The influence of gender-specific factors influencing severe anxiety in psychotic major depression: role of thyroid hormones and depression severity.

BACKGROUND: Psychotic major depression (PMD) is characterized by major depressive disorder (MDD) accompanied by delusions or hallucinations. While the prevalence of PMD and its association with anxiety have been studied, gender-specific differences and the role of thyroid hormones in PMD-related anxiety remain less explored. METHODS: A total of 1718 first-episode and drug-naïve MDD patients was assessed for the presence of PMD and severe anxiety. Clinical assessments, including Hamilton Depression Rating Scale (HAMD), Hamilton Anxiety Rating Scale (HAMA), Positive and Negative Syndrome Scale (PANSS), and Clinical Global Impressions-Severity (CGI-S) scale, were conducted to assess depression, anxiety, psychotic symptoms, and clinical severity, respectively. Blood samples were collected to measure thyroid function parameters. RESULTS: The prevalence of severe anxiety was higher in PMD patients compared to non-psychotic MDD patients (71.3% vs. 5.3%). No significant gender differences were observed in the prevalence of severe anxiety among PMD patients. However, elevated thyroid-stimulating hormone (TSH) levels and increased depression severity (HAMD scores) were identified as independent risk factors for severe anxiety in female PMD patients. In contrast, no significant risk factors were found in male PMD patients. The area under the receiver operating characteristic (AUCROC) analysis revealed that the HAMD score and TSH level showed acceptable discriminatory capacity for distinguishing between female PMD patients with and without severe anxiety. CONCLUSION: This study highlights the heightened prevalence of severe anxiety in PMD patients, with TSH levels and depression severity emerging as gender-specific risk factors for anxiety in females. These findings suggest the importance of thyroid hormone assessment and tailored interventions for managing anxiety in female PMD patients.

The association between childhood trauma and the age of onset in drug-free bipolar depression.

OBJECTIVE: This study aimed to investigate the relationship between childhood trauma and clinical correlates in bipolar depression. METHODS: A total of 61 bipolar depression patients were enrolled and assessed based on the Childhood Trauma Questionnaire-Short Form (CTQ-SF), Patient Health Questionaire-15 (PHQ-15), Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7) systems. RESULTS: The age of onset in bipolar depression patients with either trauma or abuse or neglect was significantly lower than in patients without these factors. There were statistically significant negative correlations between the age of onset and the number of different trauma types in bipolar depression patients. Multiple variable regression showed a significant association between the number of trauma types and the age of onset. Furthermore, there was a significant negative correlation between the age of onset with CTQ-SF total score (CTS), emotional abuse score and emotional neglect score, and physical neglect score. However, multiple variable regression analysis revealed that there was a significant association between emotional abuse score and the age of onset of bipolar depression patients. CONCLUSION: Our results suggest that childhood trauma may be associated with physical symptoms and the age of onset in bipolar depression patients.

Association between the improvement in depressive symptoms and serum BDNF levels in drug-naive first episode patients with schizophrenia: A longitudinal follow-up.

Depressive symptoms are frequent clinical manifestations in patients with schizophrenia. Decreased brain-derived neurotrophic factor (BDNF) has been shown to be involved in the development of depressive symptoms. However, the detailed molecular mechanism of BDNF in the depressive symptoms of schizophrenia patients remains to be fully elucidated. This study aimed to investigate the role of BDNF in the depressive symptoms in drug-naïve first-episode (DNFE) patients with schizophrenia and whether BDNF levels were associated with the improvement of depressive symptoms after olanzapine treatment. 50 DNFE schizophrenia patients and 55 healthy controls were recruited, and their serum BDNF levels were compared. All patients were treated with olanzapine monotherapy for 12 weeks, and 45 patients completed the trial. The serum BDNF levels and depressive symptoms were measured again at follow-up. We found that DNFE patients had lower BDNF levels, compared to controls. Last observation carried forward (LOCF) analysis was used for patients who dropped out after the second month, and 50 patients were included in the statistical analysis with LOCF. After 12 weeks of treatment with olanzapine, BDNF levels were significantly increased and depressive symptoms were significantly decreased. Correlation analysis showed that the change of BDNF levels after treatment was correlated with the change of HAMD total score from baseline. Further regression analysis showed that the change in BDNF levels was an independent predictor for the improvement in depressive symptoms, after controlling age, BMI change and the decrease of PANSS total score. However, the baseline BDNF levels were not associated with an improvement in depressive symptoms in patients. Our findings reveal that olanzapine treatment can increase BDNF levels and improve depressive symptoms in schizophrenia patients. Moreover, the changes in serum BDNF levels were related to the improvement in depressive symptoms.

Patient health questionnaire-15 (PHQ-15) to distinguish bipolar II disorder from major depressive disorder.

A sequential-recruited clinical trial has been conducted to assess capacity of Patient Health Questionnaire-15 (PHQ-15) in distinguishing bipolar II disorder from major depressive disorder. A total of 73 patients (49 BD-II depression patients) filled sociodemographic characteristics, Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 Questionnaire (GAD-7), and PHQ-15. Sum score of PHQ-15 showed statistically significant difference in the two groups (t-test, P = 0.027). The area under the curve was 0.663 (P = 0.025), and the specificity was 0.75 at sum score of 13. Patients with BD-II depression has more somatic symptoms than MDD, and PHQ-15 might be used for identification.

Changes in brain glucose metabolism and connectivity in somatoform disorders: an 18F-FDG PET study.

