Lithium: more than a mood stabilizier

Introduction

Bipolar disorder (BD) is characterized by episodic changes in affect, motivation, cognition and behavior. This severe mental disorder has a prevalence of at least 1% and a high heritability of 60%-80%. The pathophysiology is still poorly understood but evidence indicate that the disorder relates to disturbances in front-limbic networks relevant for emotion processing and regulation. New techniques have been used to study BD and showed aberrante white matter (WM) microstructure in the corpus callosum and from-limbic pathways. However, lithium, a mood stabilizier, it looks like has celular and neuromodulatory effects.

Objectives

The authors elaborate a narrative literature review to identify the existing clinical evidence of lithium’s effect on the WM from BD patients.

Methods

Pubmed databased searched using the therms “bipolar disorder”, “white matter” and “lithium”.

Results

Lithium is a bipolar medication that confers treatment and long-term prophylaxis and been reported as having neuroprotective effects.

Studies that used new techniques such diffusion tensor imaging measures to assess white matter integrity reported a positive effect of lithium on the integrity of WM of BD patients and suggest that response to lithium treatment in BD patients is associated with normalization of WM microstructure in regions associated with emotion processing.

Conclusions

Lithium appears to positively influence the evolution of the white matter abnormalities described in BD patients however further investigation is required to strongly reinforce this potential and safety.

Disclosure

No significant relationships.

The Role of Vagus Nerve Stimulation in Depression: What We Know?

Introduction

Depression is a leading cause of disability affecting over 300 million indivuals worldwide. About 1/3 of patients with depression fail to achive remission despite treatment with multiple antidepressants and are considered to have treatment-resistant depression (TRD). In view of such facts, vagus nerve stimulation (VNS) therapy was approved as an adjunctive long-term treatment for TRD.

Objectives

The authors elaborate a narrative literature review about de effectiveness of VNS in treatment for TRD.

Methods

PubMed database searched using the terms “treatment-resistant depression”, “vagus nerve stimulation”

Results

The pathophysiology of depression is complex and includes social environmental stress factors, genetic and biological processes, inflammation, and disturbances in monoamine neurotransmission. The overdrive of the HPA axis is most consistently seen in subjects with more severe depression, when the cortisol feedback inhibitory mechanisms are impaired, contributing to cytokine oversecretion. It has been shown that chronic exposure to elevated inflammatory cytokines can lead to depression. The vagus nerve represents the main component of the parasympathetic nervous system, which oversees a vast array of crucial bodily functions, including control of mood and imune response. VNS therapy has a demonstrated anti-inflammatory effect which might be a significant reason for its efficacy in patients who did not respond to antidepressants. Treatments thar target the vagus nerve increase the vagal tone and inhibit cytokine production and the stimulation of vagal aferente fibers in the gut influences monaminergic brain systems.

Conclusions

The mecanismos by which VNS may benefit patients nonresponsive to conventional antidepressants is unclear, with further research need to clarify this.

Disclosure

No significant relationships.

Ketamine and Electroconvulsive Therapy: Better Together?

Introduction

Major depressive disorder (MDD) is a highly prevalent clinical condition with a leading cause of disability worldwide. The currently available therapeutic agents have important limitations regarding side effects, partial or non-responsiveness. Patients are considered to have treatment-resistant depression (TRD) if there is no effect or minimal effectiveness after receiving adequate dose-duration use of antidepressants from two different categories. For this patients, electroconvulsive therapy (ECT) can be a treatment option and new therapies appear to tackle TRD like ketamine, a dissociative anesthetic and analgesic.

Objectives

The authors elaborate a narrative literature review to understand if ketamine might enhance the antidepressant efficacy of ECT.

Methods

PubMed database searched using the terms “Electroconvulsive therapy”, “ketamine” and “treatment-resistant depression”.

Results

ECT is currently recommended as an end-line therapy for TRD. Memory impairment after ECT could be a consequence of indiscriminate activation or saturation of glutamate receptors during the treatment, disrupting hippocampal plasticity involved in memory. Ketamine inhibits N-methyl-d-aspartate (NMDA) receptors, while stimulating glutamate release and was proposed as an ECT adjuvant, might reduce cognitive adverse effects, time until response/ remission and inclusively improve response rates to ECT.

However, response and remission rates of ketamine in ECT showed no significant difference from the comparator groups and was associated with higher rates of psychiatric and cardiovascular adverse events.

