork, Cork, Ireland Department of Biomedical Sciences, Creighton University, School of Medicine, Omaha, NE, USA
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Abstract
To document the impact of Tourette syndrome on the health care needs of children and access to health care among youth with Tourette syndrome, parent-reported data from the 2007-2008 National Survey of Children's Health were analyzed. Children with Tourette syndrome had more co-occurring mental disorders than children with asthma or children without Tourette syndrome or asthma and had health care needs that were equal to or greater than children with asthma (no Tourette syndrome) or children with neither asthma nor Tourette syndrome. Health care needs were greatest among children with Tourette syndrome and co-occurring mental disorders, and these children were least likely to receive effective care coordination. Addressing co-occurring conditions may improve the health and well-being of children with Tourette syndrome. Strategies such as integration of behavioral health and primary care may be needed to improve care coordination.
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Affiliation(s)
- Rebecca H Bitsko
- 1Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Brown ES, Howard C, Khan DA, Carmody TJ. Escitalopram for severe asthma and major depressive disorder: a randomized, double-blind, placebo-controlled proof-of-concept study. PSYCHOSOMATICS 2012; 53:75-80. [PMID: 22221724 DOI: 10.1016/j.psym.2011.07.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 06/22/2011] [Revised: 07/25/2011] [Accepted: 07/28/2011] [Indexed: 11/29/2022]
Abstract
BACKGROUND Depression is common in asthma and may be a risk factor for asthma-related morbidity and mortality. However, minimal data are available on depression treatment in asthma. Previously, we reported greater sustained depression remission and less oral corticosteroid use in asthma patients treated with citalopram. METHOD A 12-week randomized, double-blind, placebo-controlled, proof-of-concept trial of escitalopram was conducted in 26 outpatients with asthma requiring at least one course of oral corticosteroids in the prior 12 months and major depressive disorder (MDD) with baseline Hamilton Rating Scale for Depression (HAM-D) scores of ≥ 20. RESULTS Total evaluable sample (n = 25) showed significant baseline to exit reduction in HAM-D and Inventory of Depressive Symptomatology-Self Report (IDS-SR) scores, with no significant between-group differences, although the findings favored escitalopram. Depression remission on the HAM-D, from week 1 to exit, showed a trend (P = 0.06) favoring escitalopram. Relative risk for remission at week 12 was 6.5 with an estimated remission rate of 39.1% with escitalopram and 6.0% with placebo. Between-group differences in oral corticosteroid use were not significant. Changes in Asthma Control Questionnaire (ACQ) correlated significantly with changes in IDS-SR in the escitalopram, placebo, and combined sample groups (τ = 0.49-0.60, P < 0.05) and with changes in HAM-D only in placebo and combined groups (τ = 0.38-0.58, P < 0.05). CONCLUSIONS Medium effect sizes and a remission trend were observed favoring escitalopram over placebo on depression measures. Changes in self-reported depressive symptoms correlated with changes in asthma symptoms. A larger trial is needed to confirm the findings from this pilot study.
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Affiliation(s)
- E Sherwood Brown
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX 75390-8849, USA.
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Schumock GT, Lee TA, Joo MJ, Valuck RJ, Stayner LT, Gibbons RD. Association between leukotriene-modifying agents and suicide: what is the evidence? Drug Saf 2011; 34:533-44. [PMID: 21663330 DOI: 10.2165/11587260-000000000-00000] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
The US FDA has issued safety alerts and required manufacturers of leukotriene-modifying agents (LTMAs), including montelukast, zafirlukast and zileuton, to include suicide and neuropsychiatric events as a precaution in the drug label. This paper reviews the existing evidence on the potential association between the LTMAs and suicidal behaviour. We conducted a literature search of MEDLINE, EMBASE and International Pharmaceutical Abstracts from 1995 to 2010 (inclusive) to identify pertinent studies and reports. We also examined data obtained from the FDA adverse event reporting system. To date, there are no well conducted, comparative, observational studies of this association, and the safety alerts are based primarily on case reports. While the FDA safety alerts apply to all three LTMAs, montelukast (known by its trade name Singulair®) is by far the most widely used of these drugs and most of the reports to date regarding suicide pertain to montelukast. From 1998 to 2009 there were 838 suicide-related adverse events associated with leukotrienes reported to the FDA, of which all but five involved montelukast. Nearly all cases were reported in 2008 and 2009 (96.1%) after the FDA warnings. LTMAs are approved for use in asthma and allergic rhinitis, and are effective drugs. Both of these diseases are also associated with suicide, making confirmation of the association more difficult. Given the lack of good evidence, we recommend that a large observational cohort or case-control study be conducted to quantify the association between LTMAs and suicide. Until then, when prescribing LTMAs, clinicians should consider the potential for suicide and monitor patients who may be at elevated risk carefully for suicidal ideation or psychiatric symptoms associated with suicidal behaviour.
