The incidence of depression and anxiety disorders in spontaneous chronic urticaria patients

Objective: A frequent condition known as chronic urticaria (CU) is characterized by the appearance of wheals, angioedema, or both. CU lowers the quality of life and may also result in psychological discomfort. The literature survey revealed few studies dealing with depression and anxiety in these patients. Hence, Hamilton scores for depression and anxiety were used in this study to evaluate the incidence of depression and anxiety in chronic urticaria patients. Methodology: To evaluate CU patients' levels of depression and anxiety, the Hamilton Rating Scale for Depression (HDRS) and the Hamilton Anxiety Rating Scale (HAMA) were applied. Moreover, in a control group of thirty healthy volunteers, thirty CU patients were included in this study. It was essential to observe the patients' urticaria activity score, medications, age, gender, comorbidities, employment status, and income. When it came to levels of depression and anxiety, a comparison was made between the case group and the healthy group. Results: In the CU patients' group, the mean age was 26.9 years. The questionnaires showed that 14 (46%) subjects in the patient group had moderate to severe signs of anxiety, and 21 (70%) had moderate to severe symptoms of depression. Besides, in the control group,7 (23.3%) had moderate to severe signs of anxiety, and 8 (26.7%) had severe depression. Conclusion: According to the study, individuals with CU exhibit depression and anxiety symptoms more frequently than the control group. Therefore, the possibility of mental comorbidities should be considered when treating individuals with CU.

Outcome of angiotensin receptor-neprilysin inhibitor on anxiety and depression in heart failure with reduced ejection fraction vs. heart failure with preserved ejection fraction

Objective: In patients with heart failure (HF), anxiety and depression are commonly observed and confer an adverse outcome. The first-in-class member of angiotensin receptor-neprilysin inhibitor (ARNI), sacubitril/valsartan has been demonstrated to improve functional class and decrease mortality in patients with heart failure with reduced ejection fraction (HFrEF) and reduce the readmission of heart failure with preserved ejection fraction (HFpEF). However, its effects on anxiety and depression levels remain unknown.Methods: Sacubitril/valsartan was started on 764 symptomatic patients with HFrEF and HFpEF who were receiving guideline-directed medical therapy (GDMT) with an angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB). Patients were evaluated using Hamilton's depression rating scale (HDRS) and the hospital anxiety and depression scale (HADS) for their levels of depression and anxiety before and after treatment at a six-month follow-up.Results: A significant reduction in HADS and HDRS scores was observed in patients with HFrEF (9.7 ± 1.3 to 6.4 ± 0.7, p = 0.032 and 19.2 ± 2.2 to 8.9 ± 1.6, p < 0.001, respectively) compared with HFpEF (p = 0.161 and 0.273, respectively). The six-minute walk test (6-MWT) significantly increased HFrEF from 195 ± 68 to 321 ± 97 (p < 0.001). There was an overall improvement in the functional class of all patients.Conclusion: Patients with HFrEF have the additional advantage of using sacubitril/valsartan in the form of decreased anxiety and depression symptoms in addition to an improvement in functional class. However, patients with HFpEF did not exhibit significant improvement in their psychological scores.

Evaluation of major depression symptom networks using clinician-rated and patient-rated data

BACKGROUND

Major depressive disorder (MDD) is heterogeneous, but official diagnostic classifications and widely used rating scales are based on the premise that MDD is a single disorder and that symptoms are equally important to assess severity. Also, patients and clinicians frequently diverge in how they evaluate MDD severity. In order to better understand the differences between MDD scales used by clinicians and patients in the context of MDD heterogeneity, we performed a network analysis from an approach that focuses on the interaction of symptoms rather than total score.

METHODS

The Hamilton Depression Rating Scale (HDRS) and the Beck Depression Inventory with 21 items (BDI) scored by the clinician or patient, respectively, were used to estimate the networks based on 794 MDD patients. The networks were estimated using software R 4.0.2 and Graphical Lasso, identifying communities of symptoms by the clique percolation method, and the mixed graphical models were used to evaluate the explained variance of each symptom.