Conclusions

The results did not support the use the combination of ketamine and propofol as anesthetic agents for ECT in patients with MDD. However, further studies are needed to investigate the beneficial clinical and cognitive effects of ketamine alone in ECT settings.

Disclosure

No significant relationships.

Irritable Bowel Syndrome: The role of the Psychiatry

Introduction

Irritable bowel syndrome (IBS) is the most common functional gastrointestinal disorder, affecting about 20% of people worldwide. This complex and multifaceted disorder has been proposed as a system disease involving not only individual systems including the nervous, endocrine, imune, digestive, microbiota and the environment but also the interactions of these systems. The aetiology of IBS is complex and incompletely understood and this disease are frequently associated with a comorbid psychiatric disease. Current treatment is symptom-directed, rather than based on underlying pathophysiological mechanisms.

Objectives

The authors elaborate a narrative literature review to identify the pathophysiology and therapeutic approach of IBS.

Methods

Pubmed databased searched using the therms “psychiatry”, “irritable bowel syndrome” and “treatment”.

Results

The IBS is the most common and best described of the functional bowel disorders, which represents a considerable therapeutic challenge. Studies looked at the efficacy of fibre, antispasmodics and peppermint oil in the treatment of IBS found moderately effectiveness in the treatment of global symptoms. Elimination diets are helpful in improving IBS. There is evidence that a low-FODMAP diet can have a favorable impact on IBS symptoms, especially abdominal pain, bloating and diarrhea with improved irritable bowel syndrome symptoms and quality of life. Among the currently available classes of drugs for the treatment of IBS, antidepressants such as selective serotonin releasing inhibitors and tricyclic antidepressants are useful because of their analgesic properties, independent of their mood-improving effects.

Conclusions

Evidence suggest that antidepressants might be useful for treatment symptom of IBS however further investigation is required.

Disclosure

No significant relationships.

The role of Mediterranean Diet in mental health in pandemic times

Introduction

In late 2019, an epidemic outbreak emerges in China caused by a new coronavirus with high transmission and human infection potential which in March 2020, was characterized by WHO as a pandemic. The lockdown has repercussions on the population’s well-being, reflected in their food choices. There is a tendency to increase the consumption of energy dense food, rich in fat and carbohydrates, which are related to an increased risk of depression.

Objectives

The main goal of this non-systematic literature review was to understand the impact of the Mediterranean Diet on Mental Health promotion in SARSCoV-2 pandemic.

Methods

Literature from Pubmed database were searched, with the following keywords: COVID-19, Depression, Anxiety, Mental Health and Mediterranean Diet.

Results

Studies indicate that a diet based on the Mediterranean Diet is associated with a decreased risk of developing depressive symptoms, especially when there is moderate to high adherence to this dietary pattern. High consumption of plant and fish foods, reduced consumption of sugary products, processed and red meats and the use of olive oil as a fat source, are principles of the Mediterranean diet, associated with an improvement in endothelial function, increased levels of eicosanoids and serotonin synthesis and regulation of serotonin which seem to explain this protective effect.

Conclusions

In addition to decreasing the risk of obesity, diabetes, and hypertension, comorbidities associated with the most serious disease of COVID-19, the Mediterranean Diet seems to play an important role in promoting mental health, with a decreased risk of developing depressive symptoms.

Disclosure

No significant relationships.

Mechanisms linking gut microbiota to depression

Introduction

The gut microbiota constitute the largest and most diverse community in the body which is primarily responsible for the maintenance of the intestinal wall integrity and the protection against pathogens. Besides having an important role in the regulation of host energy metabolism, the gut microbiota can also influence neurodevelopment, modulate behavioral and might contribute to the development of psychiatry disorders.

Objectives

The authors elaborated a narrative literature review to understand how gut microbiota can influence depression.

Methods

Using PubMed as the database, a research was conducted about how Gut Microbiota relates with Depression.

Results

The microbiota-gut-brain axis encompasses the strong bidirectional communication between the gut microbiota and the CNS. Multiple mechanisms may be involved in this bilateral communication, including immune, endocrine and neural pathways. Permutations in the gut microbiome composition trigger microbial lipopolysaccharides production that activates inflammatory responses. Cytokines send signals to the vagus nerve, which links the process to the hypothalamic-pituitary-adrenal axis that consequently causes behavioral effects. Beyond this, gut microbiota have the capacity to produce many neurotransmitters and neuromodulators such as serotonin and can induce the secretion of the brain-derived neurotrophic factor, an important plasticity-related protein that promotes neuronal growth, development and survival.