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Affiliation(s)
- Glen T Schumock
- Center for Pharmacoeconomic Research, University of Illinois at Chicago, USA.
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Oppedal RJ, Khan DA, Brown ES. Hypothyroidism in patients with asthma and major depressive disorder. PRIMARY CARE COMPANION TO THE JOURNAL OF CLINICAL PSYCHIATRY 2011; 9:467-8. [PMID: 18185831 DOI: 10.4088/pcc.v09n0611d] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Gulec MY, Gulec H, Oztuna F, Kose S. Cloninger's temperament and character dimension of personality in patients with asthma. Int J Psychiatry Med 2011; 40:273-87. [PMID: 21166338 DOI: 10.2190/pm.40.3.d] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Psychosocial factors have been implicated as being important in the onset and/or exacerbation of asthma. This study was performed to evaluate the personality profiles of asthma patients. METHOD Ninety-five asthmatic, 98 psoriatic patients, and 96 healthy controls completed the Temperament and Character Inventory (TCI), Beck Anxiety Inventory (BAI), and Beck Depression Inventory (BDI). The relationships between asthma illness duration, asthma severity score, depression, anxiety, and temperament and character personality variables were evaluated. RESULTS Asthmatic patients had significantly higher mean scores on the BAI, Harm Avoidance, Persistence, and Self-transcendence dimensions and lower scores on the BDI, Novelty Seeking, and Reward Dependence dimensions of the TCI than the psoriatic patients. Significant group effect was found for the BDI and BAI scores in between groups. Significant differences in TCI scores were found across groups except for Persistence and Self-transcendence. Post hoc tests revealed significantly lower Novelty Seeking, higher Harm Avoidance, lower Reward Dependence, and higher Self-transcendence scores in patients with asthma. Regression analysis revealed a significant effect between duration of illness and Persistence and Self-transcendence. Illness severity had a significant effect on the Harm Avoidance. Anxiety scores had significant effect on the Harm Avoidance, Self-directedness, and Self-transcendence. Depression scores had no significant effect on any of the TCI dimensions. CONCLUSIONS Asthmatic patients can be distinguished by a specific pattern of temperament (low NS) and character (high ST) dimensions and compared with both psoriatic patients and healthy controls. Illness duration is associated with ST scores, and illness severity is associated with HA.
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Wilczynska-Kwiatek A, Bargiel-Matusiewicz K, Lapinski L. Asthma, allergy, mood disorders, and nutrition. Eur J Med Res 2010; 14 Suppl 4:248-54. [PMID: 20156766 PMCID: PMC3521357 DOI: 10.1186/2047-783x-14-s4-248] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Growing evidence supports comorbidity of asthma and allergies with mood disorders and various connections between these diseases. It still remains unclear whether this comorbidity is caused by the same pathophysiological factors or whether there are other links between asthma and depression. There is no definite answer to the question of an optimal treatment to deal with both asthma and depression, when they occur simultaneously. Epidemiological and clinical trials on the influence of nutrition on certain diseases suggest the effects of ω3 polyunsaturated fatty acids (PUFAs) in aiding treatment of mood disorders and inflammatory conditions. Objective This is an overview showing the connections between asthma, allergic disease, and mood disorders, and the influence of nutrition on these conditions. Evidence indicates positive correlations between consumption of PUFAs and mood correction. Several analyses show the connection between diet and asthma. They may form a basis for potential recommending ω3 PUFAs as an adjuvant in prevention and treatment of mental disorders, asthma, and allergy.
