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Objectives
The pathogenesis of fibromyalgia syndrome (FMS) is unclear. Transcranial ultrasonography revealed anechoic alteration of midbrain raphe in depression and anxiety disorders, suggesting affection of the central serotonergic system. Here, we assessed midbrain raphe echogenicity in FMS.
Methods
Sixty-six patients underwent transcranial sonography, of whom 53 were patients with FMS (27 women, 26 men), 13 patients with major depression and physical pain (all women), and 14 healthy controls (11 women, 3 men). Raphe echogenicity was graded visually as normal or hypoechogenic, and quantified by digitized image analysis, each by investigators blinded to the clinical diagnosis.
Results
Quantitative midbrain raphe echogenicity was lower in patients with FMS compared to healthy controls (p<0.05), but not different from that of patients with depression and accompanying physical pain. Pain and FMS symptom burden did not correlate with midbrain raphe echogenicity as well as the presence and severity of depressive symptoms.
Conclusion
We found reduced echogenicity of the midbrain raphe area in patients with FMS and in patients with depression and physical pain, independent of the presence or severity of pain, FMS, and depressive symptoms. Further exploration of this sonographic finding is necessary before this objective technique may enter diagnostic algorithms in FMS and depression.
Background
Fibromyalgia syndrome (FMS) is a chronic condition characterized by widespread pain and associated symptoms. We investigated cerebral activation in FMS patients by functional near-infrared spectroscopy (fNIRS).
Methods
Two stimulation paradigms were applied: a) painful pressure stimulation at the dorsal forearm; b) verbal fluency test (VFT). We prospectively recruited 25 FMS patients, ten patients with unipolar major depression (MD) without pain, and 35 healthy controls. All patients underwent neurological examination and all subjects were investigated with questionnaires (pain, depression, FMS, empathy).
Results
FMS patients had lower pressure pain thresholds than patients with MD and controls (p < 0.001) and reported higher pain intensity (p < 0.001). Upon unilateral pressure pain stimulation fNIRS recordings revealed increased bilateral cortical activation in FMS patients compared to controls (p < 0.05). FMS patients also displayed a stronger contralateral activity over the dorsolateral prefrontal cortex in direct comparison to patients with MD (p < 0.05). While all three groups performed equally well in the VFT, a frontal deficit in cortical activation was only found in patients with depression (p < 0.05). Performance and cortical activation correlated negatively in FMS patients (p < 0.05) and positively in patients with MD (p < 0.05).
Conclusion
Our data give further evidence for altered central nervous processing in patients with FMS and the distinction between FMS and MD.
Purpose
Examine the effects of an 8-week yoga therapy on fatigue in patients with different types of cancer.
Methods
A total of 173 cancer patients suffering from mild to severe fatigue were randomly allocated to yoga intervention (n = 84) (IG) versus waitlist control group (CG) (n = 88). Yoga therapy consisted of eight weekly sessions with 60 min each. The primary outcome was self-reported fatigue symptoms. Secondary outcomes were symptoms of depression and quality of life (QoL). Data were assessed using questionnaires before (T0) and after yoga therapy for IG versus waiting period for CG (T1).
Results
A stronger reduction of general fatigue (P = .033), physical fatigue (P = .048), and depression (P < .001) as well as a stronger increase in QoL (P = .002) was found for patients who attended 7 or 8 sessions compared with controls. Within the yoga group, both higher attendance rate and lower T0-fatigue were significant predictors of lower T1-fatigue (P ≤ .001). Exploratory results revealed that women with breast cancer report a higher reduction of fatigue than women with other types of cancer (P = .016) after yoga therapy.
Conclusion
The findings support the assumption that yoga therapy is useful to reduce cancer-related fatigue, especially for the physical aspects of fatigue. Women with breast cancer seem to benefit most, and higher attendance rate results in greater reduction of fatigue.
Trial registration
German Clinical Trials Register DRKS00016034
Depression is a common psychiatric disorder among geriatric patients that decreases the quality of life and increases morbidity and mortality. Vitamin D as a neuro-steroid hormone might play a role in the onset and treatment of depression. In the present study, the association between depressive symptoms and vitamin D concentration in serum was evaluated. 140 patients of a psychogeriatric day-care unit were included. The geriatric depression scale (GDS) and the Hamilton depression rating scale (HDRS) were assessed at the beginning and end of treatment, GDS scores additionally 6 weeks after discharge from the day-care unit. Vitamin D levels were measured at the beginning of the treatment, routinely. Patients with levels below 30 µg/L were treated with 1000 IU vitamin D per day. There was no association between the severity of depressive symptoms and the concentration of vitamin D at the beginning of the treatment. Patients with higher vitamin D levels showed a stronger decline of depressive symptoms measured by the GDS during their stay in the day-care unit. We provide evidence that vitamin D serum levels might influence antidepressant therapy response in a geriatric population. Prospective studies are necessary to determine which patients may profit from add-on vitamin D therapy.