RESULTS

The networks presented different communities of symptoms and connection structure (M = 0.177, p = 0.0028). The guilt connection strength and its association with suicidal ideation was greater in the BDI network.

LIMITATIONS

Transversal data from severe, chronic, or treatment resistant depression patients.

CONCLUSIONS

The present study suggests that the self-rated scale may perform better when assessing association between guilt and other symptoms, especially suicidal ideation. Communities of symptoms and edges between symptoms suggest that insomnia may be an independent symptom, thus requiring specific interventions. Some similar items are strongly connected and could be collapsed.

Preliminary prediction of individual response to electroconvulsive therapy using whole-brain functional magnetic resonance imaging data

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The negative FC networks achieve predictive accuracy of 76.23% for ECT response.

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The consensus FCs represent predominately frontal, temporal and subcortical regions.

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FCs that changed significantly were concentrated in frontal and limbic networks.

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Longitudinal change overlapped with two FCs compared with FC with predictive power.

Electroconvulsive therapy (ECT) works rapidly and has been widely used to treat depressive disorders (DEP). However, identifying biomarkers predictive of response to ECT remains a priority to individually tailor treatment and understand treatment mechanisms. This study used a connectome-based predictive modeling (CPM) approach in 122 patients with DEP to determine if pre-ECT whole-brain functional connectivity (FC) predicts depressive rating changes and remission status after ECT (47 of 122 total subjects or 38.5% of sample), and whether pre-ECT and longitudinal changes (pre/post-ECT) in regional brain network biomarkers are associated with treatment-related changes in depression ratings. Results show the networks with the best predictive performance of ECT response were negative (anti-correlated) FC networks, which predict the post-ECT depression severity (continuous measure) with a 76.23% accuracy for remission prediction. FC networks with the greatest predictive power were concentrated in the prefrontal and temporal cortices and subcortical nuclei, and include the inferior frontal (IFG), superior frontal (SFG), superior temporal (STG), inferior temporal gyri (ITG), basal ganglia (BG), and thalamus (Tha). Several of these brain regions were also identified as nodes in the FC networks that show significant change pre-/post-ECT, but these networks were not related to treatment response. This study design has limitations regarding the longitudinal design and the absence of a control group that limit the causal inference regarding mechanism of post-treatment status. Though predictive biomarkers remained below the threshold of those recommended for potential translation, the analysis methods and results demonstrate the promise and generalizability of biomarkers for advancing personalized treatment strategies.

Social cognition and interaction training (SCIT) for partially remitted patients with bipolar disorder in China

Bipolar disorder (BD) is associated with functional impairment. Social Cognition and Interaction Training (SCIT) has been shown to be feasible and effective at improving social functioning in patients with schizophrenia. We aimed to explore the association between SCIT and improvements in the clinical symptoms and functioning of partially remitted patients with BD in China. Seventy-four BD patients were randomly assigned to the SCIT and psychoeducation (Control) groups. All subjects participated in group interventions weekly for 8 weeks. Furthermore, the participants were administered the Young Mania Rating Scale (YMRS), the 17-item Hamilton Depression Rating Scale (HDRS-17), the Function Assessment Short Test (FAST) and neurocognitive measures at baseline and after eight weeks. There were no differences in demographics, the HDRS-17, YRMS, and FAST scores or neurocognitive measures between the groups at baseline (p>0.05). The repeated-measures analysis revealed that SCIT resulted in greater improvement in the HDRS, YMRS, and FAST scores (including six domains) (p<0.01) and two neurocognitive measures (p<0.05) compared to psychoeducation. Our findings suggest that SCIT is a feasible and promising intervention for the clinical symptoms and functioning of partially remitted patients with BD. Further longitudinal studies are needed to observe the long-term impact of SCIT on emotional and functional improvement in these patients.

Oligopeptidases activity in bipolar disorder: Ndel1 and angiotensin I converting enzyme

BACKGROUND

Abnormal activity of two enzymes relevant to neurodevelopment, namely nuclear-distribution element-like 1 (Ndel1) and angiotensin I-converting enzyme (ACE), was reported in individuals with schizophrenia; to our knowledge, these oligopeptidases were never measured in bipolar disorder (BD).

