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Journal Article 2014; 35(1): 64-67 PubMed PMID: 24625915 Citation  Keywords:  Adolescent, Anorexia Nervosa:blood, Body Mass Index, Comorbidity, Depression:blood, Humans, Leptin:blood, Longitudinal Studies, Psychiatric Status Rating Scales, Severity of Illness Index, Weight Gain:physiology,.   

OBJECTIVES: Anorexia nervosa (AN) often presents with comorbid depressive symptoms and is characterized by low levels of neuroimmunomodulatory hormone - leptin. Treatment-induced weight gain tends to normalize those variables. The aim of the study was the longitudinal assessment of the relationship between leptin levels and depressive symptoms in patients with AN, since previous cross-sectional studies in different populations brought conflicting results.

METHODS: Thirty AN inpatients were assessed twice - at admission and after mean body mass index (BMI) increase of 3.2 kg/m(2). Physical parameters were measured, blood samples for leptin levels drawn and depression evaluated with both clinician - (Hamilton Depression Rating Scale - HDRS) and self - (Beck Depression Inventory - BDI) rated scales at the same morning. Correlation coefficients between changes in assessed variables, and linear regression for changes in depression scores were calculated.

RESULTS: BMI and leptin levels showed significant increase after treatment, respectively 14.45±0.90 vs. 17.61±0.87 and 1.87±1.14 vs. 7.47±4.65, whereas severity of depressive symptoms measured with BDI and HDRS was significantly reduced: 18.69±12.65 vs. 11.62±11.59; 12.76±6.90 vs. 5.66±4.91, respectively. In linear regression analysis decrease of the clinician-rated depression score (HDRS) was directly associated with decrease in the self-assessed depressive symptoms (BDI) (standardized Beta=0.45; t=2.60; p<0.05) and inversely related to the increase in leptin level (standardized Beta=-0.33; t=-2.08; p<0.05).

CONCLUSIONS: These results may suggest, that increase in leptin levels during weight recovery in patients with AN is associated with objectively measured depressive symptoms. Longitudinal studies in other populations are warranted to establish whether this relationship is valid across the weight spectrum....

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Comparative Study 2014; 35(1): 20-27 PubMed PMID: 24625913 Citation  Keywords:  Adult, Antibodies:immunology, Blood Glucose:analysis, Cholesterol:blood, Cholesterol, LDL:blood, Comorbidity, Cytomegalovirus:pathogenicity, Cytomegalovirus Infections:blood, Dehydroepiandrosterone:blood, Female, Humans, Immunoglobulin G:immunology, Male,.   

OBJECTIVES: Toxoplasma gondii, the protozoan parasite infecting about 30% population worldwide, is suspected to be the etiological agent of certain form of schizophrenia disease. Toxoplasma is known to change levels of certain neurotransmitters, cytokines and several hormones in both infected animals and humans. A common feature of toxoplasmosis and schizophrenia is a disorder of immune system.

METHODS: Here we studied the levels of five neuro- and immunomodulatory steroids, selected hormones and lipids in sera of 173 schizophrenia patients.

RESULTS: Toxoplasma infected schizophrenia patients expressed only insignificantly lower concentration of neuro- and immunomodulatory DHEA metabolites. Infected women had higher concentration of glucose while infected men had higher concentration of cholesterol and LDL cholesterol. No significant effect of human cytomegalovirus infection on the concentration of the above parameters was observed. The difference in the concentration of DHEA metabolites faded with the decrease of the concentration of anti-Toxoplasma IgG antibodies (i.e. with the duration of Toxoplasma infection) while the difference in the concentration of cholesterol and LDL-cholesterol increased with the decrease of the concentration of anti-Toxoplasma IgG antibodies. The prevalence of toxoplasmosis in male (53.2%) but not female (29.8%) schizophrenia patients was unusually high in comparison with prevalence of toxoplasmosis in a general population.

CONCLUSION: Our results provided an explanation for seemingly decreasing prevalence of toxoplasmosis in schizophrenia patients observed in current studies (increased concerns about the rights of patients resulting in absence of non-cooperative Toxoplasma-positive patients in the study population) and suggest possible explanation for reported positive correlation between prevalence of toxoplasmosis and incidence of cardiovascular diseases (accelerated atherosclerotic development due to increased level of cholesterol and LDL in Toxoplasma infected humans)....

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Journal Article 2013; 34(8): 738-744 PubMed PMID: 24522015 Citation  Keywords:  Anxiety Disorders:epidemiology, Bipolar Disorder:epidemiology, Comorbidity, Humans, Panic Disorder:epidemiology, Prevalence,.   