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Wilson DH, Appleton SL, Taylor AW, Tucker G, Ruffin RE, Wittert G, Hugo G, Goldney RD, Findlay C, Adams RJ. Depression and obesity in adults with asthma: multiple comorbidities and management issues. Med J Aust 2010; 192:381-3. [PMID: 20367584 DOI: 10.5694/j.1326-5377.2010.tb03559.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2008] [Accepted: 11/08/2009] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To examine the comparative prevalence and distribution of obesity and psychological disturbance in the asthma and non-asthma populations, and to determine how these comorbidities are associated with physical functioning. DESIGN, SETTING AND PARTICIPANTS A South Australian population-representative study of 3175 adults who provided data on asthma, psychological morbidity, physical functioning, and body mass index. Bivariate and multivariate analyses identified how these comorbidities were distributed in asthma and non-asthma subpopulations, and the variance in physical functioning that they explained. MAIN OUTCOME MEASURES Rates of obesity and psychological morbidity, and physical functioning scores in asthma and non-asthma populations. RESULTS Men and women in the asthma population had similar prevalences of obesity (35.3% v 33.6%) and psychological morbidity (29.5% v 29.4%). When compared with non-asthma controls, both comorbidities were significantly higher only in men with asthma. The prevalence of psychological morbidity within different weight categories in the asthma population compared with non-asthma weight-category controls varied by sex. Physical functioning was lower in the asthma population than the non-asthma population (46.6 [95% CI, 45.9-47.3] v 48.8 [95% CI, 47.8-50.0]; P < 0.001), and psychological morbidity explained 22% of this variance. CONCLUSIONS Psychological morbidity and obesity are common in people with asthma. The sex-specific variation in psychological morbidity across weight categories suggests that future studies of psychological morbidity in groups with asthma should adopt designs that consider sex-specific controls rather than comparisons between the sexes.
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Affiliation(s)
- David H Wilson
- The Health Observatory, Discipline of Medicine, University of Adelaide, Adelaide, SA, Australia.
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Vázquez I, Romero-Frais E, Blanco-Aparicio M, Seoane G, Otero I, Rodríguez-Valcarcel ML, Pértega-Díaz S, Pita-Fernández S, Vera-Hernando H. Psychological and self-management factors in near-fatal asthma. J Psychosom Res 2010; 68:175-81. [PMID: 20105700 DOI: 10.1016/j.jpsychores.2009.04.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2008] [Revised: 04/20/2009] [Accepted: 04/28/2009] [Indexed: 11/25/2022]
Abstract
BACKGROUND Several studies that have analyzed differences in psychological and self-management variables between patients with a near-fatal asthma (NFA) attack and asthmatics without a NFA attack (non-NFA) have shown conflicting results, probably due to the heterogeneity of the events studied and the selection of comparison groups. OBJECTIVE To determine whether NFA patients, in stable situation, have greater psychological morbidity and worse self-management behavior than non-NFA patients with similar sociodemographic and clinical characteristics. METHODS A sample of 44 NFA patients (mean=5.65 years after the NFA episode) and 44 non-NFA patients matched for age, sex, and asthma severity was assessed. All patients were in clinical stable situation. Information about sociodemographic, clinical, functional, and morbidity variables was collected for each patient, and the Cognitive Depression Inventory, the Trait-Anxiety Scale, the Toronto Alexithymia Scale, the Practical Knowledge of Self-management questionnaire, and the Medication Adherence scale were administered. RESULTS In comparison with non-NFA patients, NFA patients showed higher levels of trait-anxiety (23.84 vs. 16.86; P=.001) and more difficulties describing and communicating feelings (11.36 vs. 8.90; P=.002). NFA and non-NFA patients did not differ in self-management variables. After adjustment in multivariate logistic regression analysis for age, sex, and asthma severity, significant differences were observed between NFA and control group patients in marital status [odds ratio (OR)=0.26; P=.017; 95% confidence interval (CI)=0.09-0.78], prescribed dose of inhaled corticoids (OR=4.48; P=.006;95% CI=1.53-13.09), and trait-anxiety (OR=1.071;P=.025;95%CI=1.01-1.14). CONCLUSIONS NFA patients show higher psychological morbidity than non-NFA, even years after the NFA episode.
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Affiliation(s)
- Isabel Vázquez
- Departamento de Psicología Clínica y Psicobiología, Facultad de Psicología, Universidad de Santiago de Compostela, Santiago de Compostela, Spain.