AIMS

Evaluate the enzyme activity of Ndel1 and ACE in euthymic individuals with BD type 1 which was compare to healthy control (HC) group.

METHODS

Ndel1 and ACE activities were assessed in the serum of individuals with BD type 1 according to DSM-IV criteria (n = 70) and a HC group (n = 34). The possible differences between BD type 1 and HC groups were evaluated using Analysis of Covariance (ANCOVA), and the results were adjusted for age, gender and body mass index.

RESULTS

We observed a positive correlation between Ndel1 activity and the total YMRS score in BD group (p = 0.030) and a positive correlation between ACE activity and Ham-D score (p = 0.047). ANCOVA analysis showed lower Ndel1 activity in BDs compared to HCs. Interestingly, we did not observe between-groups differences in ACE activity, despite the recognized correlation of ACE activity levels with cognitive functions, also described to be worsened in psychiatric patients.

CONCLUSION

Oligopeptidases, especially Ndel1, which has been strongly correlated with neurodevelopment and brain formation, are potentially a good new target in the study of the neurobiology of BD.

LIMITATIONS

The relatively small sample size did not permit to examine the cause-effect relationship of clinical dimensions of BD and the enzymatic activity.

BanI polymorphism of cytosolic phospholipase A2 gene and somatic symptoms in medication-free acute depressed patients

Somatic symptoms are commonly seen in patients with major depressive disorder (MDD) and might be associated with inflammatory activation. Cytosolic phospholipase A2 (cPLA2) and cyclo-oxygenase-2 (COX-2) are the key enzymes in the metabolism of polyunsaturated fatty acids (PUFAs), which in turn may play an important role in inflammation and somatic symptoms in depression. This study investigated the effects of BanI polymorphism of cPLA2 gene and COX-2 rs4648308 genotypes on somatic symptoms and inflammatory marker in patients with MDD. Eighty-two patients with MDD were assessed for their psychopathology including psychiatric and somatic symptoms, BanI polymorphism of cPLA2 and COX-2 rs4648308 genotypes and CRP levels. The results revealed that MDD patients with the cPLA2 BanI GG genotypes had higher somatic symptoms and higher levels of C-reactive protein (CRP), while no differences were found among the COX-2 rs4648308 genotypes. Inflammatory process, such as arachidonic acid cascade pathway, might help explain the effect of cPLA2 BanI polymorphism on the somatic symptoms, and may be a potential target for future investigation on treatment for MDD with somatic symptoms. However, the interpretation of the findings in this study is limited since we analyzed the data from a subset data from a larger study.

Does oral administration of ketamine accelerate response to treatment in major depressive disorder? Results of a double-blind controlled trial

BACKGROUND

Major depressive disorder (MDD) exerts a high health and financial burden on society. The conventional pharmacotherapies for MDD are partially effective and the response to medication often starts with some delay. There are recent reports of antidepressant effects for oral ketamine.

METHODS

We employed a double-blind controlled trial to examine the time course of the therapeutic effect of ketamine when combined with the conventional administration of sertraline. A total of 81 patients participated in the study and were scored with the Hamilton Depression Rating Scale (HDRS) at baseline and at 2, 4 and 6 weeks after the start of the trial RESULTS: General linear model repeated measures demonstrated significant effect for time × treatment interaction on the HDRS scores, with significant difference at all time points post treatment. Early improvement was significantly greater in the ketamine group (85.4%) compared to the placebo group (42.5%). We did not observe any side effects for ketamine administration.

LIMITATIONS

Our follow up was limited to 6 weeks post initiation of treatment and cannot reveal the potential long-term adverse effects of oral ketamine and the sustainability of its benefit.

CONCLUSION

Altogether, our results suggest that oral ketamine may be considered as suitable adjuvant to sertraline in relieving depressive symptoms.

