Therapeutic termination of pregnancy and major psychiatric outcomes in parents.

OBJECTIVES: Therapeutic termination of pregnancy (TToP) may have psychiatric outcomes like depression, anxiety and post-traumatic-stress disorder (PTSD). MATERIAL AND METHODS: 45 couples had psychiatric evaluation before TToP and after one-year period. RESULTS: TToP is linked to acute development of depressive symptoms that recover with time and professional support. Twelve percent of women developed PTSD (but 29.5% refused one-year evaluation due to mental distress at recalling TToP). Fathers showed no psychiatric outcomes. CONCLUSIONS: Acute depressive symptoms after TToP improve with professional support but PTSD rate is concerning and stress importance of mental health implications and need for adequate related treatments.

Disentangling binge eating disorder and food addiction: a systematic review and meta-analysis.

BACKGROUND AND AIMS: The concept of "Food Addiction" has been based on criteria of Substance Use Disorder. Several studies suggested a relationship between food addiction and eating disorders, but little is known about its extent or role. We aim at exploring if food addiction is coincident with a specific eating disorder (binge eating disorder appears the closest) or it is a separate diagnostic entity that afflicts in comorbidity with eating disorders or other conditions like obesity or even in the general population. METHODS: This systematic review and meta-analysis analyzed observational studies with a comparative estimation on rates of subjects affected by binge eating disorder and food addiction. RESULTS: Binge eating disorder shows higher comorbidity with food addiction compared to other eating disorders (OR = 1.33, 95% CI, 0.64-2.76; c2 = 4.42; p = 0.44;I2 = 0%), or each eating disorder [anorexia nervosa purging type (OR = 1.93, 95% CI, 0.20-18.92; p = 0.57) and restrictive type (OR = 8.75, 95% CI, 1.08-70.70; p = 0.04)], obese patients (OR = 5.72, 95% CI, 3.25-10.09; p = < 0.0001) and individuals from the general population (OR = 55.41, 95% CI, 8.16-376.10; c2 = 18.50; p < 0.0001; I2 = 0%)but has decreased prevalence when compared to bulimia nervosa (OR = 0.85, 95% CI, 0.33-2.22; c2 = 0.35; p = 0.74; I2 = 0%). DISCUSSION AND CONCLUSIONS: Our data show that the prevalence of food addiction in binge eating disorder is higher than in other eating disorders except in bulimia nervosa. Moreover, it is a separate diagnostic reality and can be detected in people without mental illness and in the general population. Food addiction might have a prognostic value, since in comorbidity, and should be addressed to boost treatment efficacy and patient's recovery. LEVEL OF EVIDENCE: I: Evidence obtained systematic reviews and meta-analyses.

Cannabis and Pregnancy: A Psychiatric, Medical, or General Population Issue?

BACKGROUND: Cannabis use during pregnancy may adversely affect the health of pregnant women and their fetus. Several recent surveys led in the US general population in the last decade showed an increase in cannabis use during pregnancy from 1.95 to 7%, with a 0.5% for medical-only purposes. OBJECTIVES: Our aim was to investigate if an increased incidence might be due to a greater public acceptability after introduction of cannabis medical use or due to psychiatric implications and unmet needs. METHOD: 500 pregnant women (302 psychiatric patients and 198 healthy controls) were tested with the Edimburgh Post-Natal Depression Scale, Beck Anxiety and Depression Inventory, and Structured Clinical Interview for the DSM-IV Axis II while substance use disorder was documented with the fulfillment of the DSM-5 criteria. RESULTS: Five percent of the whole sample had a documented addiction to cannabis during pregnancy (all among psychiatric patients and none in the general population). All psychiatric patients with cannabis use disorder were affected by borderline personality disorder, except for 1 patient with cannabis and cocaine use disorders who suffered from adjustment disorder with anxiety. CONCLUSIONS: Addiction to cannabis during pregnancy has an increased rate confirming surveys on the general US population but seem entirely linked to psychiatric issues, especially borderline personality disorder. Personality disorders may have been underestimated in surveys in the general population until now because these are usually not assessed.

The burden of personality disorders on the DSM 5 addiction to tobacco during pregnancy.

BACKGROUND: Tobacco smoking is a major health concern. Many women smoke during their reproductive years, some of them during their pregnancy. Adverse outcomes for the newborns physical health are well recognized, while the influence on their mental health is still under investigation. We aim at demonstrating the contribution of maternal personality disorders in maintaining addiction to tobacco during pregnancy, to underline their role and the need of their detection as a preventive effort. METHOD: 150 women, consecutively admitted to the Perinatal Psychiatric Outpatient Department were tested with the SCID II, CTQ, WHOQOL-BREF, EPDS, BDI and BAI. Tobacco use disorder was attested with the fulfillment of DSM 5 criteria. RESULTS: 46% (n = 69) of the sample was affected by at least one personality disorder ("PD+"). "PD+" showed a significant higher rate of pregnant women addicted to tobacco (p = 0.021). The average number of cigarettes per day was notably distinct, since patients affected by "NPD" smokes twice the amount compared to "PD-" and "other PDs", while those affected by Borderline PD has a halfway consumption (7.20 ±â€¯5.54 vs 3.37 ±â€¯4.62 vs 3 ±â€¯3.39 vs 5.50 ±â€¯4.10). ANOVA and POST HOC showed a significance between "NPD" and "other PDs" (p = 0.035), and "other PDs" has significantly the highest rate of active smokers. CONCLUSION: Personality disorders demonstrate to be a clear contributor in supporting addiction to tobacco during pregnancy. Short and long term health and mental consequences attested in the newborn, encourage awareness in detecting tobacco dependency during this sensitive period. The inclusion of personality evaluation and management in tobacco dependency treatment programs is strictly encouraged to boost their efficiency and increase tobacco abstinence.

Regulation of autophagy and the ubiquitin-proteasome system by the FoxO transcriptional network during muscle atrophy.

Stresses like low nutrients, systemic inflammation, cancer or infections provoke a catabolic state characterized by enhanced muscle proteolysis and amino acid release to sustain liver gluconeogenesis and tissue protein synthesis. These conditions activate the family of Forkhead Box (Fox) O transcription factors. Here we report that muscle-specific deletion of FoxO members protects from muscle loss as a result of the role of FoxOs in the induction of autophagy-lysosome and ubiquitin-proteasome systems. Notably, in the setting of low nutrient signalling, we demonstrate that FoxOs are required for Akt activity but not for mTOR signalling. FoxOs control several stress-response pathways such as the unfolded protein response, ROS detoxification, DNA repair and translation. Finally, we identify FoxO-dependent ubiquitin ligases including MUSA1 and a previously uncharacterised ligase termed SMART (Specific of Muscle Atrophy and Regulated by Transcription). Our findings underscore the central function of FoxOs in coordinating a variety of stress-response genes during catabolic conditions.