An Indicator of environmental enrichment to measure physical, social and cognitive activities in human daily life.

BACKGROUND: The concept of environmental enrichment (EE) encompasses complex physical, social, cognitive, motor, and somatosensory stimuli to which individuals are differentially exposed. An indicator of EE comprising these elements would facilitate the study of the impact of EE in diverse clinical settings by allowing an easy and comparable measurement. This study aimed to create and test such an EE indicator based on the Florida Cognitive Activities Scale (FCAS), the Multidimensional Social Integration in Later Life Scale (SILLS), and the International Physical Activity Questionnaire (IPAQ). METHODS: Participants with major depression and control subjects were recruited in this cross-sectional comparative study. Depressive symptom severity was assessed with the Hamilton Depression Rating Scale (HAM-D). The EE indicator was used to evaluate cognitive, social, and physical activity. We divided the sample into three levels of cognitive and social activities to construct an EE indicator and compared the obtained scores between participants with major depression and control subjects. RESULTS: 40 patients suffering from major depression and 50 control subjects were included. Higher HAM-D scores were associated with lower EE levels. Cognitive and social items exhibited adequate reliability. Control subjects reported higher scores in all three activities evaluated, except for some items of physical activities. This indicator of EE clearly differentiated between participants with major depression from control subjects. CONCLUSIONS: FCAS, SILLS, and IPAQ used together are valid to evaluate EE. This EE indicator may be a useful tool during clinical practice. The cross-sectional design and the small sample size are limitations of the present study.

Chemokine profile in women with moderate to severe anxiety and depression during pregnancy.

BACKGROUND: Cytokine levels have been extensively described in pregnant subjects under normal and pathological conditions, including mood-related disorders. Concerning chemokines, very few studies have reported their association with psychiatric disorders during pregnancy. Therefore, we explored the chemokine profile in women exhibiting anxiety and depression during late pregnancy in the present study. METHODS: One hundred twenty-six pregnant women in the 3rd trimester of pregnancy, displaying moderate to severe anxiety (ANX) alone and women exhibiting moderate to severe anxiety with comorbid depression (ANX + DEP), and 40 control pregnant women without affective disorders (CTRL) were evaluated through the Hamilton Anxiety Rating Scale (HARS) and the Hamilton Depression Rating Scale (HDRS). Serum chemokine levels of MCP-1 (CCL2), RANTES (CCL5), IP-10 (CXCL10), Eotaxin (CCL11), TARC (CCL17), MIP-1α (CCL3), MIP-1ß (CCL4), MIG (CXCL9), MIP-3α (CCL20), ENA-78 (CXCL5), GROα (CXCL1), I-TAC (CXCL11) and IL-8 (CXCL8)] were measured by immunoassay. Clinical, biochemical, and sociodemographic parameters were correlated with HARS and HDRS score values. RESULTS: Serum levels of most chemokines were significantly higher in the ANX and in the ANX + DEP groups, when compared to the CTRL group. Positive correlations were observed between MIP-1α/CCL3, MIP-1ß/CCL4, MCP-1/CCL2, MIP-3α/CCL20, RANTES/CCL5, Eotaxin/CCL11, and I-TAC/CXCL11 with high scores for anxiety (HARS) (p < 0.05) and for depression (HDRS) (p < 0.004). After controlling clinical measures for age + gwk + BMI, chemokines such as IL-8/CXCL8, MCP-1/CCL2 and MIP-1ß/CCL4 were found associated with high scores for anxiety (p < 0.05) in the ANX group. TARC/CCL17 and Eotaxin/CCL11 showed significant associations with high scores for depression (p < 0.04) whereas, MCP-1/CCL2 and MIP-1α/CCL3 were significantly associated with high scores for anxiety (p < 0.05) in the ANX + DEP group. Using a multivariate linear model, high serum levels of MIP-1ß/CCL4 and Eotaxin/CCL11 remained associated with depression (p < 0.01), while, IL-8/CXCL8, MIP-1ß/CCL4, MCP-1/CCL2, and MIP-1α/CCL3 were associated with anxiety (p < 0.05) in the symptomatic groups. CONCLUSIONS: Our data show that serum levels of distinct chemokines are increased in women exhibiting high levels of affective symptoms during late pregnancy. Our results suggest that increased levels of anxiety, depressive symptoms, and mood-related disorders may promote changes in specific functional chemokines associated with a chronic inflammatory process. If not controlled, it may lead to adverse obstetric and negative neonate outcomes, child development and neuropsychiatric alterations in the postnatal life. HIGHLIGHTS: Chemokine levels increase in affective disorders during pregnancy.