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Hajhashemi V, Sadeghi H, Minaiyan M, Movahedian A, Talebi A. The role of central mechanisms in the anti-inflammatory effect of amitriptyline on carrageenan-induced paw edema in rats. Clinics (Sao Paulo) 2010; 65:1183-7. [PMID: 21243294 PMCID: PMC2999717 DOI: 10.1590/s1807-59322010001100022] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2010] [Accepted: 08/26/2010] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE The present study was designed to further investigate the effect of amitriptyline, a classical tricyclic antidepressant, on carrageenan-induced paw edema in rats. METHODS First, amitriptyline was administered intraperitoneally (i.p.) at doses of 20, 40 and 80 mg kg-1, 30 min before subplantar injection of carrageenan. Second, amitriptyline was given intracerebroventriculary or intrathecally at doses of 25, 50 and 100 μg/rat, 30 min prior to carrageenan challenge. Third, the effect of adrenergic receptor antagonists such as propranolol (10 mg kg-1, i.p.), prazosin (4 mg kg-1, i.p.) and yohimbine (10 mg kg-1, i.p.) and an opioid receptor antagonist (naloxone, 4 mg kg-1, i.p.) on the anti-inflammatory effect of amitriptyline (40 mg kg-1, i.p.) was investigated. RESULTS Our data confirm that intraperitoneally administered amitriptyline exhibits a marked anti-inflammatory effect on carrageenan-induced paw edema in rats 4 h postcarrageenan challenge (P < 0.001). Intracerebroventricular (i.c.v.) administration of amitriptyline also reduced the development of paw edema at 4 h postcarrageenan (P < 0.001), but intrathecal (i.t.) application of amitriptyline failed to alter the degree of paw swelling. Furthermore, the applied antagonists did not modify the anti-inflammatory effect of amitriptyline. CONCLUSION These results support the view that amitriptyline has a considerable anti-inflammatory effect on carrageenan-induced paw edema in rats and suggest that at least a part of this property could be mediated through supraspinal sites. Moreover, it seems unlikely that the investigated adrenergic and opioid receptors have a significant role in this effect of amitriptyline.
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Affiliation(s)
- Valiollah Hajhashemi
- Isfahan Pharmaceutical Sciences Research Center, School of Pharmacy and Pharmaceutical Sciences, School of Pharmacy and Pharmaceutical Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
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Alkhalil M, Schulman E, Getsy J. Obstructive sleep apnea syndrome and asthma: what are the links? J Clin Sleep Med 2009; 5:71-8. [PMID: 19317386 PMCID: PMC2637171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Recent data suggest that obstructive sleep apnea syndrome (OSAS) is an independent risk factor for asthma exacerbations. Neuromechanical reflex bronchoconstriction, gastroesophageal reflux, inflammation (local and systemic), and the indirect effect on dyspnea of OSAS-induced cardiac dysfunction have been suggested as mechanisms that lead to worsening asthma control in patients with concomitant OSAS. Vascular endothelial growth factor-induced airway angiogenesis, leptin-related airway changes, and OSAS-induced weight gain also may play a common mechanistic role linking both disorders. Several studies have confirmed that asthmatic patients are more prone to develop OSAS symptoms than are members of the general population. The common asthmatic features that promote OSAS symptoms are nasal obstruction, a decrease in pharyngeal cross sectional area, and an increase in upper airway collapsibility. Clarifying the nature of the relationship between OSAS and asthma is a critical area with important therapeutic implications.
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Affiliation(s)
- Michel Alkhalil
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Drexel University College of Medicine, 245 North 15th Street, Mail Stop 107, Philadelphia, PA 19102, USA.
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Yen IH, Yelin E, Katz P, Eisner MD, Blanc PD. Impact of perceived neighborhood problems on change in asthma-related health outcomes between baseline and follow-up. Health Place 2008; 14:468-77. [PMID: 17950654 PMCID: PMC2600882 DOI: 10.1016/j.healthplace.2007.09.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2006] [Revised: 07/31/2007] [Accepted: 09/10/2007] [Indexed: 11/20/2022]
Abstract
We investigated whether perceived neighborhood problems (NP) predicted changes over a 2-year period in asthma-specific quality of life (QOL), physical functioning (PF), and depressive symptomology (DEP) in a longitudinal cohort of 340 adults with asthma. There is a threshold and plateau effect between NP and PF, such that NP do not affect changes in PF until the problems reach the level of Quartile 3. People who had NP scores in Quartile 3 had lower PF compared to people who reported NP in Quartiles 1 or 2 (mean difference -3.09). High NP also predicted over two-fold odds of high DEP (Center for Epidemiological Studies Depression [CES-D] score > or = 16) at follow-up (odds ratio=2.34; 95% confidence interval: 1.09-5.00). NP did not predict decline in QOL. Analyses adjusted for demographics, asthma severity, and baseline value of the health outcome.
