Mood,anxiety, and physical illness: body and mind,or mind and body?

This research review examines the recent articles that have investigated the relationship between mood, anxiety, and physical illness (e.g., asthma, autoimmune disorders, cancer, cardiovascular disease, obesity, and sexual dysfunction). There is growing evidence of an overall negative impact of depression and other mood states, and anxiety on numerous physical illnesses and conditions, and their outcome.     

Physical training and fatigue, fitness, and quality of life in Guillain-Barré syndrome and CIDP

Many patients with Guillain-Barré syndrome (GBS) and chronic inflammatory demyelinating polyneuropathy (CIDP) experience excessive fatigue, which may persist for years and reduce quality of life. The authors performed a 12-week study of bicycle exercise training in 20 patients with severe fatigue, 16 with relatively good recovery from GBS, and 4 with stable CIDP. Training seemed well tolerated, and self-reported fatigue scores decreased 20% (p = 0.001). Physical fitness, functional outcome, and quality of life were improved.     

Psychopathology and resident status – comparing asylum seekers,refugees, illegal migrants,labor migrants,and residents

Purpose

This study aimed to describe, compare, and predict mental health outcomes of different migrant groups and native residents in Switzerland.

Subjects and methods

Asylum seekers (n = 65); refugees holding permanent protection visas (n = 34); illegal migrants (n = 21); labor migrants (n = 26); and residents (n = 56) completed an assessment by questionnaire. Main outcome variables were symptoms of posttraumatic stress, anxiety and depression. It was tested whether resident status predicted psychopathology over and above the influence of control variables including social desirability, traumatic event types and post-migration resources.

Results

Asylum seekers (54.0%) and refugees (41.4%) fulfilled criteria of PTSD most frequently. Clinically relevant symptoms of anxiety and depression were most frequently reported by asylum seekers (84.6% and 63.1%, resp.) and illegal migrants (both 47.6%). Resident status contributed to psychopathology over and above the influence of control variables.

Conclusions

Overall, asylum seekers, refugees, and illegal migrants showed high psychiatric morbidity. Differences in resident status appear to be specifically associated with mental health outcomes. This association persists even when controlling for social desirability, post-migration resources and traumatic events. This emphasizes the importance of current socio-political living conditions for mental health, even with respect to the psychopathological sequelae of past traumatic experiences.     

Neurostimulation—Past,Present, and Beyond

Neurostimulation as a treatment for epilepsy has been around for almost 20 years in the form of vagus nerve stimulation. Newer types of neurostimulation are being developed and stand on the brink of approval for use. The two newest therapies, not yet approved in the United States, are deep brain stimulation and the Responsive Neurostimulator System . In fact, in Europe, approval has already been given for deep brain stimulation and newer forms of vagus nerve stimulation. Efficacy is similar between these therapies, and side effects are moderate, so what will be the future? The challenge will be to learn how to use these therapies correctly and offer the right treatment for the right patient.Despite the development of new antiepileptic drugs (AEDs), of which there are now 24 in total available in the United States, there are still many patients suffering from continued seizures. Patients with refractory epilepsy should initially be evaluated for resective epilepsy surgery. Neurostimulation is not a replacement for resective surgical options. Unfortunately, not all patients can be cured of their seizures by epilepsy surgery, therefore other methodologies have to be developed as well. Of the nonpharmacologic therapies available, vagus nerve stimulation (VNS) has been the procedure that has been the most accessible and best studied. The therapy has been approved since 1997 in the United States, and in Europe since 1994. Efficacy can be compared with that of a newer AED (1). Deep brain stimulation (DBS) has been studied in different forms, but only a double-blind study of bilateral stimulation of the anterior nucleus of the thalamus (2) has been accepted by the European Medicinal Agency as showing efficacy and is now approved as a therapy for epilepsy in Europe. DBS for epilepsy has not been approved in the United States. The closed-loop system (the Responsive Neurostimulator System, RNS) is also under development, and a double-blind study has also been completed (3), but approval for use in refractory focal onset epilepsy patients is pending.     

How do risk factors work together? Mediators, moderators, and independent, overlapping, and proxy risk factors

OBJECTIVE: The authors developed a methodological basis for investigating how risk factors work together. Better methods are needed for understanding the etiology of disorders, such as psychiatric syndromes, that presumably are the result of complex causal chains. METHOD: Approaches from psychology, epidemiology, clinical trials, and basic sciences were synthesized. RESULTS: The authors define conceptually and operationally five different clinically important ways in which two risk factors may work together to influence an outcome: as proxy, overlapping, and independent risk factors and as mediators and moderators. CONCLUSIONS: Classifying putative risk factors into these qualitatively different types can help identify high-risk individuals in need of preventive interventions and can help inform the content of such interventions. These methods may also help bridge the gaps between theory, the basic and clinical sciences, and clinical and policy applications and thus aid the search for early diagnoses and for highly effective preventive and treatment interventions.     

Are child-, adolescent-, and adult-onset depression one and the same disorder?

