Serum levels of chemokines in adolescents with major depression treated with fluoxetine.

BACKGROUND: Major depressive disorder (MDD) is a global health issue that affects 350 million people of all ages. Although between 2% and 5.6% of affected individuals are adolescents, research on young patients is limited. The inflammatory response contributes to the onset of depression, and in adult MDD patients, symptom severity has been linked to chemokine levels. AIM: To determine the differences in circulatory levels of chemokines in healthy volunteers (HVs) and adolescents with MDD, and assess the changes induced by fluoxetine consume. METHODS: The 22 adolescents with MDD were monitored during the first 8 wk of clinical follow-up and clinical psychiatric evaluation was done using the Hamilton depresión rating scale (HDRS). The serum levels of monocyte chemoattractant protein-1 (MCP-1), macrophage inflammatory protein (MIP)-1α, MIP-1ß, interleukin (IL)-8, interferon gamma-induced protein (IP)-10, and eotaxin were measured in patients and HVs. RESULTS: In all cases, significant differences were detected in circulating chemokine levels between patients before treatment and HVs (P < 0.0001). All chemokines decreased at 4 wk, but only MCP-1 and IL-8 significantly differed (P < 0.05) between 0 wk and 4 wk. In the patients, all chemokines rose to their initial concentrations by 8 wk vs 0 wk, but only IP-10 did so significantly (P < 0.05). All patients experienced a significant decrease in HDRS scores at 4 wk (P < 0.0001) and 8 wk (P < 0.0001) compared with 0 wk. CONCLUSION: Despite the consumption of fluoxetine, patients had significantly higher chemokine levels, even after considering the improvement in HDRS score. The high levels of eotaxin, IP-10, and IL-8 partially explain certain aspects that are affected in MDD such as cognition, memory, and learning.

Alterations in the Levels of Growth Factors in Adolescents with Major Depressive Disorder: A Longitudinal Study during the Treatment with Fluoxetine.

Major depressive disorder (MDD) has a prevalence of 5% in adolescents. Several studies have described the association between the inflammatory response and MDD, but little is known about the relationship between MDD and growth factors, such as IL-7, IL-9, IL-17A, VEGF, basic FGF, G-CSF, and GM-CSF. It must be appointed that there are scarce reports on growth factors in adolescents with MDD and even fewer with a clinical follow-up. In this work, we evaluated the levels of growth factors (IL-7, IL-9, IL-17A, VEGF, basic FGF, G-CSF, and GM-CSF) in MDD adolescents and the clinical follow-up during eight weeks of treatment with fluoxetine. Methods. All patients were diagnosed according to the DSM-IV-TR, and the severity of the symptoms was evaluated using the Hamilton Depression Rating Scale (HDRS). Growth factors IL-7, IL-9, IL-17A, VEGF, basic FGF, G-CSF, and GM-CSF were quantified by cytometric bead array using serum samples from 22 adolescents with MDD and 18 healthy volunteers. Results. All patients showed clinical improvement since the fourth week of pharmacological treatment according to the HDRS. Considerably higher levels of IL-7, IL-9, IL-17A, VEGF, basic FGF, G-CSF, and GM-CSF were detected in MDD adolescents as compared to healthy volunteers. A significant but temporal decrease was detected in basic FGF, G-CSF, and GM-CSF at week four of fluoxetine administration. Conclusions. To the best of our knowledge, this is the first report to show alterations in the levels of growth factors, such as IL-7, IL-9, IL-17A, VEGF, basic FGF, G-CSF, and GM-CSF in MDD adolescents during eight weeks of clinical follow-up. These disturbances might be involved in the physiopathology of MDD since such growth factors have been proven to participate in the neural development and correct functioning of the CNS; therefore, subtle alterations in it may contribute to MDD.

A prospective study of adverse effects of antipsychotics in adolescents with schizophrenia during a 6-month follow-up.