In der vorliegenden Studie wurde der Zusammenhang des depressiven Syndroms mit dem Vitamin D-Spiegel an einer Stichprobe gerontopsychiatrischer Patienten (n = 140) der Neurogerontopsychiatrischen Tagesklinik Würzburg untersucht. Die Depressivität der Patienten zu Beginn und im Verlauf der Behandlung wurde zum einen mittels der ICD-10-Klassifikation, zum anderen mittels des Scores auf der GDS- und Hamilton-Skala zu Beginn und Ende des Aufenthalts in der Tagesklinik sowie bei einer poststationären Kontrolle bestimmt. Der Vitamin D-Spiegel wurde bei Behandlungsbeginn bestimmt und im Falle eines Mangels 1000 IU Vitamin D am Tag oral substituiert. Hierbei zeigte sich kein Zusammenhang zwischen der Ausprägung des depressiven Syndroms und dem Vitamin D-Spiegel zu Beginn der Behandlung. Dagegen stellte sich heraus, dass Patienten mit einem höheren Spiegel eine deutlichere Verbesserung der depressiven Symptome auf der GDS im Verlauf der Behandlung erfuhren. Außerdem bestand eine signifikante negative Korrelation zwischen BMI und Vitamin D-Spiegel sowie eine Abhängigkeit der Spiegelhöhe von der Jahreszeit. Vitamin D könnte nach den Ergebnissen dieser Studie möglicherweise eine wirkungssteigernde und nebenwirkungsarme Komedikation in der antidepressiven Therapie von älteren psychisch erkrankten Menschen darstellen. Es bedarf weiterer ausführlicher Forschung über den neurophysiologischen Zusammenhang zwischen Vitamin D und der Schwere einer depressiven Erkrankung. Besonders hinsichtlich der Verwendung von Vitamin D als Komedikation gilt es, weitere intensive Forschung in Form von gut designten, randomisierten Fall-Kontroll-Studien und prospektiven Interventionsstudien zu betreiben, um die Therapie von depressiven Patienten im höheren Lebensalter weiter zu verbessern.
The learned helplessness phenomenon is a specific animal behavior induced by prior exposure to uncontrollable aversive stimuli. It was first found by Seligman and Maier (1967) in dogs and then has been reported in many other species, e.g. in rats (Vollmayr and Henn, 2001), in goldfishes (Padilla, 1970), in cockroaches (Brown, 1988) and also in fruit flies (Brown, 1996; Bertolucci, 2008). However, the learned helplessness effect in fruit flies (Drosophila melanogaster) has not been studied in detail. Thus, in this doctoral study, we investigated systematically learned helplessness behavior of Drosophila for the first time.
Three groups of flies were tested in heatbox. Control group was in the chambers experiencing constant, mild temperature. Second group, master flies were punished in their chambers by being heated if they stopped walking for 0.9s. The heat pulses ended as soon as they resumed walking again. A third group, the yoked fly, was in their chambers at the same time. However, their behavior didn’t affect anything: yoked flies were heated whenever master flies did, with same timing and durations. After certain amount of heating events, yoked flies associated their own behavior with the uncontrollability of the environment. They suppressed their innate responses such as reducing their walking time and walking speed; making longer escape latencies and less turning around behavior under heat pulses. Even after the conditioning phase, yoked flies showed lower activity level than master and control flies. Interestingly, we have also observed sex dimorphisms in flies. Male flies expressed learned helplessness not like female flies. Differences between master and yoked flies were smaller in male than in female flies. Another interesting finding was that prolonged or even repetition of training phases didn’t enhance learned helplessness effect in flies.
Furthermore, we investigated serotonergic and dopaminergic nervous systems in learned helplessness. Using genetic and pharmacological manipulations, we altered the levels of serotonin and dopamine in flies’ central nervous system. Female flies with reduced serotonin concentration didn’t show helpless behavior, while the learned helplessness effect in male flies seems not to be affected by a reduction of serotonin. Flies with lower dopamine level do not display the learned helplessness effect in the test phase, suggesting that with low dopamine the motivational change in learned helplessness in Drosophila may decline faster than with a normal dopamine level.
