Comorbidity, multimorbidity and personalized psychosomatic medicine: epigenetics rolling on the horizon

This review focuses first on conceptual chaos and different connotations in psychosomatic medicine, then on new perspectives on comorbidity and multimorbidity, especially from epigenetics perspective. Comorbidity is one of the greatest research and clinical challenges to contemporary psychiatry and psychosomatic medicine. Recently altered gene expression due to epigenetic regulation has been implicated in the development of multifarious mental disorders and somatic diseases. The potential relevance of epigenetics for better understanding and more successful treatment of comorbidity and multimorbidity is described.

Metabolic syndrome and schizophrenia from integrative medicine perspective

BACKGROUND

There has been a growing interest in the effect that comorbid schizophrenia and metabolic syndrome may have on each other.

OBJECTIVE

To examine metabolic syndrome from integrative medicine point of view including prevalence of metabolic syndrome in patients with schiziphrenia compared to their first-degree relatives, healthy volunteers without schizophrenia in close family, and patients with PTSD, as well as the percentage patients with schizophrenia without any component of metabolic syndrome.

METHOD

Metabolic syndrome according to NCEP/ATP III criteria and number of its components were analysed in 205 patients with schizophrenia, 140 healthy volunteers and 105 patients with combat PTSD.

RESULTS

Metabolic syndrome was identified in 45.9% of the patients with schizophrenia, 38.1% of the war veterans with PTSD, 36.7% of the first-degree relatives of patients with schizophrenia and 16.2% of the healthy volunteers without schizophrenia in close family. Only 21.5% of the patients with schizophrenia were without any metabolic syndrome component.

CONCLUSION

The comorbidity of schizophrenia and metabolic syndrome is very important for theory and practice of integrative medicine. Almost 80% of the patients with schizophrenia have increased risk or developed cardiovascular disorders,.

Metabolic syndrome and depression in war veterans with post-traumatic stress disorder

BACKGROUND

Post-traumatic stress disorder (PTSD), depression and metabolic syndromes are growing public health problems in post-war countries. Understanding the co-morbidity among PTSD, depression and metabolic syndrome has an important clinical and theoretical issue.

OBJECTIVE

To examine the relationship between combat-related PTSD, co-morbid depression and metabolic syndrome as well as between severity of depression and metabolic syndrome.

METHOD

Metabolic syndrome and co-morbid depression were investigated in 100 male war veterans with combat PTSD and in 79 males who needed medical attention in dispensary of family medicine.

RESULTS

Metabolic syndrome according NCEP: ATP III was found in 25 % of war veterans with PTSD. Metabolic syndrome was identified more frequently in PTSD patients with co-morbid depression (47.8 %) compared to those without depression (9.1%). PTSD with moderate and severe co-morbid depression was associated with higher rates of metabolic syndrome (78.6% and 90.9% respectively) in comparison with mild depression (26.2%).

CONCLUSIONS

PTSD is frequently comorbid with depression, and when the two disorders co-occur, the risk for metabolic syndrome is increased. Treatment of war veterans with PTSD should address co-morbid depression and metabolic syndrome as well as the clinical features of PTSD.

Mental disorders and metabolic syndrome: a fatamorgana or warning reality?

BACKGROUND

There has been a growing interest in the effect that comorbid mental and somatic disorders may have on each other. Metabolic syndrome is an important risk factor for the development of diabetes mellitus, cardiovascular disease and premature mortality.

OBJECTIVES

To examine the association between various mental disorders (schizophrenia, schizoaffective disorder, bipolar disorder, depression, post-traumatic stress disorder and other mental disorders) and metabolic syndrome and discuss the possible pathophysiologic mechanisms that may link specific mental disorders and metabolic syndrome.

METHOD

A MEDLINE search, citing articles from 1966 onward, supplemented by a review of bibliographies, was conducted to identify relevant studies. Criteria used to identify studies included (1) English language, (2) published studies with original data in peer-reviewed journals.

RESULTS

Clinical investigation of the metabolic syndrome in patients with mental disorders, except schizophrenia, has been surprisingly scarce. Metabolic syndrome was reported in 19-63% of schizophrenic patients, in 42.4% of patients with schizo-affective disorder, in 24.6-50% of bipolar patients, in 12-36% of the patients with recurrent depression and in 31.9-35% of patients with combat posttraumatic stress disorder.

CONCLUSION

Metabolic syndrome can contribute to significant morbidity and premature mortality and should be accounted for in the treatment of mental disorders. No definite or reliable insight into the pathophysiological link between metabolic syndrome and mental disorders is available.

Modulatory effects of octreotide on anti-CD3 and dexamethasone-induced apoptosis of murine thymocytes

In an attempt to elucidate the effects of somatostatin on two crucial processes that regulated T-cell differentiation and selection in thymus in this study, we investigated in vivo and in vitro the effects of octreotide (SMS 201-995) on dynamics of apoptosis, induced by dexamethasone (DEX) or by anti-CD3 monoclonal antibodies (mAb). The data were estimated by analysis of absolute cellularity, DNA fragmentation and maturational stage of thymocytes, detecting the CD4 and/or CD8 and T cell receptor (TCR) expression on thymocytes. The results, obtained by estimation of subdiploid peak of DNA and ladder DNA formation, have shown that SMS given in vivo, may potentiate the early phase of DEX-induced nuclear fragmentation (at 24 h), accelerating simultaneously the elimination of thymic cells with double positive (DP) CD4high CD8high phenotype (expressed both as percentage and absolute number). On the contrary, SMS, given both in vivo and in vitro, down-regulated the late process (at 72 h) of nuclear fragmentation, induced by anti-CD3 mAb, minimizing simultaneously the elimination of DP cells (expressed both as percentage and absolute number). In anti-CD3-treated cultures of thymocytes, SMS retarded also the elimination of immature thymocytes, expressing the TRC alpha/betalow or intermediate phenotype. The data emphasize that octreotide might have important regulatory effect on processes of thymic differentiation and maturation, which are crucial for T cell selection, induction of tolerance and prevention of autoimmune diseases.

Platelet 5-HT and plasma cortisol concentrations after dexamethasone suppression test in patients with different time course of schizophrenia

Platelet 5-HT and plasma cortisol concentrations were determined in 59 schizophrenic patients with different time course of illness before and after dexamethasone suppression test (DST). An abnormal DST (nonsuppression) was observed in 51% of patients. In these patients basal cortisol and platelet 5-HT concentrations were higher than in patients with normal DST. After DST, plasma cortisol levels were higher in nonsuppressors with intermittent and intermittent-chronic time course, whereas platelet 5-HT concentrations were increased in nonsuppressors with intermittent-chronic time course. The results suggest that schizophrenic patients have dysregulated hypothalamic-pituitary-adrenal axis as shown by a high rate of DST nonsuppression, and that nonsuppressors showed hypercortisolemia and hyperserotonemia independent of the time course of schizophrenia. No significant association between DST and time course of the illness was found.