BACKGROUND: Anxiety disorders are common in patients with bipolar disorder and show considerable influence on the course of the disease and response to treatment.

METHOD: We conducted a series of literature searches using key words, such as bipolar disorder and anxiety disorders, as items in indexed fields. The studies were obtained through a MEDLINE search from 1970 to 2012. We also examined additional studies cited in articles from these searches or our previous studies.

RESULTS: Several studies have shown poorer outcomes for patients with bipolar and comorbid anxiety disorders. Some studies have indicated worse outcomes in patients with bipolar disorder and associated anxiety disorders. Shorter periods of euthymia, increased suicidal thoughts and an increased number of suicide attempts were observed. Whether the effective treatment of anxiety reduces suicide and the severity of bipolar disorder or improves the response to treatment remains unknown. There are no well-designed intervention studies in bipolar patients with anxiety symptoms.

CONCLUSION: Further studies concerning the influence of anxiety on the course of bipolar disorder would be useful....

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Journal Article 2013; 34(1): 1-8 PubMed PMID: 23524617 Citation  Keywords:  Bipolar Disorder:epidemiology, Comorbidity, Exploratory Behavior, Humans, Personality Disorders:epidemiology, Reward, Substance-Related Disorders:epidemiology,.   

BACKGROUND: Outcome in bipolar patients can be affected by comorbidity of other psychiatric disorders. Comorbid personality disorders are frequent and may complicate the course of bipolar illness. We have much information about treating patients with uncomplicated bipolar disorder (BD) but much less knowledge about possibilities for patients with the comorbidity of BD and personality disorder.

METHOD: We conducted a series of literature searches using, as key words or as items in indexed fields, bipolar disorder and personality disorder or personality traits. Articles were obtained by searching MEDLINE from 1970 to 2012. In addition, we used other papers cited in articles from these searches, or cited in articles used in our own work.

RESULTS: Tests of personality traits indicated that euthymic bipolar patients have higher scores on harm avoidance, reward dependence, and novelty seeking than controls. Elevation of novelty seeking in bipolar patients is associated with substance abuse comorbidity.

CONCLUSION: Comorbidity with personality disorders in BD patients is associated with a more difficult course of illness (such as longer episodes, shorter time euthymic, and earlier age at onset) and an increase in comorbid substance abuse, suicidality and aggression. These problems are particularly pronounced in comorbidity with borderline personality disorder. Comorbidity with antisocial personality disorder elicits a similar spectrum of difficulties; some of the antisocial behavior exhibited by patients with this comorbidity is mediated by increased impulsivity....

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Journal Article 2012; 33(7): 684-688 PubMed PMID: 23391876 Citation  Keywords:  Adult, Aged, Cardiovascular Diseases:epidemiology, Circadian Rhythm:physiology, Cohort Studies, Comorbidity, Disorders of Excessive Somnolence:epidemiology, Female, Humans, Male, Middle Aged, Polysomnography, REM Sleep Behavior Disorder:epidemiology, Rest.   

BACKGROUND: Obstructive sleep apnoea (OSA) is a condition leading to excessive daytime sleepiness. The aim of the study was a) to study course of daytime sleepiness in patients with OSA and b) to find the most important nocturnal polysomnography parameters influencing daytime sleepiness in OSA.

METHODS: The cohort consisted of forty-five patients (6 women, 39 men) diagnosed with OSA. All patients underwent polysomnography, Multiple Sleep Latency Test (MSLT) and rated subjectively their daytime tendency to sleep with the Epworth Sleepiness Scale.

RESULTS: Sleep latency was significantly longer at 15:00 and at 17:00 hours compared to previous tests. A significant negative correlation was found between the mean of the MSLT sleep latency and a number of awakenings, the apnoea/hypopnoea index and oxygen desaturation index values.

CONCLUSIONS: The study showed the sleep latency prolongation at 15:00 and 17:00 hours respectively and confirmed connection of excessive daytime sleepiness to fragmentation of nocturnal sleep and OSA severity....

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Case Reports 2011; 32(6): 748-750 PubMed PMID: 22286782 Citation  Keywords:  Adolescent, Anorexia Nervosa:epidemiology, Blindness:epidemiology, Body Image, Comorbidity, Female, Humans, Psychotherapy,.   

: Eating disorders represent significant psychopathological spectrum, particularly in adolescent girls. One of the risk factors associated with eating disorders is a strong emphasis of western visual-oriented culture on physical appearance and slimness. However, sensory handicap leading to disability to see one's own body and bodies of others does not mean that eating disorder cannot develop in blind people. The authors believe that body image is a mental construct that is not dependent on sensory perception only. They present the case of an adolescent patient, blind from early childhood, who shows symptoms of mental anorexia, depression, suicidal behavior and self-harming....