This paper reviews prior research studies examining neurobiological correlates and treatment response of depression in children, adolescents, and adults. Although there are some similarities in research findings observed across the life cycle, both children and adolescents have been found to differ from depressed adults on measures of basal cortisol secretion, corticotropin stimulation post-corticotropin releasing hormone (CRH) infusion, response to several serotonergic probes, immunity indices, and efficacy of tricyclic medications. These differences are proposed to be due to 1) developmental factors, 2) stage of illness factors (e.g., number of episodes, total duration of illness), or 3) heterogeneity in clinical outcome (e.g., recurrent unipolar course vs. new-onset bipolar disorder). Relevant clinical and preclinical studies that provide support for these alternate explanations of the discrepant findings are reviewed, and directions for future research are discussed. To determine whether child-, adolescent-, and adult-onset depression represent the same condition, it is recommended that researchers 1) use the same neuroimaging paradigms in child, adolescent, and adult depressed cohorts; 2) carefully characterize subjects' stage of illness; and 3) conduct longitudinal clinical and repeat neurobiological assessments of patients of different ages at various stages of illness. In addition, careful attention to familial subtypes (e.g., depressive spectrum disorders vs. familial pure depressive disorders) and environmental factors (e.g., trauma history) are suggested for future investigations.     

Culture,Psychiatry, and the Written Word†

Pessimistic views about the course and outcome of schizophrenia have been replaced by a more hopeful perspective that emphasizes on providing opportunities for recovery. Recovery, from a provider perspective, means that priority is placed on providing access to treatments and community services that have been proven effective in both decreasing symptoms and assisting individuals to lead maximally productive and personally meaningful lives. In 2004, the Schizophrenia Patient Outcomes Research Team (PORT) published a consensus list of evidence-based practices (EBPs) that includes six psychosocial treatments. These psychosocial interventions in combination with access to pharmacotherapy are important components of comprehensive treatment programs for the seriously mentally ill. This paper summarizes and updates the research basis for the PORT psychosocial EBPs and discusses several additional issues and research topics to be considered in the future.     

Uniforms—fact,fashion, fantasy and fetish

A uniform is a prescribed set of clothes which enables the observer to identify the wearer's organization or affiliation. Uniforms serve various other purposes, too, including functional ones. People have also been attracted to uniforms as part of fetishistic behaviour and fantasy. The interest of sexologists and sex therapists in uniforms derives from this aspect. This paper discusses some of these issues and outlines underlying aetiological theories about factors which may lead to an attraction towards uniforms. The roles of perceived power and of other paraphilias in relation to such attraction are discussed. Uniforms and attraction towards uniforms are not necessarily pathological; however, their study will contribute to our understanding of other fetishes and of normal attraction.     

Therapists’ and clients’ ratings of real relationship,attachment, therapist self-disclosure,and treatment progress

Objective: While there has been much research on the role of the working alliance in psychotherapy, researchers only recently began investigating the role of the real relationship in treatment. Methods: In the current study on therapist and client dyads, we used actor–partner interdependence modeling (APIM) to examine associations between therapists’ and clients’ ratings of the real relationship, therapist self-disclosure, attachment, and treatment progress. APIM analyses allowed for an examination into how therapists’ and clients’ views of a particular phenomenon might affect their own ratings (actor), as well as the others’ (partner) ratings of that same phenomenon. Results: Significant negative associations between therapist self-reported attachment anxiety and avoidance and therapist-rated real relationship and treatment progress. Significant positive associations were found between client-rated real relationship and client-rated treatment progress. These results and others are discussed in the context of the literature along with implications for future research in this area.     

Adipose tissue,systematic inflammation,and neurodegenerative diseases

Obesity is associated with several diseases, including mental health. Adipose tissue is distributed around the internal organs, acting in the regulation of metabolism by storing and releasing fatty acids and adipokine in the tissues. Excessive nutritional intake results in hypertrophy and proliferation of adipocytes, leading to local hypoxia in adipose tissue and changes in these adipokine releases. This leads to the recruitment of immune cells to adipose tissue and the release of pro-inflammato...     

FIRES—Pathophysiology,therapeutical approach,and outcome

Background

The acronym FIRES stands for febrile infection-related epileptic syndrome, which is a rare epileptic syndrome in the pediatric population. The initial presentation of FIRES is similar to febrile seizures (FS). Both start after a febrile episode; however, in FIRES the epileptic seizure evolves into a super refractory status epilepticus within days despite appropriate treatment. FIRES needs to be diagnosed early and treated by a multidisciplinary team to control the status epilepticus (SE) as fast as possible. Limiting the duration of the SE is paramount for the prevention of catastrophic sequelae such as severe neurologic disabilities or even death.

Objective/Conclusion

We describe possible pathophysiological mechanisms and summarize important clinical features of FIRES. The aim of this review is to raise awareness, foster early recognition and improve neurologic long-term outcomes. Moreover, we propose a diagnostic approach and list therapeutic options providing an algorithm.