Die vorliegende prospektive Studie hatte zum Ziel, den Zusammenhang zwischen Depression und Mortalität einerseits und Lebensqualität und Mortalität andererseits bei chronischer Herzinsuffizienz zu untersuchen. Zusätzlich wurden Determinanten für Depression und Lebensqualität untersucht. Eine konsekutive Kohorte von 231 ambulanten Patienten mit chronischer Herzinsuffizienz wurde bei Studieneinschluss eingehend medizinisch untersucht und gebeten Fragebögen bezüglich Lebensqualität (KCCQ und SF-36) und Depression (PHQ) zu beantworten. Die Überlebensdaten wurden 2 bis 4 Jahre nach Studieneinschluss erhoben. In der vorliegenden Studie konnte ein Zusammenhang zwischen dem Vorliegen einer Major Depression und einer kürzeren Überlebenszeit nachgewiesen werden, der auch nach Kontrolle biomedizinischer prognostischer Faktoren bestand. Eine Minor Depression ging nicht mit einer kürzeren Überlebenszeit einher. Ferner kamen wir zu dem Ergebnis, dass der Schweregrad der NYHA-Klasse eine starke Determinante der Depression ist. Geschlecht, Alter und Ejektionsfraktion konnten nicht als Determinanten der Depression identifiziert werden. Auch die subjektiv empfundene Lebensqualität des Patienten steht im Zusammenhang mit der Überlebenszeit. Je höher die Lebensqualität, desto geringer ist das Risiko für Mortalität. Als Prädiktoren der Lebensqualität erwiesen sich Geschlecht, Alter, NYHA-Klasse und Depression, nicht jedoch die Ejektionsfraktion. Einschränkungen der Studie bestehen aufgrund der kleinen Stichprobe sowie des selektiven Patientenguts. Mögliche Mechanismen, die den Zusammenhang zwischen Depression und Überlebenszeit erklären können, sind verminderte Compliance des depressiven Patienten sowie unter anderem eine Dysregulation immunologischer Abläufe. Zur kausalen Klärung des Zusammenhangs von Depression bzw. Lebensqualität und Mortalität bedarf es zukünftig vor allem randomisierter Interventionsstudien.
Background: The distinctness of grief from depression has been the subject of a long scholarly debate, even influencing definitions of diagnostic criteria. Aims: This study aims at clarifying the issue by a multifaceted analysis of data from a large German sample. Method: A community sample of 406 bereaved persons answered the Wuerzburg Grief Inventory (WGI), a multidimensional grief questionnaire designed to measure normal grief in the German language, and the General Depression Scale – Short Version (GDS-S), a self-report depression scale. Data were analyzed by factor analysis to identify structural (dis-)similarities of the constructs, and analysis of variance (ANOVA) to identify the influence of the factors relationship to the deceased, type of death, and time since loss on grief measures and depression scores. Results: Factor analysis clustered items referring to grief-related impairments and depression into one factor, items referring to other dimensions of grief on separate factors, however. Relationship to the deceased influenced the grief measures impairments and nearness to the deceased, but not depression scores if controlled for impairments. Type of death showed specific effects on grief scores, but not on depression scores. Time since loss influenced grief scores, but not depression scores. Limitations: The analysis is based on a self-selected community sample of grieving persons, self-report measures, and in part, on cross-sectional data. Conclusion: Factor analysis and objective data show a clear distinction of dimensions of grief and depression. The human experience of grief contains a sense of nearness to the lost person, feelings of guilt, and positive aspects of the loss experience in addition to components resembling depression.
Background: \(^{123}\)I-metaiodobenzylguanidine (mIBG) provides independent prognostic value for risk stratification among heart failure patients, but the use of concomitant medication should not impact its quantitative information. We aimed to evaluate the four most-prescribed antidepressants currently used as a first‑line treatment for patients with major depressive disorder (MDD) and their potential on altering mIBG imaging results.