Scales for assessment of depression in schizophrenia: Factor analysis of calgary depression rating scale and hamilton depression rating scale

This study aimed to evaluate the factor structure of Calgary depression rating scale (CDSS) and Hamilton Depression Rating Scale (HDRS) among patients with schizophrenia in acute and remission phase of illness by using exploratory factor analysis. For this, 267 patients with schizophrenia were assessed on CDSS and HDRS. Exploratory factor analysis of CDSS yielded 2 factor models for the whole sample, patients in clinical remission and patients not in clinical remission phase of schizophrenia. Factor analysis of HDRS yielded 3 factor models; however, there was significant difference in the factor structure between those in clinical remission and those not in clinical remission phase of schizophrenia. CDSS total score did not correlate with PANSS positive and negative subscale scores. In contrast, HDRS total score correlated positively with PANSS positive subscale score, PANSS negative subscale score and PANSS general psychopathology subscale score. To conclude, present study suggests while CDSS items separate out into 2 factors, which are stable across different stages of illness, whereas HDRS factor structure appears to be less stable across different stages of illness. Correlation analysis suggests that rating on HDRS may be affected by positive and negative symptoms of schizophrenia, whereas CDSS do not correlate with positive and negative symptoms of schizophrenia.

Depression In Type-2 Diabetic Patients Presenting To A Tertiary Care Hospital In Pakistan

BACKGROUND

Diabetes affects almost every system including mental health. When depression and diabetes coexist, the outcome is even worse. This study was conducted to find the prevalence of comorbid depression in diabetic patients and its association with diabetic control.

METHODS

This was a descriptive cross sectional observational study conducted in the department of general medicine of Pakistan Institute of Medical Sciences, Islamabad from March to September 2014. A total of 223 adult diabetic patients 30-60 years of age were enrolled. Becks Depression score (BDI) and HDRS (Hamilton Depression Rating Score) of each patient was calculated. Patients were stratified into various categories based on their demographics, depressions scores and diabetic control (by means of HbA1C). Percentages, frequencies and means were calculated accordingly using SPSS-16.

RESULTS

Out of a total of 223 patients, 55.6% were females while the rest (44.4%) were males. The mean age of the patients was 51 years. Majority of the patients were uneducated (35.9%). Eighty-seven% were married, Mean BMI, duration of diabetes and HbA1C were 27 Kg/m2, 8.3 years±6.1 years and 8.15±2.13% respectively. Mean BDI and HDRS were 9.97±9.42 and 6.27±6.74 respectively. 25.6% and 21.1% of the patients had at least some degree of depression when assessed by BDI and HDRS score respectively..

CONCLUSIONS

Depression is common in diabetic patients especially females, uneducated, have social issues like widows, those having long standing diabetes and those who have uncontrolled blood sugars.

Plasma peptidases as prognostic biomarkers in patients with first-episode psychosis

The plasma activity of nine aminopeptidases was monitored over a year in first-episode psychotic patients. We observed significant differences in aminopeptidase B (APB), aminopeptidase N (APN) and dipeptidyl peptidase IV (DPPIV), but not in puromycin-sensitive aminopeptidase (PSA), prolyl endopeptidase (PEP), cysteine aminopeptidase (Cys-AP), aspartate aminopeptidase (Asp-AP), glutamate aminopeptidase (Glu) or piroglutamate aminopeptidase (PGI) in these patients compared to controls, and also a progressive increase in plasma activity, correlated to changes in scores on clinical scales, Global Assessment of Functioning scale (GAF) and Hamilton Depression Rating Scale (HDRS), at 1 month of follow-up. At 1 month after diagnosis, the median score obtained by patients on the GAF was negatively associated with the plasma activity of APB and PEP measured at the beginning of the psychotic episode, indicating a role as a negative prognostic factor that can predict psychiatric symptomatology. In the case of HDRS, scores at 1 month after diagnosis were found to be positively associated with the initial plasma activity of DPPIV, APN and PSA, indicating that their initial elevation is a negative prognostic factor that can predict subsequent depressive symptomatology. Taken together, these results suggest a pathophysiological involvement of plasma peptidases and indicate that aminopeptidase activity can predict the course of first-episode psychosis patients, acting as a prognostic indicator.