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Affiliation(s)
- Irene H Yen
- Department of Medicine, University of California, San Francisco, 3333 California Street, Suite 335, San Francisco, CA 94143-0856, USA.
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Laforest L, Van Ganse E, Devouassoux G, Osman LM, Pison C, El Hasnaoui A, Bauguil G, Chamba G. Factors influencing dispensing of psychotropic medications to patients with asthma: a community pharmacy-based survey. Ann Allergy Asthma Immunol 2008; 100:230-6. [PMID: 18426142 DOI: 10.1016/s1081-1206(10)60447-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND To our knowledge, the use of psychotropic medications (antidepressant, anxiolytic, and hypnotic agents) in patients with asthma has not been extensively explored. OBJECTIVE To identify factors associated with the use of these medications in patients with asthma. METHODS Regular customers (aged 18-50 years) of 348 pharmacies in 9 French regions were consecutively recruited from November 2003 to June 2004. Patients with a prescription for an asthma medication were included. Patients completed a questionnaire, complemented by the computerized records of their therapy dispensed in the past 12 months. Asthma control was measured with the Asthma Control Test. RESULTS Among 886 patients (mean age, 37.4 years; 55.0% female), during the 12 months before the survey, the proportions who received at least 1 U of anxiolytic, antidepressant, and hypnotic agents were 25.6%, 13.7%, and 13.0%, respectively. Higher dispensing levels of antidepressant, anxiolytic, and hypnotic agents were observed with decreasing asthma control (P < .001 for each drug class). Other correlates of receiving any of these classes included older age, female sex, smoking status, and dispensing of antireflux treatment (P < .001 for all). These results were confirmed in multivariate analyses. CONCLUSIONS Psychotropic drugs were commonly dispensed to patients with asthma, and correlates of receiving these drugs were identified in this population. The high use of psychotropic medication, particularly in patients with poorly controlled asthma, is of concern.
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Kewalramani A, Bollinger ME, Postolache TT. Asthma and Mood Disorders. INTERNATIONAL JOURNAL OF CHILD HEALTH AND HUMAN DEVELOPMENT : IJCHD 2008; 1:115-123. [PMID: 19180246 PMCID: PMC2631932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The high rate of comorbidity of asthma and mood disorders would imply the possibility of potential shared pathophysiologic factors. Proposed links between asthma and mood disorders include a vulnerability (trait) and state connection. Vulnerability for both asthma and mood disorders may involve genetic and early developmental factors. State-related connections may include obstructive factors, inflammatory factors, sleep impairment, psychological reactions to chronic medical illness, as well as exacerbation of asthma in individuals with chronic stress. Treatment for asthma may also exacerbate mood disorders. New research suggests involvement of the central nervous system in asthma and allergy. Further characterization of clinical, psychological, cellular and molecular interconnections between asthma and mood disorders is needed to better evaluate and treat these patients. A close collaboration between mental health professionals and allergists could result in improved symptom control, quality of life, overall functioning and ultimately, decreased mortality.
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Affiliation(s)
- Anupama Kewalramani
- Department of Pediatrics, Division of Allergy/Pulmonology, University of Maryland School of Medicine, Baltimore, MD
| | - Mary E. Bollinger
- Department of Pediatrics, Division of Allergy/Pulmonology, University of Maryland School of Medicine, Baltimore, MD
| | - Teodor T. Postolache
- Mood and Anxiety Program, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, United States of America
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Abstract
Lung disease is a prominent cause of morbidity and mortality worldwide. When a patient has a common lung disease, such as asthma, or a less prevalent one, such as idiopathic pulmonary fibrosis, psychiatric issues should be considered as an integral part of the care plan for each patient. There have been many studies of psychologic factors and psychiatric syndromes in various lung diseases and their treatment. In this article, the authors focus on an evidence-based approach to reviewing this clinical literature.