Methods: The inhibition effect of four different types of antidepressants (desipramine, escitalopram, venlafaxine and bupropion) for MDD treatment on \(^{131}\)I-mIBG uptake was assessed by in-vitro cell uptake assays using human neuroblastoma SK-N-SH cells. The half maximal inhibitory concentration (IC50) of tracer uptake was determined from dose-response curves. To evaluate the effects of IV pretreatment with desipramine (1.5 mg/kg) and escitalopram (2.5, 15 mg/kg) on mIBG cardiac uptake, in-vivo planar 123I-mIBG scans in healthy New Zealand White Rabbits were conducted. Results: The IC50 values of desipramine, escitalopram, venlafaxine and bupropion on \(^{131}\)I-mIBG cellular uptake were 11.9 nM, 7.5 μM, 4.92 μM, and 12.9 μM, respectively. At the maximum serum concentration (Cmax, as derived by previous clinical trials), the inhibition rates of 131I-mIBG uptake were 90.6 % for desipramine, 25.5 % for venlafaxine, 11.7 % for bupropion and 0.72 % for escitalopram. A low inhibition rate for escitalopram in the cell uptake study triggered investigation of an in-vivo rabbit model: with dosage considerably higher than clinical practice, the non-inhibitory effect of escitalopram was confirmed. Furthermore, pretreatment with desipramine led to a marked reduction of cardiac 123I-mIBG uptake.
Conclusions: In the present in-vitro binding assay and in-vivo rabbit study, the selective-serotonin reuptake inhibitor escitalopram had no major impact on neuronal cardiac mIBG uptake within therapeutic dose ranges, while other types of first-line antidepressants for MDD treatment led to a significant decrease. These preliminary results warrant further confirmatory clinical trials regarding the reliability of cardiac mIBG imaging, in particular, if the patient’s neuropsychiatric status would not tolerate withdrawal of a potentially norepinephrine interfering antidepressant.
Bei morbider Adipositas (BMI > 40 kg/m²), von der in Deutschland 1,6% der übergewichtigen Frauen und 0,5% der übergewichtigen Männer (BMI > 25 kg/m²) betroffen sind, erweisen sich für eine ausreichende und dauerhafte Gewichtsreduktion nur chirurgische Maßnahmen, wie z.B. laparoskopisches Gastric banding als effektiv. Allerdings fehlen Studien zur langfristigen Effektivität. In der vorliegenden Katamnesestudie zur Langzeiteffektivität von Gastric banding acht Jahre nach stattgefundener Operation wurden Veränderungen in Gewicht, depressiver Symptomatik, Selbstakzeptanz, Essverhalten und aufgetretene Komplikationen untersucht.
Die als Eingruppen-Prä-Post-Studie konzipierte Arbeit umfasste ein Probandengut von 46 Patienten mit der Diagnose einer Major Depression nach DSM-IV, die sich im Zeitraum von 1999 bis 2005 in ambulanter psychiatrischer Therapie befanden und nach Prinzipien und Methoden der kognitiven Verhaltenstherapie behandelt wurden. Mit dem Fragebogen für Psychovulnerabilität und Psychoprotektion (FPVP) wurden dabei biographische Merkmale sowie Persönlichkeitscharakteristika der Probanden erfasst. Zur quantitativen Beschreibung des momentanen Befindens dienten ferner die Eigenschaftswörterliste (EWL) sowie die Befindlichkeitsskala (Bf-S). Jeweils am Anfang sowie nach Abschluss der kognitiven Psychotherapie füllten die Patienten die entsprechenden Fragebögen aus. Eine Überprüfung der so ermittelten Ergebnisse auf statistisch signifikante Veränderungen nach Abschluss der Therapie erfolgte mittels des Wilcoxon-Vorzeichen-Rangsummen-Testes. Außerdem wurden Spearman-Rangkorrelationskoeffizienten zwischen den prätherapeutischen Werten der biographischen beziehungsweise persönlichkeitsbezogenen Variablen und den Veränderungen der allgemeinen Stimmungslage im Verlauf der Therapie errechnet. So sollte der Fragestellung nachgegangen werden, ob sich bestimmte Wesensmerkmale respektive biographische Einschätzungen der Probanden als Prädiktoren für die Veränderungen des allgemeinen Befindens im Laufe einer psychotherapeutischen Depressionsbehandlung erweisen. Die Studie konnte einerseits aufzeigen, dass die psychovulnerablen FPVP-Persönlichkeitsvariablen „Neurotizismus“ (NE) sowie „Desorganisation“ (DO) und „Arbeitsbezogenheit“ (AB) einer kognitiven Umstrukturierung