There is a paucity of follow-up studies of neurological, endocrine, and metabolic adverse effects of antipsychotics in adolescents from low-income and middle-income countries, who have a higher prevalence of obesity and overweight, and could present increased morbidity. A Mexican sample of 86 adolescents with schizophrenia was examined during a 6-month follow-up using the Simpson-Angus, abnormal involuntary movement and Barnes Akathisia rating scales, in addition to a side effects score sheet and other laboratory measures. Binary logistic regression models were used to identify specific variables as predictors of weight gain. Sleep difficulties, restlessness, drowsiness, changes in thyroid hormones, and a linear increase in weight gain were observed. A baseline positive and negative syndrome scale score greater than 97 predicted a 5 kg increase at month 3 (odds ratio: 4.52, 95% confidence interval: 1.5-13.2). The absence of a plateau in weight gain in the present study across the 6-month treatment period and its relationship with illness severity suggests that even longer follow-up time should be examined in future studies in these patient populations.

Validity and reliability of the kiddie schedule for affective disorders and schizophrenia present and lifetime version DSM-5 (K-SADS-PL-5) Spanish version.

BACKGROUND: There are various language adaptations of the Schedule for Affective Disorders and Schizophrenia for School Age Children Present and Lifetime Version (K-SADS-PL). In order to comply with the changes in DSM classification, the Spanish edition of the interview was in need of update and evaluation. METHODS: K-SADS-PL was adapted to correspond to DSM-5 categories. All clinicians received training, and a 90% agreement was reached. Patients and their parents or guardians were interviewed and videotaped, and the videos were exchanged between raters. Factor analysis was performed and inter-rater reliability was calculated only in the case of diagnoses in which there were more than five patients. RESULTS: A total of 74 subjects were included. The Factor Analysis yielded six factors (Depressive, Stress Hyperarousal, Disruptive Behavioral, Irritable Explosive, Obsessive Repetitive and Encopresis), representing 72% of the variance. Kappa values for inter-rater agreement were larger than 0.7 for over half of the disorders. CONCLUSIONS: The factor structure of diagnoses, made with the instrument was found to correspond to the DSM-5 disorder organization. The instrument showed good construct validity and inter-rater reliability, which makes it a useful tool for clinical research studies in children and adolescents.

Inflammatory Profiles in Depressed Adolescents Treated with Fluoxetine: An 8-Week Follow-up Open Study.

Changes in cytokine levels in major depression and during treatment have been reported in adults. However, few studies have examined cytokine levels in an adolescent sample despite this being a common age of onset. Methods. We measured proinflammatory (IL-2, IFN-γ, IL-1ß, TNF-α, IL-6, IL-12, and IL-15) and anti-inflammatory (IL-4, IL-5, IL-13, IL-1Ra, and IL-10) cytokine serum levels in 22 adolescents with major depression and 18 healthy volunteers. Cytokines were measured by multiplex bead-based immunoassays at baseline, and 4 and 8 weeks after commencement of fluoxetine administration in the clinical group. Results. Compared to healthy volunteers, adolescents with major depression at baseline showed significant increases in all pro- and anti-inflammatory cytokines, except IL-1Ra and IL-10. Significant changes were observed in fluoxetine treatment compared to baseline: proinflammatory cytokines IFN-γ, IL-1ß, TNF-α, IL-6, IL-12, and IL-15 were decreased only at week 4 whereas IL-2 was increased only at week 8; anti-inflammatory cytokines IL-4 and IL-5 were increased at week 8 while IL-1Ra was reduced only at week 4. There were no significant correlations between cytokine levels and symptomatic improvement in HDRS. Discussion. The results suggest a significant interplay between cytokine levels, the depressive state, and the stage of treatment with an SSRI. To the best of our knowledge, this is the first report in depressed adolescents with elevated IL-12, IL-13, and IL-15 levels. Further studies are necessary to clarify the role and mechanisms of altered cytokine levels in the pathogenesis and physiopathology of major depressive disorder.

Validity and reliability of the Spanish version of the Personal and Social Performance scale in adolescents with schizophrenia.

BACKGROUND: The Personal and Social Performance (PSP) scale is a widely used tool to evaluate adults with schizophrenia; however, more studies are needed regarding its usefulness in the assessment of adolescent patients, since the evaluation of their functioning could require adaptations according to development. OBJECTIVE: To examine construct validity, convergent validity, internal consistency and interrater reliability of the PSP in a sample of Mexican adolescents with schizophrenia. METHODS: A total of 40 patients with a DSM-IV diagnosis of schizophrenia or schizophreniform disorder were evaluated with PSP, CGAS, PANSS and the MATRICS battery. Construct and convergent validity were determined by the correlation between PSP with PANSS factors, MATRICS dimensions and CGAS. In addition, reliability was evaluated with Cronbach's alpha and intraclass correlation coefficients. RESULTS: PSP scores correlated with negative, excitement and cognitive factors of PANSS, CGAS as well as MATRICS domains. The PSP also showed high internal consistency and interrater reliability. CONCLUSIONS: The PSP is a valid and reliable instrument for the assessment of adolescent patients.