Conclusions

Neuroinflammatory processes like those that occur in depression are deeply modulated by peripheral inflammatory stimuli, especially those from the intestinal microbiota. However, the knowledge is currently limited and the information available is not enough to understand the exact mechanisms. Therefore, more studies are required to show how gut microbiota influences the human brain.

Disclosure

No significant relationships.

The role of intranasal esketamine in treatment-resistant depression

Introduction

Major depressive disorder (MDD) is a highly prevalent clinical condition with a leading cause of disability worldwide. Unfortunately, about 1/3 of patients with MDD fail to achieve remission despite treatment with multiple antidepressants and are considered to have treatment-resistant depression (TRD). Research showed abnormalities in glutamatergic transmission in neural circuits and antidepressant efficacy with the N-methyl-D-aspartate (NMDA) receptor antagonist, ketamine.

Objectives

The authors elaborate a narrative literature review on the intranasal esketamine as a new-class antidepressant.

Methods

PubMed database searched using the terms “treatment-resistant depression” and “esketamine”.

Results

Ketamine, synthetized from PCP, acts as an antagonist of NMDA receptor, reducing Central Nervous System excitability. One limitation of ketamine for treating depression is that requires intravenous administration, reducing its applicability in outpatient settings. Esketamine, the S-enantiomer of ketamine, developed as an intranasal formulation has a higher affinity for the NMDA receptor. The evidence of the rapid antidepressant effect of intranasal esketamine was first made by Lapidus et al, that demonstrated intranasal esketamine ability to reduce depressive symptomatology. However, some recent studies reported significant acute cardiovascular, psychotomimetic and neurological side-effects. Thus, drug formulation, delivery device, insufflation technique, and individual factors seem to contribute importantly to the tolerability and efficacy of the intranasal administration rote.

Conclusions

There is the need to develop novel treatments providing effective, more rapid-acting, and sustained relief of depressive symptoms, especially in patients with TRD. Intranasal esketamine has shown antidepressant effects in patients with TRD but further investigation is required to strongly reinforce this potential and safety.

Effects of psilocybin-assisted therapy on treatment-resistant depression

Introduction

Major depressive disorder is a highly prevalent clinical condition, affecting more than 300 million individuals worldwide. About 1/3 of patients with MDD fail to achieve remission despite treatment with multiple antidepressants and are considered to have treatment-resistant depression (TRD). Novel antidepressants with rapid and sustained effects on mood and cognition could represent a breakthrough in the TRD and may potentially improve or save lives. Psilocybin, a classic hallucinogen, more commonly found in the Psilocybe mushrooms has a combined serotonergic and glutamatergic action. The preliminary evidence of antidepressant effects of psilocybin-assisted therapy indicates the potential of psilocybin-assisted therapy as a novel antidepressant intervention.

Objectives

The authors elaborate a narrative literature review about the effects of Psilocybin-based therapy on patients diagnosed with treatment-resistant depression.

Methods

PubMed database searched using the terms “Treatment-Resistant Depression AND Psilocybin” and targeting clinical trials. References of selected articles and review articles were also assessed.

Results

2 articles evaluate psilocybin effects in 32 patients with TRD and showed that two doses of psilocybin alongside psychological support significantly reduces depressive symptoms. All patients presented some reduction in symptoms from baseline to one week after the second dose and reproduced immediate and substantial improvements in depression that ultimately could sustain up to 6 months.

Conclusions

Psilocybin-assisted therapy is a very appealing new possibility in the treatment of depression. However, due to the small populations of the existing trials, future studies are needed to prove this positive association and to fully understand Psilocybin’s mechanisms of actions and effects.

Disclosure

No significant relationships.