zugänglich waren. Gleiches galt für die psychoprotektive Persönlichkeitsvariable „Zielgerichtetheit“ (ZG). Weiterhin konnte dargelegt werden, dass die biographischen Skalen „Kindliches Kontaktverhalten“ (KI) sowie „Schulisches Engagement“ (SCH), der Tatsache entsprechend, dass sie auf Erlebnissen und Erfahrungen basieren, die bereits in einer gewissen Weise stattgefunden haben, einer kognitiven Veränderung nicht unmittelbar zugänglich waren. Andererseits zeigte sich, dass es im Verlauf der kognitiven Psychotherapie zu einer Verbesserung der gegenwärtigen Stimmungslage und psychischen Befindlichkeit innerhalb des Patientenkollektivs kam. Dieses Ergebnis steht im Einklang mit zahlreichen früheren Studien, welche die hohe Effektivität der kognitiven Verhaltenstherapie bei der psychotherapeutischen Depressionsbehandlung hinreichend belegen. Außerdem wurde dargelegt, dass die Prä-Werte der klinischen Skalen „Desorganisation“ (DO) und „Neurotizismus“ (NE) die Veränderungen der allgemeinen Stimmungslage im Laufe der kognitiven Therapie korrelativ beeinflussten. Je höher nämlich die prätherapeutischen Scores der genannten Variablen ausfielen, umso ausgeprägter verbesserte sich das psychische Befinden der Probanden verglichen mit den prätherapeutischen Ausgangswerten. Schließlich imponierte der Befund, dass sich die psychische Befindlichkeit der Testpersonen im Laufe der Behandlung umso positiver veränderte, je höher deren Introversions- beziehungsweise je geringer deren Extraversions-Werte zu Beginn der Therapie waren. Introvertierte Patienten scheinen demnach einen höheren Nutzen von dem psychotherapeutischen Verfahren der kognitiven Umstrukturierung zu haben. Auf Grundlage dieser Ergebnisse sowie auf den Erkenntnissen früherer Arbeiten, welche bereits den Zusammenhang zwischen Persönlichkeit und aktuellem Befinden darlegen konnten, wurden Folgerungen für das klinisch-therapeutische Vorgehen gezogen: Durch bewusste Förderung gewisser psychoprotektiver Faktoren beziehungsweise gezielte Abschwächung und kognitive Umstrukturierung psychovulnerabler Persönlichkeitsvariablen lässt sich die psychische Grundverfassung depressiver Patienten therapeutisch positiv beeinflussen. Biographische Merkmale können demgegenüber nicht unmittelbar verändert werden; jedoch ist es möglich, dem Patienten eine veränderte Perspektive auf Aspekte seiner Lebensgeschichte zu vermitteln, was bis hin zu einer fiktiven Rekonstruktion der eigenen Biographie reichen kann. Der im Rahmen dieser Studie aufgezeigte Befund, dass ein erfolgreicher Verlauf der kognitiven Therapie mit hohen Introversions- respektive geringen Extraversions-Werten der Probanden korrelierte, wirft schließlich die Frage auf, ob die kognitive Verhaltenstherapie als adäquates Therapieverfahren zur Behandlung depressiver Erkrankungen bei stark extravertierten Patienten verstanden werden kann. Da demgegenüber gerade introvertierte, emotional labile Patienten von diesem psychotherapeutischen Verfahren zu profitieren scheinen, bietet sich die kognitive Therapie als geeignete Behandlungsmethode zur Therapie depressiver Störungen bei solchen Patienten an.
Bereits bestehende wissenschaftliche Literatur weist in präklinischen Ergebnissen darauf hin, dass das sympathische Nervensystem eine entscheidende Rolle bei der Mobilisierung von hämatopoetischen Stammzellen spielt. Mehrere Vorarbeiten lieferten Hinweise, dass psychischer Distress bei Stammzelltransplantation mit einem langsameren Anstieg der absoluten Leukozytenzahl während Aplasie einhergehen könnte. Die Dauer der Aplasie ist von klinischer Relevanz.
In der vorliegenden Arbeit wurden Zusammenhänge zwischen Distress in Form von depressiven Symptomen und hämatologischer Rekonstitution nach erster autologer Stammzelltransplantation bei Patienten mit Multiplem Myelom (n = 47) untersucht.
Mit Hilfe des Fragebogens PHQ-9 wurden die Patienten mit Multiplem Myelom am Tag ihrer ersten autologen Stammzelltransplantation auf depressive Symptome gescreent.
Patienten mit Multiplem Myelom wiesen ein hohes Maß an Distress auf. In der Stichprobe aus 47 konsekutiven Patienten lag bei 12 Patienten (26%) Distress in Form von Symptomen einer Depression vor.