Somatoform disorders (SFD) are defined as a syndrome characterized by somatic symptoms which cannot be explained by organic reasons. Chronic or recurrent forms of somatization lead to heavy emotional and financial burden to the patients and their families. However, the underlying etiology of SFD is largely unknown. The purpose of this study is to investigate the changed brain glucose metabolic pattern in SFD. In this study, 18 SFD patients and 21 matched healthy controls were enrolled and underwent an 18F-FDG PET scan. First, we explored the altered brain glucose metabolism in SFD. Then, we calculated the mean 18F-FDG uptake values for 90 AAL regions, and detected the changed brain metabolic connectivity between the most significantly changed regions and all other regions. In addition, the Pearson coefficients between the neuropsychological scores and regional brain 18F-FDG uptake values were computed for SFD patients. We found that SFD patients showed extensive hypometabolism in bilateral superolateral prefrontal cortex, insula, and regions in bilateral temporal gyrus, right angular gyrus, left gyrus rectus, right fusiform gyrus, right rolandic operculum and bilateral occipital gyrus. The metabolic connectivity between right insula and prefrontal areas, as well as within prefrontal areas was enhanced in SFD. And several brain regions were associated with the somatic symptoms, including insula, putamen, middle temporal gyrus, superior parietal gyrus and orbital part of inferior frontal gyrus. Our study revealed widespread alterations of the brain glucose metabolic pattern in SFD patients. Those findings might elucidate the neuronal mechanisms with glucose metabolism and shed light on the pathology of SFD.

Olanzapine May Inhibit Colonic Motility Associated with the 5-HT Receptor and Myosin Light Chain Kinase.

OBJECTIVE: To study whether the effects of olanzapine on gastrointestinal motility is related to the serotonin antagonism and myosin light chain kinase. METHODS: Male Sprague-Dawley rats were randomly divided into four groups. Olanzapine gavage was performed for each treatment group during the course of 30 continuous days, while the same volume of saline was given to the rats in the control group. Defecation of the rats was observed on days 7 and 30 after olanzapine gavage. The effects of olanzapine on contraction of colonic smooth muscles were observed in ex vivo experiments. A Western blot was used to evaluate expression levels of the serotonin transporter (SERT) and MLCK in colon segments of the rats. RESULTS: ResultsaaCompared to the control group, 5-160 µ M of olanzapine could inhibit dose-dependently the contraction of colonic smooth muscle ex vivo experiments. The maximum smooth muscle contraction effects of 5-HT and acetylcholine significantly decreased after treatment with 40-160 µ M of olanzapine. Constipation was found in the olanzapine-treated rats on day 7 and have sustained day 30 after gavage. Expression of MLCK in olanzapine-treated rats was significantly decreased, whereas the expression of SERT significantly increased on the day 7, then significantly decreased on the day 30 after olanzapine gavage. CONCLUSION: SERT and MLCK may involve in the inhibition of colonic contraction induced by olanzapine.

Psychological status and quality of life in acoustic neuroma patients with facial palsy after microsurgery: a 1-year postoperative follow-up study.

Psychological status and quality of life in postoperative acoustic neuroma patients were well documented. However, few studies have been proceed in China and investigated in a relative homogenous group. To assess the psychological status and quality of life in patients with facial palsy operated by an identical surgeon in Shanghai, China. We retrospectively reviewed 24 patients who had undergone microsurgery via a retrosigmoid approach in 2009-2010. Each patient was followed up with MRI/CT image and facial palsy evaluation. A mailed comprehensive questionnaire was used to assess the psychological status and quality of life for these patients. Meanwhile, a telephone interview was previously carried out for the consents. Statistical analysis was performed using Stata software. We found that a proportion of anxiety and depression existed among the postoperative acoustic neuroma patients, although a relative physical health was reserved. Facial palsy caused by microsurgery treatment may be a key factor triggered and involved in the psychiatric symptoms and clinicians must be aware that early involvement of a clinical psychologist may be very helpful.

Emotion and cognitive function assessment of patients with central neurocytoma resection through transcortical frontal approach: a 5-year postoperative follow-up study.

BACKGROUND: Central neurocytoma accounts for 0.1% of primary brain tumor that often occurs in young adults. Surgery is the main treatment for central neurocytoma and the rate of 5-year survival reaches up to over 90%. This study aimed to assess the effect of transcortical frontal approach to surgical resection of central neurocytoma on emotion and cognitive function 5 years after surgery. METHODS: Telephone following-up visits were used in this study. By means of neuropsychological testing, assayed emotion, memory and abstract thinking ability of 18 patients undergoing central neurocytoma resection by transcortical frontal approach for 5 years or more, with another 21 normal cases as control group were enrolled. The data were analyzed statistically by paired t test with SPSS11.5. RESULTS: Patients whose central neurocytoma was removed by transcortical frontal approach were not affected on calculating ability 5 years after operation while ability of memory declined sharply (P = 0.000), the older, the more sharply (P = 0.036). Ability of abstract thinking was significantly reduced (P = 0.000), the older, the more significantly as well (P = 0.012); additionally, anxiety and depression occurred in patients rather more than those of control group (P = 0.000), especially cognitive impairment. CONCLUSIONS: Transcortical frontal approach for surgical resection of central neurocytoma has certain long-term influence on patients' life quality, vulnerable to anxiety, depression and cognitive impairment, the severity of which was correlated to age. Therefore, improving surgical approach will be of value for better long-term life quality of patients.