Thermal Infrared Sensing for Near Real-Time Data-Driven Fire Detection and Monitoring Systems

With the increasing interest in leveraging mobile robotics for fire detection and monitoring arises the need to design recognition technology systems for these extreme environments. This work focuses on evaluating the sensing capabilities and image processing pipeline of thermal imaging sensors for fire detection applications, paving the way for the development of autonomous systems for early warning and monitoring of fire events. The contributions of this work are threefold. First, we overview image processing algorithms used in thermal imaging regarding data compression and image enhancement. Second, we present a method for data-driven thermal imaging analysis designed for fire situation awareness in robotic perception. A study is undertaken to test the behavior of the thermal cameras in controlled fire scenarios, followed by an in-depth analysis of the experimental data, which reveals the inner workings of these sensors. Third, we discuss key takeaways for the integration of thermal cameras in robotic perception pipelines for autonomous unmanned aerial vehicle (UAV)-based fire surveillance.

Post partum sexuality

In the post partum period many changes happen to the woman, including in the sexual life. Short-term post partum sexual problems are highly prevalent. Even though all kinds of dysfunction can arise, the most frequent are hypoactive sexual desire, vaginal dryness, orgasmic dysfunction and dyspareunia.

The aim of this poster is to overview six main etiological factors of the post partum sexual dysfunction: hormonal changes and breastfeeding, perineal trauma, fatigue, changes in social role, partner interaction and mood. The knowledge of these etiological factors and identification of the risk factors are important weapons in the prevention and approach to post partum sexuality by the couple and health professionals.

Augmentation mammoplasty and sexuality

The interest in breasts in our society can hardly escape the attention of even a casual observer. It has been found that women with larger breasts than the average were considered to be more physically attractive and have greater social outcomes.

Some women consider themselves less beautiful or feminine because of the lack of “ideal” size and shape. This feeling of inadequacy may lead to lowered levels of self-esteem and sexuality.

Although not extensively researched, psychologic factors have attributed to the dramatic increase in the number of performed breast augmentation procedures. As this number continues to rise it is important that healthcare providers comprehend the degree to sexuality may affect their patients’ outcomes.

This review is designed to provide an overview of the psychological and sexuality literature on cosmetic breast augmentation. It seems to exist a positive effect of breast augmentation surgery on woman's sexuality, as well in other psychological aspects. This relation need to be explored further in future studies.

Analysis of treatment results in the electroconvulsive therapy unit of centro hospitalar psiquiatrico de lisboa (CHPL)

Introduction

Electroconvulsive therapy is widely used for treatment-resistant psychiatric patients, with remission rates close to 50% and response rates between 60–70%. Post ictal suppression index (PISI) has been positively correlated with clinical outcome.

Objectives

Characterize the treatment results of the electroconvulsive therapy unit of CHPL; find a correlation between improvement on HAM-D, PANSS and PSAS and PISI.

Methods

The patient data was collected and divided according to ICD-10 diagnosis. Evaluation scales were applied at the beginning and end of treatment: depressed patients (F31.3–5; F33; F20.4; F25.1) - HAM-D; schizophrenic/ schizoaffective/ bipolar-manic or mixed patients (F20.X, F25.X, F31.0, F31.6) - PANSS; with any of these diagnosis - PSAS. A correlation between the points of improvement on each scale and PISI was investigated using the Pearson product-moment correlation coefficient.

Results

Of 101 depressed patients, 33,7% showed remission and 49,5% showed response, over 11 sessions (average). The reduction on HAM-D score was significantly greater for patients with initial HAM-D score > 18 versus HAM-D ≤ 18 (52,9% versus 37,75%). Patients with unipolar depression (N = 72) and bipolar depression (N = 22) showed comparable results (response:47,2% versus 52,4%; remission: 30,6% versus 40,1%). Schizophrenic patients (N = 43) had higher response rates: 88%. No correlation was found between PISI and HAM-D, PANSS or PSAS improvement (r = -0,1;-0,01;-0,07).

Conclusion

Response and remission rates in depressed patients were inferior to other ECT studies, except in patients with higher severity. Those rates were comparable for schizophrenic patients. PISI did not correlate with clinical outcome.

“Sexsomnia” - sleep sexual behaviour

Sexsomnia is a disorder that is characterized by abnormal sexual behaviours during sleep and can vary from explicit sexual vocalizations to violent masturbation and complex sexual acts including oral, vaginal or anal penetration. This disorder has clinical, psychosocial and medico-legal consequences, both to the patient and the people that surround him. Despite the scarce literature and infrequent reports, there are some descriptions of violent behaviours, sexual assault and sexual involvement of minors. Whenever we suspect that a patient suffers from sexsomnia, we must write a rigorous and complete clinical history, make a neurologic and phychiatric evaluation and nocturnal videopolysomnography. As soon as the diagnosis is established, we must plan treatment approaches. More attention should be payed to the psychosocial and medico-legal issues, and new research is needed to provide for better understanding of etiology and to improve the clinical evaluation and management.