[Clinical research XXI. From the clinical judgment to survival analysis]. / Investigación clínica XXI. Del juicio clínico al análisis de supervivencia.

Decision making in health care implies knowledge of the clinical course of the disease. Knowing the course allows us to estimate the likelihood of occurrence of a phenomenon at a given time or its duration. Within the statistical models that allow us to have a summary measure to estimate the time of occurrence of a phenomenon in a given population are the linear regression (the outcome variable is continuous and normally distributed -time to the occurrence of the event-), logistic regression (outcome variable is dichotomous, and it is evaluated at one single interval), and survival curves (outcome event is dichotomous, and it can be evaluated at multiple intervals). The first reference we have of this type of analysis is the work of the astronomer Edmond Halley, an English physicist and mathematician, famous for the calculation of the appearance of the comet orbit, recognized as the first periodic comet (1P/Halley's Comet). Halley also contributed in the area of health to estimate the mortality rate for a Polish population. The survival curve allows us to estimate the probability of an event occurring at different intervals. Also, it leds us to estimate the median survival time of any phenomenon of interest (although the used term is survival, the outcome does not need to be death, it may be the occurrence of any other event).

La toma de decisiones durante la atención médica implica el conocimiento de la evolución clínica de la enfermedad. A su vez, el conocimiento de la evolución clínica permite estimar la posibilidad de ocurrencia de un fenómeno en un tiempo determinado o su tiempo de duración. Entre los modelos estadísticos con los que es posible obtener una medida de resumen para estimar el tiempo de ocurrencia de un fenómeno en una población determinada se encuentran la regresión lineal (variable dependiente continua y con distribución normal [tiempo a la ocurrencia del fenómeno]), la regresión logística (variable dependiente dicotómica, en un solo intervalo) y las curvas de supervivencia (variable dependiente dicotómica, en múltiples intervalos). La primera referencia que se tiene sobre este tipo de análisis es el trabajo publicado en 1693 por el astrónomo, físico y matemático inglés Edmundo Halley ­famoso por el cálculo de la órbita y aparición del cometa reconocido como el primer cometa periódico (el 1P/cometa Halley)­ quien contribuyó en el área de la salud con la estimación de la tasa de mortalidad para una población polaca. Las curvas de supervivencia permiten calcular la probabilidad de que ocurra un fenómeno a distintos intervalos y, de igual forma, permiten estimar la mediana de supervivencia de cualquier fenómeno de interés (aunque se utiliza el término supervivencia, el desenlace no necesariamente tiene que ser muerte, sino la ocurrencia de cualquier otro fenómeno).

Relationship of dropout and psychopathology in a high school sample in Mexico.

School dropout has significant consequences for both individuals and societies. Only 21% of adults in Mexico achieve the equivalent of a high school education. We examined the relationship between school dropout and self-reported psychiatric symptoms in a middle school in a suburb of Mexico City. We used binomial logistic regression to examine the odds ratio (OR) of school dropout associated with students' self-reported psychopathology. Two-hundred thirty-seven students participated in the study. Psychosis [OR = 8.0 (95% confidence interval, CI: 1.7-37.2)], depression [OR = 4.7 (95% CI: 2.2-9.7)], tic disorders [OR = 3.7 (95% CI: 1.4-9.5)], ADHD [OR = 3.2 (95% CI: 1.5-6.4)], and social phobia [OR = 2.6 (95% CI: 1.2-5.8)] were associated with increased risk of school dropout after controlling for age and gender as covariates. Our study suggested that students' self-reported psychopathology is associated with increased school dropout in Mexico. ADHD and depression may be particularly useful childhood psychiatric disorders to target with public health interventions because they explain the greatest amount of the variance in school dropout of child psychiatric disorders.