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Brown ES, Vornik LA, Khan DA, Rush AJ. Bupropion in the treatment of outpatients with asthma and major depressive disorder. Int J Psychiatry Med 2007; 37:23-8. [PMID: 17645195 DOI: 10.2190/d235-2285-2121-6724] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Depressive disorders are common in asthma. Despite the high prevalence, antidepressant therapy in asthma patients with depression remains under-investigated. The objective of this pilot study was to investigate the use of bupropion for depression and anxiety in depressed asthma patients. METHOD We conducted a 12-week open-label study of bupropion in 18 depressed asthma patients. Participants were assessed with the Hamilton Rating Scale for Depression (HAM-D-17), Hamilton Rating Scale for Anxiety (HAM-A), Inventory of Depressive Symptomatology--Self-Report (IDS-SR), Asthma Control Questionnaire (ACQ) and spirometry at baseline and weeks 1, 2, 4, 8, and 12. RESULTS Significant baseline to exit improvements were observed on the HAM-D-17 (mean change = 4.72, SD = 7.78, p = 0.02) and the HAM-A (mean change = 2.12, SD = 3.97, p = 0.04). Based on the HAM-D-17 scores, 27.8% of the patients were responders and 16.7% were remitters. Significant correlations were found between changes in ACQ score and HAM-D-17 r = 0.73, p = 0.001), ACQ score and IDS-SR r = 0.58, = 0.012), and FEV1% Predicted and HAM-D-17 r = -0.66, p = 0.006). CONCLUSIONS Bupropion treatment was associated with significant improvements in depression and anxiety symptoms in asthma patients. Improvements in asthma correlated significantly with improvements in depression.
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Affiliation(s)
- E Sherwood Brown
- Department of Psychiatry, University of Texas Southwestern Medical Center at Dallas, 75390-8849, USA.
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Roumestan C, Michel A, Bichon F, Portet K, Detoc M, Henriquet C, Jaffuel D, Mathieu M. Anti-inflammatory properties of desipramine and fluoxetine. Respir Res 2007; 8:35. [PMID: 17477857 PMCID: PMC1876225 DOI: 10.1186/1465-9921-8-35] [Citation(s) in RCA: 173] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2007] [Accepted: 05/03/2007] [Indexed: 11/25/2022] Open
Abstract
Background Antidepressants are heavily prescribed drugs and have been shown to affect inflammatory signals. We examined whether these have anti-inflammatory properties in animal models of septic shock and allergic asthma. We also analysed whether antidepressants act directly on peripheral cell types that participate in the inflammatory response in these diseases. Methods The antidepressants desipramine and fluoxetine were compared in vivo to the glucocorticoid prednisolone, an anti-inflammatory drug of reference. In a murine model of lipopolysaccharides (LPS)-induced septic shock, animals received the drugs either before or after injection of LPS. Circulating levels of tumour necrosis factor (TNF)-α and mortality rate were measured. In ovalbumin-sensitized rats, the effect of drug treatment on lung inflammation was assessed by counting leukocytes in bronchoalveolar lavages. Bronchial hyperreactivity was measured using barometric plethysmography. In vitro production of TNF-α and Regulated upon Activation, Normal T cell Expressed and presumably Secreted (RANTES) from activated monocytes and lung epithelial cells, respectively, was analysed by immunoassays. Reporter gene assays were used to measure the effect of antidepressants on the activity of nuclear factor-κB and activator protein-1 which are involved in the control of TNF-α and RANTES expression. Results In the septic shock model, all three drugs given preventively markedly decreased circulating levels of TNF-α and mortality (50% mortality in fluoxetine treated group, 30% in desipramine and prednisolone treated groups versus 90% in controls). In the curative trial, antidepressants had no statistically significant effect, while prednisolone still decreased mortality (60% mortality versus 95% in controls). In ovalbumin-sensitized rats, the three drugs decreased lung inflammation, albeit to different degrees. Prednisolone and fluoxetine reduced the number of macrophages, lymphocytes, neutrophils and eosinophils, while desipramine diminished only the number of macrophages and lymphocytes. However, antidepressants as opposed to prednisolone did not attenuate bronchial hyperreactivity. In vitro, desipramine and fluoxetine dose-dependently inhibited the release of TNF-α from LPS-treated monocytes. In lung epithelial cells, these compounds decreased TNF-α-induced RANTES expression as well as the activity of nuclear factor-κB and activator protein-1. Conclusion Desipramine and fluoxetine reduce the inflammatory reaction in two animal models of human diseases. These antidepressants act directly on relevant peripheral cell types to decrease expression of inflammatory mediators probably by affecting their gene transcription. Clinical implications of these observations are discussed.