Es ließ sich kein Zusammenhang zwischen psychischer Belastung und verlängerter hämatologischen Rekonstitution (r = 0.025; n = 37; p = 0.882) feststellen.
Erstmalig wurde der Zusammenhang zwischen psychischer Belastung und klinischen Parametern während hämatologischer Rekonstitution untersucht. Dabei ergaben sich klinisch relevante Resultate. Es zeigte sich eine Tendenz mit einem größeren Bedarf an Erythrozytenkonzentraten bei Verdacht auf Depression (V = 0.387; p = 0.071). Nebenbefundlich ergab sich in der multivariaten Analyse der signifikante Zusammenhang, dass ein hohes molekulargenetisches Risiko mit einer größeren Anzahl an verabreichten Erythrozytenkonzentraten einhergeht (p = 0.046). Darüber hinaus ergab sich ein relevanter Zusammenhang zwischen Verdacht auf Depression nach PHQ-9 und Aufenthaltsdauer. Depressive Patienten waren demnach tendenziell kürzer im Krankenhaus (r = -0.25; n = 47; p = 0.09).
Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disease that causes progressive autonomy loss and need for care. This does not only affect patients themselves, but also the patients’ informal caregivers (CGs) in their health, personal and professional lives. The big efforts of this multi-center study were not only to evaluate the caregivers' burden and to identify its predictors, but it also should provide a specific understanding of the needs of ALS patients' CGs and fill the gap of knowledge on their personal and work lives. Using standardized questionnaires, primary data from patients and their main informal CGs (n = 249) were collected. Patients' functional status and disease severity were evaluated using the Barthel Index, the revised Amyotrophic Lateral Sclerosis Functional Rating Scale (ALSFRS-R) and the King’s Stages for ALS. The caregivers' burden was recorded by the Zarit Burden Interview (ZBI). Comorbid anxiety and depression of caregivers were assessed by the Hospital Anxiety and Depression Scale. Additionally, the EuroQol Five Dimension Five Level Scale evaluated their health-related quality of life. The caregivers' burden was high (mean ZBI = 26/88, 0 = no burden, ≥24 = highly burdened) and correlated with patients' functional status (r\(_p\) = −0.555, p < 0.001, n = 242). It was influenced by the CGs' own mental health issues due to caregiving (+11.36, 95% CI [6.84; 15.87], p < 0.001), patients' wheelchair dependency (+9.30, 95% CI [5.94; 12.66], p < 0.001) and was interrelated with the CGs' depression (r\(_p\) = 0.627, p < 0.001, n = 234), anxiety (r\(_p\) = 0.550, p < 0.001, n = 234), and poorer physical condition (r\(_p\) = −0.362, p < 0.001, n = 237). Moreover, female CGs showed symptoms of anxiety more often, which also correlated with the patients' impairment in daily routine (r\(_s\) = −0.280, p < 0.001, n = 169). As increasing disease severity, along with decreasing autonomy, was the main predictor of caregiver burden and showed to create relevant (negative) implications on CGs' lives, patient care and supportive therapies should address this issue. Moreover, in order to preserve the mental and physical health of the CGs, new concepts of care have to focus on both, on not only patients but also their CGs and gender-associated specific issues. As caregiving in ALS also significantly influences the socioeconomic status by restrictions in CGs' work lives and income, and the main reported needs being lack of psychological support and a high bureaucracy, the situation of CGs needs more attention. Apart from their own multi-disciplinary medical and psychological care, more support in care and patient management issues is required.
Mental disorders at the beginning of adolescence: Prevalence estimates in a sample aged 11-14 years
(2022)
Objectives
This study aims to provide a deeper insight into mental disorders in early adolescence. We report prevalence rates (mental health problems, depressive symptoms, eating disorders, NSSI, STBs) to be used in future studies and clinical ventures. We also expected to find gender differences, with girls being be more affected than boys are.
Study design
877 adolescents (M = 12.43, SD = 0.65) from seven German high schools completed a series of questionnaires assessing their mental health (SDQ, PHQ-9, SEED, DSHI-9, Paykel Suicide Scale, FAS III).
Methods
We calculated cut-off-based prevalence estimates for mental health issues for the whole sample and compared estimates between genders.