Rating depression over brief time intervals with the Hamilton Depression Rating Scale: standard vs. abbreviated scales

Although antidepressant trials typically use weekly ratings to examine changes in symptoms over six to 12 weeks, antidepressant treatments may improve symptoms more quickly. Thus, rating scales must be adapted to capture changes over shorter intervals. We examined the use of the 17-item Hamilton Depression Rating Scale (HDRS) to evaluate more rapid changes. Data were examined from 58 patients with major depressive disorder or bipolar disorder enrolled in double-blind, placebo-controlled, crossover studies who received a single infusion of ketamine (0.5 mg/kg) or placebo over 40 min then crossed over to the other condition. HDRS subscales, a single HDRS Depressed mood item, and a visual analogue scale were used at baseline, after a brief interval (230 min), and one week post-infusion. Effect sizes for the ketamine-placebo difference were moderate (d > 0.50), but one and two-item HDRS subscales had the smallest effects. Response rates on active drug were lowest for the complete HDRS (43%); the remaining scales had higher response rates to active drug, but the shortest subscales had higher response rates to placebo. Correlations between the changes from baseline to 230 min post-ketamine across scores were similar for most subscales (r = 0.82-0.97), but correlations using the single items were lower (r < 0.74). Overall, effect sizes for drug-placebo differences and correlations between changes were lower for one- and two-item measures. Response rates were lower with the full HDRS scale. The data suggest that, to best identify rapid antidepressant effects, a scale should have more than two items, but fewer items than a full scale.

Therapeutic effects of add-on low-dose dextromethorphan plus valproic acid in bipolar disorder

Changes in inflammatory cytokines and dysfunction of the neurotrophic system are thought to be involved in the pathology of bipolar disorder (BP). We investigated whether inflammatory and neurotrophic factors were changed in BP. We also investigated whether treating BP with valproic acid (VPA) plus low-dose (30 or 60 mg/day) dextromethorphan (DM) is more effective than treating it with VPA only, and whether DM affects plasma cytokines and brain derived neurotrophic factor (BDNF) levels. In a 12-week, randomized, double-blind study, patients were randomly assigned to the VPA+DM30, VPA+DM60, or VPA+Placebo groups. The Young Mania Rating Scale (YMRS) and Hamilton Depression Rating Scale (HDRS) were used to evaluate symptom severity, and ELISA to analyze plasma cytokine and BDNF levels. We recruited 309 patients with BP and 123 healthy controls. Before treatment, patients with BP had significantly higher plasma cytokine and lower plasma BDNF levels than did healthy controls. After treatment, HDRS and YMRS scores in each group showed significant improvement. Plasma cytokine levels tended to decline in all groups. Changes in plasma BDNF levels were significantly greater in the VPA+DM60 group than in the VPA+Placebo group.

CONCLUSION

patients with BP have a certain degree of systemic inflammation and BDNF dysfunction. Treatment with VPA plus DM (60 mg/day) provided patients with BP significantly more neurotrophic benefit than did VPA treatment alone.

The effect of early group psychotherapy on depressive symptoms and quality of life among residents of an apartment building for seniors

BACKGROUND

The aim of this study was to investigate the effectiveness of group psychotherapy on depressive symptoms and four domains of quality of life in the elderly.

METHODS

Ninety-six elderly persons were selected from one apartment building for seniors. The 15-question version of the Geriatric Depression Scale was used to screen for depressive symptoms. The treatment and control groups each comprised 12 subjects. The treatment group received one session of group psychotherapy each week for 8 weeks. The 24-item Hamilton Depression Rating Scale and the World Health Organization Quality of Life-BREF scale were used for assessment at the beginning of group psychotherapy and during the fourth and eighth weeks.