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Affiliation(s)
- Caroline Roumestan
- Inserm, U454, Montpellier, F-34295, France
- Laboratoire de Pharmacologie et Physiopathologie Expérimentales, Faculté de Pharmacie, Univ Montpellier, Montpellier, F-34090, France
- Present address : Laboratoires Macors, Auxerre, F-89000, France
| | - Alain Michel
- Laboratoire de Pharmacologie et Physiopathologie Expérimentales, Faculté de Pharmacie, Univ Montpellier, Montpellier, F-34090, France
| | - Florence Bichon
- Laboratoire de Pharmacologie et Physiopathologie Expérimentales, Faculté de Pharmacie, Univ Montpellier, Montpellier, F-34090, France
| | - Karine Portet
- Laboratoire de Pharmacologie et Physiopathologie Expérimentales, Faculté de Pharmacie, Univ Montpellier, Montpellier, F-34090, France
| | - Maëlle Detoc
- Inserm, U454, Montpellier, F-34295, France
- Present address : Inserm, U826, Montpellier, F-34298, France
| | - Corinne Henriquet
- Inserm, U454, Montpellier, F-34295, France
- Present address : Inserm, U826, Montpellier, F-34298, France
| | - Dany Jaffuel
- Centre Médical Spécialisé de Pneumologie, 30 boulevard Kennedy, Béziers, F-34500, France
| | - Marc Mathieu
- Inserm, U454, Montpellier, F-34295, France
- Present address : Inserm, U844, Montpellier, F-34091, France
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Volicer BJ, Quattrocchi N, Candelieri R, Nicolosi R, Ladebauche P. Depression and alcohol abuse in asthmatic college students. Nurse Pract 2006; 31:49-54. [PMID: 16452902 DOI: 10.1097/00006205-200602000-00009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Slattery MJ. Psychiatric Comorbidity Associated with Atopic Disorders in Children and Adolescents. Immunol Allergy Clin North Am 2005; 25:407-20, viii. [PMID: 15878463 DOI: 10.1016/j.iac.2005.02.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This article examines evidence of an association between psychiatric disorders and atopic disorders in children and adolescents. Findings are discussed within a developmental framework and compared with adult studies, when available, to illustrate similarities and differences between youth and adults. Finally, the article discusses the clinical relevance of comorbid psychiatric and atopic disorders.
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Affiliation(s)
- Marcia J Slattery
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, University of Wisconsin Medical School, 6001 Research Park Boulevard, Madison, WI 53719, USA
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Abstract
Corticosteroids, such as prednisone and dexamethasone, are frequently prescribed medications sometimes associated with severe systemic side effects. Currently there are limited data regarding the psychiatric side effects of these medications, although mood changes and even psychoses have been reported. This study was designed to quantify psychiatric changes during brief courses of prednisone in patients with asthma. Outpatients with asthma (N = 32) receiving bursts of prednisone (>40 mg/day) were evaluated before, during, and after corticosteroid therapy by use of the Hamilton Rating Scale for Depression, the Young Mania Scale, the Brief Psychiatric Rating Scale, and the Internal State Scale. A Structured Clinical Interview for DSM-IV disorders was also conducted to examine past psychiatric history. Highly significant increases in the Young Mania Scale and Activation subscale of the Internal State Scale (both measures of mania) were observed with no increase in depression measures during the first 3 to 7 days of prednisone therapy. Mood changes were not correlated with improvement in airway obstruction, suggesting that mood elevations may not be in response to improvement in asthma symptoms. Subjects with past or current symptoms of depression had a significant decrease in depressive symptoms during prednisone therapy compared with those without depression. Some patients with posttraumatic stress disorder reported increases in depression and memories of the traumatic event during prednisone therapy. In summary, statistically significant changes in mood were observed even during brief courses of corticosteroids at modest dosages. The symptoms were primarily manic, not depressive. Persons with depression did not become more depressed during prednisone therapy, and, in fact, some showed improvement.
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Affiliation(s)
- E Sherwood Brown
- Departments of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX 75390-9070, USA.
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