Results
12.5% of the sample reported general mental health problems. The estimated prevalence of depressive symptoms lay at of 11.5%. Additionally, 12.1% and 1.3% of the participants displayed relevant symptoms of anorexia or bulimia nervosa, respectively. A total of 10.8% reported engaging in non-suicidal self-injury (NSSI) at least once in their lifetime, of whom 5.6% reported repetitive NSSI. 30.1% of the participants described suicidal thoughts, 9.9% suicide plans, and 3.5% at least one suicide attempt. Girls were generally more affected than boys, except for bulimia nervosa, suicidal behavior, and partly NSSI.
Conclusion
Our findings corroborate the established relevance of early adolescence for the development of mental health problems and suggest that a substantial proportion of young adolescents suffer from such problems early on. Considering the ongoing COVID-19 pandemic and reported negative mental health consequences, the current findings underline the importance of preventive interventions to avoid the manifestation of mental disorders during adolescence.
This compilation focuses on adolescent mental disorders and their prevention. It comprises three distinct studies, each contributing to a deeper understanding of this critical topic. This work addresses a critical gap in the understanding of, and approach to, adolescent mental health, and as a result reveals a critically important and urgently needed policy implication for action. The thematic structure of these studies begins with an examination of the epidemiology of child and adolescent mental disorders. Baseline data were collected from N = 877 adolescents with a mean age of 12.43 years (SD = 0.65). Mental health problems, such as depressive symptoms, non-suicidal self-injury, suicidal ideation, symptoms of eating disorders, and gender differences, are thoroughly examined. Results revealed a significant portion of our sample displaying mental health problems as early as the 6th and 7th grades, with girls generally being more affected than boys. The findings underscore the importance of early adolescence in the emergence of mental health problems and thereby emphasize the need for preventive measures. Moving beyond prevalence estimates, the compilation delves into the etiology of these disorders, exploring their potential correlation with a COVID-19 infection. Understanding the early signs and risk factors is crucial for timely support. While numerous studies have investigated potential risk and protective factors during the pandemic, our focus shifts to adolescents’ coping when an infection with the virus was involved (N = 2,154, M = 12.31, SD = 0.67). We hypothesized that students infected or with close family members infected, would exhibit an increased psychopathology and a decreased functioning of protective factors such as self-efficacy or self-esteem. We found no connection between infection and the mental health status within our sample, but protective factors and mental well-being were positively associated. Thus, universal primary prevention appears to be the preferred approach for promoting mental health. Lastly, the compilation introduces LessStress, a noteworthy contribution to more evidence-based prevention programs. This universal approach is designed to reduce stress in schools, accompanied by a cluster-randomized trial to evaluate its effectiveness (estimated sample size N = 1,894). Existing studies have demonstrated the effectiveness of stress prevention, leading us to introduce a short and easy-to-implement prevention program. There is positive evidence for one-lesson interventions in schools for promoting well-being and health behaviors among adolescents. LessStress is designed based on a life skills approach that not only imparts psychoeducational content but also teaches skills relevant to everyday life and directly applicable. Throughout these studies, a common thread emerges: the pressing need to address mental disorders during childhood and adolescence. These formative years play a pivotal role in the development of mental health problems. These formative years play a crucial role in the development of mental health problems. They highlight the importance of epidemiological data collection and analysis based on the latest models to develop prevention interventions that are not only effective but also reach young people on a global level.
While there is abounding literature on virus-induced pathology in general and coronavirus in particular, recent evidence accumulates showing distinct and deleterious brain affection. As the respiratory tract connects to the brain without protection of the blood–brain barrier, SARS-CoV-2 might in the early invasive phase attack the cardiorespiratory centres located in the medulla/pons areas, giving rise to disturbances of respiration and cardiac problems. Furthermore, brainstem regions are at risk to lose their functional integrity. Therefore, long-term neurological as well as psychiatric symptomatology and eventual respective disorders cannot be excluded as evidenced from influenza-A triggered post-encephalitic Parkinsonism and HIV-1 triggered AIDS–dementia complex. From the available evidences for coronavirus-induced brain pathology, this review concludes a number of unmet needs for further research strategies like human postmortem brain analyses. SARS-CoV-2 mirroring experimental animal brain studies, characterization of time-dependent and region-dependent spreading behaviours of coronaviruses, enlightening of pathological mechanisms after coronavirus infection using long-term animal models and clinical observations of patients having had COVID-19 infection are calling to develop both protective strategies and drug discoveries to avoid early and late coronavirus-induced functional brain disturbances, symptoms and eventually disorders. To fight SARS-CoV-2, it is an urgent need to enforce clinical, molecular biological, neurochemical and genetic research including brain-related studies on a worldwide harmonized basis.