RESULTS

The Hamilton Depression Rating Scale score decreased significantly in the treatment group by the eighth week of group psychotherapy compared to the control group (4.9 ± 3.6 vs 17.6 ± 6.4, respectively; P < 0.0001). The World Health Organization Quality of Life-BREF score decreased significantly in the control group by the eighth week compared to the treatment group (95.3 ± 9.9 vs 80.2 ± 10.6, respectively; P = 0.002) with Hamilton Depression Rating Scale interaction (χ(2) = 2.11, P = 0.146). Analysis of the four quality of life domains showed significant differences in the psychological and social domains (P = 0.004 and P = 0.004, respectively) but not in the physical and environmental domains (P = 0.133 and P = 0.147, respectively).

CONCLUSIONS

These findings suggest that studies of the outcome of group psychotherapy must control for depressive symptoms. Quality of life may have been mediated by depression in this preliminary study.

Neural correlates of obsessive-compulsive related dysfunctional beliefs

There have been few attempts to integrate neurobiological and cognitive models of obsessive-compulsive disorder (OCD), although this might constitute a key approach to clarify the complex etiology of the disorder. Our study aimed to explore the neural correlates underlying dysfunctional beliefs hypothesized by cognitive models to be involved in the development and maintenance of OCD. We obtained a high-resolution magnetic resonance image from fifty OCD patients and 30 healthy controls, and correlated them, voxel-wise, with the severity of OC-related dysfunctional beliefs assessed by the Obsessive Beliefs Questionnaire-44. In healthy controls, significant negative correlations were observed between anterior temporal lobe (ATL) volume and scores on perfectionism/intolerance of uncertainty and overimportance/need to control thoughts. No significant correlations between OBQ-44 domains and regional gray matter volumes were observed in OCD patients. A post-hoc region-of-interest analysis detected that the ATLs was bilaterally smaller in OCD patients. On splitting subjects into high- and low-belief subgroups, we observed that such brain structural differences between OCD patients and healthy controls were explained by significantly larger ATL volumes among healthy subjects from the low-belief subgroup. Our results suggest a significant correlation between OC-related dysfunctional beliefs and morphometric variability in the anterior temporal lobe, a brain structure related to socio-emotional processing. Future studies should address the interaction of these correlations with environmental factors to fully characterize the bases of OC-related dysfunctional beliefs and to advance in the integration of biological and cognitive models of OCD.

Effects of zinc supplementation on efficacy of antidepressant therapy, inflammatory cytokines, and brain-derived neurotrophic factor in patients with major depression

OBJECTIVE

Zinc is found in abundance in the human brain. Patients with depression may have decreased consumption of food sources rich in zinc, and zinc supplementation may have a potential influence on depressive symptoms. However, clinical trials on the effect of zinc supplementation in depression are limited. The objective of the present study was to determine the effect of zinc supplementation on efficacy of antidepressant therapy. Furthermore, the effect of zinc on plasma levels of interleukin-6 (IL-6), tumor necrosis factor (TNF-α), and brain-derived neurotrophic factor-a (BDNF-a) were assessed.

DESIGN

A single-center, randomized, double-blind, placebo-controlled trial of zinc supplementation was conducted in patients with DSM-IV major depression. Forty-four patients of both sexes aged 18-55 years were recruited for this study from a university hospital. The zinc-supplemented group received zinc sulfate (25 mg elemental Zn/day) orally in addition to their selective serotonin reuptake inhibitor antidepressants for 12 weeks. Symptoms were evaluated using the Hamilton Depression Rating Scale (HDRS) on arrival, weeks 6 and 12. Plasma levels of IL-6, TNF-α and BDNF-a were measured at baseline and at the end of study.

RESULTS

Twenty patients in zinc group and 17 patients in placebo groups completed the study. At baseline, there were no significant differences in any variable between the patients allocated to receive placebo and those taking zinc supplement. Zinc supplementation significantly reduced HDRS compared to placebo (P < 0.01 at 12th week). No significant differences were observed in plasma levels of IL-6, TNF-α, and BDNF-a between zinc-supplemented and placebo-supplemented group.

CONCLUSION

Zinc supplementation in conjunction with antidepressant drugs might be beneficial for reducing depressive symptoms. However, its effect does not appear to be mediated through impact of zinc on inflammatory processes.