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Journal Article 2011; 32(2): 133-140 PubMed PMID: 21552194 Citation  Keywords:  Adult, Antioxidants:metabolism, Biomarkers:blood, Case-Control Studies, Comorbidity, Coronary Artery Disease:epidemiology, Depression:blood, Disease Progression, Fatigue Syndrome, Chronic:blood, Female, Glutathione Peroxidase:blood, Humans, Male, Middle A.   

BACKGROUND: Major depression and myalgic encephalomyelitis / chronic fatigue syndrome (ME/CFS) are two disorders accompanied by an upregulation of the inflammatory and oxidative and nitrosative (IO&NS) pathways and a decreased antioxidant status. Moreover, depression is accompanied by disorders in inflammatory and neuroprogressive (IN-PRO) pathways.

METHODS: This study examines whole blood glutathione peroxidase (GPX) in depression and in ME/CFS; GPX is an enzyme that reduces hydroperoxides by oxidizing glutathione and consequently protects the cells from oxidative damage. Blood was sampled in 39 patients with depression, 40 patients with ME/CFS and 24 normal volunteers. Whole blood was analysed for GPX activity using the Ransel assay (Randox). Severity of illness was measured by means of the Hamilton Depression Rating Scale (HDRS) and the Fibromyalgia and Chronic Fatigue Syndrome Rating Scale (FF scale).

RESULTS: We found that whole blood GPX activity was significantly (p=0.001) lower in depressed patients than in normal controls and that there were no significant differences between ME/CFS and controls. In depression and ME/CFS, there were significant and inverse relationships between GPX activity and the FF items, depressed mood and autonomic symptoms. In depression, there were significant and negative correlations between whole blood GPX and the HDRS score and autonomic symptoms.

DISCUSSION: The results show that lowered whole blood GPX activity contributes to the lowered antioxidant status in depression. Since GPX activity is a predictor of neuroprogression and coronary artery disease (CAD), lowered GPX activity in depression contributes to the IN-PRO pathways and the comorbidity between depression and CAD. Our results suggest that patients with depression would benefit from Ebselen or a supplementation with glutathione, N-Acetyl-l-Cysteine and selenium....

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Journal Article 2011; 32(1): 7-24 PubMed PMID: 21407167 Citation  Keywords:  Animals, Comorbidity, Depression:epidemiology, Humans, Inflammation:epidemiology, Neuroimmunomodulation:physiology, Oxidative Stress:immunology, Reactive Nitrogen Species:metabolism, Signal Transduction:immunology, Stress, Psychological:epidemiology,.   

: There is now evidence that depression, as characterized by melancholic symptoms, anxiety, and fatigue and somatic (F&S) symptoms, is the clinical expression of peripheral cell-mediated activation, inflammation and induction of oxidative and nitrosative stress (IO&NS) pathways and of central microglial activation, decreased neurogenesis and increased apoptosis. This review gives an explanation for the multiple "co-morbidities" between depression and a large variety of a) brain disorders related to neurodegeneration, e.g. Alzheimer's, Parkinson's and Huntington's disease, multiple sclerosis and stroke; b) medical disorders, such as cardiovascular disorder, chronic fatigue syndrome, chronic obstructive pulmonary disease, rheumatoid arthritis, psoriasis, systemic lupus erythematosus, inflammatory bowel disease, irritable bowel syndrome, leaky gut, diabetes type 1 and 2, obesity and the metabolic syndrome, and HIV infection; and c) conditions, such as hemodialysis, interferon-α-based immunotherapy, the postnatal period and psychosocial stressors. The common denominator of all those disorders/conditions is the presence of microglial activation and/or activation of peripheral IO&NS pathways. There is evidence that shared peripheral and / or central IO&NS pathways underpin the pathophysiology of depression and the previously mentioned disorders and that activation of these IO&NS pathways contributes to shared risk. The IO&NS pathways function as a smoke sensor that detect threats in the peripheral and central parts of the body and signal these threats as melancholic, anxiety, and fatigue and somatic (F&S) symptoms. The presence of concomitant depression is strongly associated with a lower quality of life and increased morbidity and mortality in medical disorders. This may be explained since depression contributes to increased (neuro)inflammatory burden and may therefore drive the inflammatory and degenerative progression. It is concluded that the activation of peripheral and / or central IO&NS pathways may explain the co-occurrence of depression with the above disorders. This shows that depression belongs to the spectrum of inflammatory and degenerative disorders....

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