Monoamine oxidase inhibitors (MAO-I) belong to the earliest drugs tried in Parkinson's disease (PD). They have been used with or without levodopa (L-DOPA). Non-selective MAO-I due to their side-effect/adverse reaction profile, like tranylcypromine have limited use in the treatment of depression in PD, while selective, reversible MAO-A inhibitors are recommended due to their easier clinical handling. For the treatment of akinesia and motor fluctuations selective irreversible MAO-B inhibitors selegiline and rasagiline are recommended. They are safe and well tolerated at the recommended daily doses. Their main differences are related to (1) metabolism, (2) interaction with CYP-enzymes and (3) quantitative properties at the molecular biological/genetic level. Rasagiline is more potent in clinical practise and has a hypothesis driven more favourable side effect/adverse reaction profile due to its metabolism to aminoindan. Both selegiline and rasagiline have a neuroprotective and neurorestaurative potential. A head-to head clinical trial would be of utmost interest from both the clinical outcome and a hypothesis-driven point of view. Selegiline is available as tablet and melting tablet for PD and as transdermal selegiline for depression, while rasagiline is marketed as tablet for PD. In general, the clinical use of MAO-I nowadays is underestimated. There should be more efforts to evaluate their clinical potency as antidepressants and antidementive drugs in addition to the final proof of their disease-modifying potential. In line with this are recent innovative developments of MAO-I plus inhibition of acetylcholine esterase for Alzheimer's disease as well as combined MAO-I and iron chelation for PD.
Anxiety disorders and depression are common comorbidities in cardiac patients. Mice lacking the serotonin transporter (5-HTT) exhibit increased anxiety-like behavior. However, the role of 5-HTT deficiency on cardiac aging, and on healing and remodeling processes after myocardial infarction (MI), remains unclear. Cardiological evaluation of experimentally naïve male mice revealed a mild cardiac dysfunction in ≥4-month-old 5-HTT knockout (−/−) animals. Following induction of chronic cardiac dysfunction (CCD) by MI vs. sham operation 5-HTT−/− mice with infarct sizes >30% experienced 100% mortality, while 50% of 5-HTT+/− and 37% of 5-HTT+/+ animals with large MI survived the 8-week observation period. Surviving (sham and MI < 30%) 5-HTT−/− mutants displayed reduced exploratory activity and increased anxiety-like behavior in different approach-avoidance tasks. However, CCD failed to provoke a depressive-like behavioral response in either 5-Htt genotype. Mechanistic analyses were performed on mice 3 days post-MI. Electrocardiography, histology and FACS of inflammatory cells revealed no abnormalities. However, gene expression of inflammation-related cytokines (TGF-β, TNF-α, IL-6) and MMP-2, a protein involved in the breakdown of extracellular matrix, was significantly increased in 5-HTT−/− mice after MI. This study shows that 5-HTT deficiency leads to age-dependent cardiac dysfunction and disrupted early healing after MI probably due to alterations of inflammatory processes in mice.
This study examined the impact of three clinical psychological variables (non-pathological levels of depression and anxiety, as well as experimentally manipulated mood) on fat and taste perception in healthy subjects. After a baseline orosensory evaluation, ‘sad’, ‘happy’ and ‘neutral’ video clips were presented to induce corresponding moods in eighty participants. Following mood manipulation, subjects rated five different oral stimuli, appearing sweet, umami, sour, bitter, fatty, which were delivered at five different concentrations each. Depression levels were assessed with Beck’s Depression Inventory (BDI) and anxiety levels were assessed via the Spielberger’s STAI-trait and state questionnaire. Overall, subjects were able to track the concentrations of the stimuli correctly, yet depression level affected taste ratings. First, depression scores were positively correlated with sucrose ratings. Second, subjects with depression scores above the sample median rated sucrose and quinine as more intense after mood induction (positive, negative and neutral). Third and most important, the group with enhanced depression scores did not rate low and high fat stimuli differently after positive or negative mood induction, whereas, during baseline or during the non-emotional neutral condition they rated the fat intensity as increasing with concentration. Consistent with others’ prior observations we also found that sweet and bitter stimuli at baseline were rated as more intense by participants with higher anxiety scores and that after positive and negative mood induction, citric acid was rated as stronger tasting compared to baseline. The observation that subjects with mild subclinical depression rated low and high fat stimuli similarly when in positive or negative mood is novel and likely has potential implications for unhealthy eating patterns. This deficit may foster unconscious eating of fatty foods in sub-clinical mildly depressed populations.