Morphometric brain characterization of refractory obsessive-compulsive disorder: diffeomorphic anatomic registration using exponentiated Lie algebra

BACKGROUND

Few studies have used neuroimaging to characterize treatment-refractory obsessive-compulsive disorder (OCD). This study sought to explore gray matter structure in patients with treatment-refractory OCD and compare it with that of healthy controls.

METHODS

A total of 18 subjects with treatment-refractory OCD and 26 healthy volunteers were analyzed by MRI using a 3.0-T scanner and voxel-based morphometry (VBM). Diffeomorphic anatomical registration using exponentiated Lie algebra (DARTEL) was used to identify structural changes in gray matter associated with treatment-refractory OCD. A partial correlation model was used to analyze whether morphometric changes were associated with Yale-Brown Obsessive-Compulsive Scale scores and illness duration.

RESULTS

Gray matter volume did not differ significantly between the two groups. Treatment-refractory OCD patients showed significantly lower gray matter density than healthy subjects in the left posterior cingulate cortex (PCC) and mediodorsal thalamus (MD) and significantly higher gray matter density in the left dorsal striatum (putamen). These changes did not correlate with symptom severity or illness duration.

CONCLUSIONS

Our findings provide new evidence of deficits in gray matter density in treatment-refractory OCD patients. These patients may show characteristic density abnormalities in the left PCC, MD and dorsal striatum (putamen), which should be verified in longitudinal studies.

Longitudinal associations between mismatch negativity and disability in early schizophrenia- and affective-spectrum disorders

BACKGROUND

Impaired mismatch negativity (MMN) is a robust finding in schizophrenia and, more recently, similar impairments have been reported in other psychotic- and affective-disorders (including at early stages of illness). Although cross-sectional studies have been numerous, there are few longitudinal studies that have explored the predictive value of this event-related potential in relation to clinical/functional outcomes. This study assessed changes in MMN (and the concomitant P3a) amplitude over time and aimed to determine the longitudinal relationship between MMN/P3a and functional outcomes in patients recruited during the early stage of a schizophrenia- or affective-spectrum disorder.

METHODS

Sixty young patients with schizophrenia- and affective-spectrum disorders and 30 healthy controls underwent clinical, neuropsychological and neurophysiological assessment at baseline. Thirty-one patients returned for clinical and neuropsychological follow-up 12-30months later, with 28 of these patients also repeating neurophysiological assessment. On both occasions, MMN/P3a was elicited using a two-tone passive auditory paradigm with duration deviants.

RESULTS

Compared with controls, patients showed significantly impaired temporal MMN amplitudes and trend-level deficits in central MMN/P3a amplitudes at baseline. There were no significant differences for MMN measures between the diagnostic groups, whilst the schizophrenia-spectrum group showed reduced P3a amplitudes compared to those with affective-spectrum disorders. For those patients who returned for follow-up, reduced temporal MMN amplitude at baseline was significantly associated with greater levels of occupational disability, and showed trend-level associations with general and social disability at follow-up. Paired t-tests revealed that MMN amplitudes recorded at the central-midline site were significantly reduced in patients over time. Interestingly, those patients who did not return for follow-up showed reduced frontal MMN and fronto-central P3a amplitudes compared to their peers who did return for repeat assessment.

CONCLUSIONS

This study provides some evidence of the predictive utility of MMN at the early stages of schizophrenia- and affective-spectrum disorders and demonstrated that MMN impairments in such patients may worsen over time. Specifically, we found that young patients with the most impaired MMN amplitudes at baseline showed the most severe levels of disability at follow-up. Furthermore, in the subset of patients with repeat neurophysiological testing, central MMN was further impaired suggestive of neurodegenerative effects. MMN may serve as a neurophysiological biomarker to more accurately predict functional outcomes and prognosis, particularly at the early stages of illness.