     

Only connect? Communication, identification, and autism

In this paper, we elaborate a theoretical position and report an empirical study on a specific form of interpersonal engagement: the propensity to identify with the subjective orientation of another person. On the basis of a hypothesis that individuals with autism have a relative lack of this form of intersubjective connectedness (Hobson, 1993, 2002), we predicted that children and adolescents with autism would contrast with matched participants without autism (n=12 per group) in specific aspects of communication when someone requested them to "Get Pete to do this" and demonstrated actions in Pete's absence. As predicted, on blind ratings of videotapes of participants' communication, those with autism achieved lower scores on four indices of identification that were selected a priori: emotional engagement, sharing experience in joint attention, communication of style, and shifting in communicative role. The two groups were almost completely separate on a composite measure of identification. We consider the implications of these findings for typical and atypical development.     

Cognitive ability, neighborhood deprivation, and young children’s emotional and behavioral problems

Purpose

To examine if cognitive ability moderates the effect of area (neighborhood) deprivation on young children’s problem behavior.

Methods

Data from the first two sweeps of the Millennium Cohort Study (MCS) in the UK were used. Children were clustered in small areas in nine strata in the UK and were aged 9?months at Sweep 1 and 3?years at Sweep 2. Neighborhood deprivation was measured with the Index of Multiple Deprivation at Sweep 1. Overall and specific problem behavior was measured with the Strengths and Difficulties Questionnaire at Sweep 2. To explore moderator specificity we used three indices of ability (verbal cognitive ability, non-verbal cognitive ability, and attainment of developmental milestones). Adjustment was made for child’s age and sex, and for Sweep 1 family adversity (number of adverse life events), family structure, mother’s social class and psychological distress, and family socio-economic disadvantage.

Results

We found both support for our main hypothesis, and evidence for specificity. Neighborhood deprivation was, even after adjustment for covariates, significantly associated with children’s peer problems. However, verbal and non-verbal cognitive ability moderated this association.

Conclusions

Neighborhood deprivation was related to peer problems even at preschool age. Although the effect of neighborhood deprivation on externalizing problems was mediated by family poverty and parental socio-economic position and although its effect on internalizing problems was mediated by parental mental health, its effect on difficulties with peers was independent of both parental and child characteristics. Cognitive ability moderated the effect of neighborhood deprivation on preschoolers’ peer relationships difficulties.     

Probing and Trapping a Sensitive Conformation: Amyloid-β Fibrils, Oligomers, and Dimers

Alzheimer's disease (AD) is a devastating neurodegenerative disease with pathological misfolding of amyloid-β protein (Aβ). The recent interest in Aβ misfolding intermediates necessitates development of novel detection methods and ability to trap these intermediates. We speculated that two regions of Aβ may allow for detection of specific Aβ species: the N-terminal and 22-35, both likely important in oligomer interaction and formation. We determined via epitomics, proteomic assays, and electron microscopy that the Aβ42 species (wild type, ΔE22, and MetOx) predominantly formed fibrils, oligomers, or dimers, respectively. The 2H4 antibody to the N-terminal of Aβ, in the presence of 2% SDS, primarily detected fibrils, and an antibody to the 22-35 region detected low molecular weight Aβ species. Simulated molecular modeling provided insight into these SDS-induced structural changes. We next determined if these methods could be used to screen anti-Aβ drugs as well as identify compounds that trap Aβ in various conformations. Immunoblot assays determined that taurine, homotaurine (Tramiprosate), myoinositol, methylene blue, and curcumin did not prevent Aβ aggregation. However, calmidazolium chloride trapped Aβ at oligomers, and berberine reduced oligomer formation. Finally, pretreatment of AD brain tissues with SDS enhanced 2H4 antibody immunostaining of fibrillar Aβ. Thus we identified and characterized Aβs that adopt specific predominant conformations (modified Aβ or via interactions with compounds), developed a novel assay for aggregated Aβ, and applied it to drug screening and immunohistochemistry. In summary, our novel approach facilitates drug screening, increases the probability of success of antibody therapeutics, and improves antibody-based detection and identification of different conformations of Aβ.     

Tobacco leaf, smoke and smoking, MAO inhibitors, Parkinson's disease and neuroprotection; are there links?

The potential neuroprotective properties of monoamine oxidase B (MAO-B) inhibitors have been of interest in part because of the role that this enzyme plays in the bioactivation of the parkinsonian inducing neurotoxin 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP). Interestingly, tobacco smokers have lowered levels of brain and blood platelet MAO-B activity and a well documented lowered incidence of Parkinson's disease (PD) compared to non-smokers. This correlation has led to the intriguing question of whether there are possible relationships between smoking, MAO-B activity and PD. Recent studies have evaluated specific components of tobacco smoke for their MAO inhibiting and neuroprotective properties. This chapter summarizes the relevant literature relating to the basic questions in these areas. We have undertaken studies to identify possible inhibitors of MAO-B in the tobacco leaf and tobacco smoke and have evaluated one such compound in the MPTP PD mouse model. In this chapter we report on the results of these studies and present a discussion of potential avenues of research and their implication with respect to PD, smoking and monoamine oxidase.