Takotsubo syndrome: A theoretical review over a clinical case

The clinical case serves as an introductory note to the description of the Takotsubo Syndrome.

The Takotsubo Syndrome has gained recent notoriety. It is estimated that this diagnosis is made in 2% of acute coronary syndromes. In up to 75% of the cases, a psychological stressor can be found, usually traumatic, and 25–40% of the patients meet the diagnostic criteria for depressive or anxious pathologies. It presents as an acute coronary syndrome, with pre-cordial pain and dyspnea, and in 90% of the cases there is elevated Troponin I, in average 0.49 ng/mL. There is mild ST-wave elevation and T-wave invertion, mostly on V2 and V3. The ventriculography presents the typical image, with apical ballooning and hypokinesia, that reverse in 20 days, average.

The ratio of ß1 and ß2 receptors in the human heart is 4:1, and norepineprhin acts mostly in the former. It is released by the sympathetic terminals in the heart, which are 40% more dense in the basal region. Thus, the catecholaminergic action at the apex is mostly performed by circulating epinephrine, via ß2 receptors. The phenomena that occurs at supra-physiologic levels of epinephrine is called “stimulus trafficking” and results in a net change of intracellular signaling from Gs protein to Gi protein. The effect exists to protect against apoptosis in such conditions, but results in negative inotropism, most evident at the apex, where ß2 receptors are most prevalent.

At last, this poster points some pathophysiologic factors in common between anxious pathologies and Takotsubo syndrome.

Children of homosexual parents

Like families headed by heterosexual parents, lesbian and gay parents and their children are a diverse group. Unlike heterosexual parents, however, lesbian and gay parents are often subject of discrimination because of their sexual orientation while facing adoption, custody or assisted reproductive technologies, based on stereotypes concerning children psychological development and wellbeing.

This work reviews empirical evidence regarding children with gay and lesbian parents. The results of existing research comparing children of homosexual parents with children of heterosexual parents are quite clear: common stereotypes are not supported by the data.

cAMP acts as a second messenger in pollen tube growth and reorientation

Pollen tube growth and reorientation is a prerequisite for fertilization and seed formation. Here we report imaging of cAMP distribution in living pollen tubes microinjected with the protein kinase A-derived fluorosensor. Growing tubes revealed a uniform distribution of cAMP with a resting concentration of approximately 100-150 nM. Modulators of adenylyl cyclase (AC), forskolin, and dideoxyadenosine could alter these values. Transient elevations in the apical region could be correlated with changes in the tube-growth axis, suggesting a role for cAMP in polarized growth. Changes in cAMP arise through the activity of a putative AC identified in pollen. This signaling protein shows homology to functional motifs in fungal AC. Expression of the cDNA in Escherichia coli resulted in cAMP increase and complemented a catabolic defect in the fermentation of carbohydrates caused by the absence of cAMP in a cyaA mutant. Antisense assays performed with oligodeoxynucleotide probes directed against conserved motifs perturbed tip growth, suggesting that modulation of cAMP concentration is vital for tip growth.

Relocation of a Ca2+-dependent protein kinase activity during pollen tube reorientation

Pollen tube reorientation is a dynamic cellular event that is crucial for successful fertilization. We have shown previously that pollen tube orientation is regulated by cytosolic free calcium ([Ca2+]c). In this paper, we studied the activity of a Ca2+-dependent protein kinase during reorientation. The kinase activity was assayed in living cells by using confocal ratio imaging of BODIPY FL bisindolylmaleimide. We found that growing pollen tubes exhibited higher protein kinase activity in the apical region, whereas nongrowing cells showed uniform distribution. Modification of growth direction by diffusion of inhibitors/activators from a micropipette showed the spatial redistribution of kinase activity to predict the new growth orientation. Localized increases in [Ca2+]c induced by photolysis of caged Ca2+ that led to reorientation also increased kinase activity. Molecular and immunological assays suggest that this kinase may show some functional homology with protein kinase C. We suggest that the tip-localized gradient of kinase activity promotes Ca2+-mediated exocytosis and may act to regulate Ca2+ channel activity.