Possible role of adrenomedullin and nitric oxide in major depression

Adrenomedullin (ADM) and nitric oxide (NO) have been implicated in the pathogenesis of certain psychiatric disorders such as schizophrenia and bipolar disorder. ADM induces vasorelaxation by activating adenylate cyclase and stimulating the release of NO. These two molecules are known to influence cerebral activity. In this study, we aimed to examine the serum levels of ADM and NO in patients with major depression (MD). We enrolled 50 patients with MD and 50 healthy control subjects. The diagnosis of MD was established on the basis of a structured clinical interview using the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). The severity of depressive symptoms was evaluated using Hamilton's 17-item Depression Rating Scale. The mean serum levels of ADM and NO in patients with MD were significantly higher than those in healthy subjects (p=0.001, for both). The severity of psychomotor retardation in patients with MD was significantly correlated with the ADM (r=0.37, p=0.007) and NO levels (r=0.29, p=0.038). The patients with obvious psychomotor retardation had significantly higher levels of ADM and NO than did the patients with no psychomotor retardation (p=0.025, p=0.030). A significantly positive correlation was found between ADM and NO levels in patients with MD (r=0.79, p=0.001). Serum levels of ADM and NO levels were not correlated with the severity or duration of depression or depressive symptoms (except psychomotor retardation). In conclusion, our study indicates that serum levels of ADM and NO are elevated in patients with MD and that increased serum levels of ADM and NO may be associated with psychomotor retardation. The ADM-NO system may serve as a new target in the treatment of patients with MD and psychomotor retardation.

Lack of association between dendritic cell nuclear protein-1 gene and major depressive disorder in the Han Chinese population

OBJECTIVES

Dendritic cell nuclear protein-1 (DCNP1) has been associated with major depressive disorder (MDD) based on analysis of a population of patients in the United Kingdom. In the present study we have investigated a possible role of DCNP in MDD in the Han Chinese population, including a meta-analysis of different ethnic populations.

METHODS

Eight single nucleotide polymorphisms (SNPs) spanning the entire DCNP1 were carefully selected, genotyped and used for the SNP and haplotype analyses in 574 patients with MDD and 642 healthy controls. Considering the potential genetic association difference across different ethnic populations, we further conducted a meta-analysis for Chinese and European populations.

RESULTS

rs10061623 showed initial association with MDD in females in the allele analysis (p-value: 0.043). However, this association did not remain significant after Bonferroni correction to adjust for multiple comparisons (corrected p-value: 0.344). Other single-marker and haplotype analyses did not reveal any significant differences between patients and controls. The SNP (rs12520799), positive in the original UK study, gave negative results in all our analyses. The meta-analysis results of rs12520799 also suggested possible negative association between this SNP and MDD in the Han Chinese population.

CONCLUSIONS

In the Han Chinese population, common DCNP1 polymorphisms are unlikely to be important in the genetic susceptibility to MDD.

Vascular endothelial growth factor gene (VEGFA) polymorphisms may serve as prognostic factors for recurrent depressive disorder development

Recurrent depressive disorder (rDD) is a multifactorial disease. Vascular endothelial growth factor (VEGF) is one of the factors that have been suggested to play a role in the etiology and/or development of this disease. Limited information related to the role of VEGFA gene polymorphism in depressive disorder is available. The aim of the study was to analyze the association between VEGFA gene polymorphisms (+405G/C; rs2010963, +936C/T; rs 3025039), VEGFA gene expression, and its serum protein levels in rDD in the Caucasian population. In the current study, 268 patients and 200 healthy controls of the Caucasian origin were involved. Genotyping and gene expression were performed using polymerase chain reaction (PCR)-based methods. Enzyme-linked immunosorbent assay (ELISA) was used for detection of circulating serum VEGF levels. The distribution of VEGFA polymorphism +405G/C differed significantly between rDD patients and healthy subjects. The results of this study indicated that the C allele and CC genotype of VEGFA are risk factors for rDD. Haplotypes CC and TG are the important factors for depression development. Further, VEGFA mRNA expression and VEGF levels were higher in rDD patients than in controls. The VEGFA gene polymorphism may serve as a prognostic factor for rDD development. Our study showed higher levels of both VEGFA mRNA in the peripheral blood cells and serum VEGF in patients diagnosed with rDD than in healthy controls. The obtained results suggest VEGF and the gene encoding the molecule play a role in the etiology of the disease and should be further investigated.