Short Daily Exposure to Environmental Enrichment, Fluoxetine, or Their Combination Reverses Deterioration of the Coat and Anhedonia Behaviors with Differential Effects on Hippocampal Neurogenesis in Chronically Stressed Mice.

Depression is a neuropsychiatric disorder with a high impact on the worldwide population. To overcome depression, antidepressant drugs are the first line of treatment. However, pre-clinical studies have pointed out that antidepressants are not entirely efficacious and that the quality of the living environment after stress cessation may play a relevant role in increasing their efficacy. As it is unknown whether a short daily exposure to environmental enrichment during chronic stress and antidepressant treatment will be more effective than just the pharmacological treatment, this study analyzed the effects of fluoxetine, environmental enrichment, and their combination on depressive-associated behavior. Additionally, we investigated hippocampal neurogenesis in mice exposed to chronic mild stress. Our results indicate that fluoxetine reversed anhedonia. Besides, fluoxetine reversed the decrement of some events of the hippocampal neurogenic process caused by chronic mild stress. Conversely, short daily exposure to environmental enrichment changed the deterioration of the coat and anhedonia. Although, this environmental intervention did not produce significant changes in the neurogenic process affected by chronic mild stress, fluoxetine plus environmental enrichment showed similar effects to those caused by environmental enrichment to reverse depressive-like behaviors. Like fluoxetine, the combination reversed the declining number of Ki67, doublecortin, calretinin cells and mature newborn neurons. Finally, this study suggests that short daily exposure to environmental enrichment improves the effects of fluoxetine to reverse the deterioration of the coat and anhedonia in chronically stressed mice. In addition, the combination of fluoxetine with environmental enrichment produces more significant effects than those caused by fluoxetine alone on some events of the neurogenic process. Thus, environmental enrichment improves the benefits of pharmacological treatment by mechanisms that need to be clarified.

Cortisol and DHEA-S levels in pregnant women with severe anxiety.

BACKGROUND: A complex interaction between cortisol and dehydroepiandrosterone-sulphate (DHEA-S) is crucial in the stress system balance; several studies have reported increased cortisol levels during chronic stress and a weak counter-regulation by DHEA-S. During pregnancy, scarce information about this system is available, although cortisol and DHEA-S play an important role in the initiation and acceleration of labor. We conducted the present study in order to determine both cortisol and DHEA-S levels during the last trimester of pregnancy in patients exhibiting severe anxiety. METHODS: Pregnant women during the 3rd trimester of pregnancy were evaluated by using the self-reported version of the Hamilton Anxiety Rating Scale (HARS). According to the scores obtained from the psychometric scale, participants were divided into two groups: 1) patients exhibiting a cutoff score > 15 were considered with severe anxiety (ANX) (n = 101), and control pregnant subjects (CTRL) (n = 44) with a cutoff score < 5. Morning cortisol, DHEA-S and Cortisol/DHEA-S index were measured in all participants. Comparisons between groups were performed; additionally, correlations between clinical variables, biochemical data and HARS were calculated. RESULTS: Cortisol levels were significantly higher in the ANX group (p < 0.001), whereas those of DHEA-S were significantly lower in the same group (p < 0.01) when compared to healthy pregnant subjects. An increased cortisol/DHEA-S index was observed in the ANX group (p < 0.05). A significant association between cortisol and HARS scores (p = 0.03), was observed even after adjusting by gestational weeks (p = 0.004). CONCLUSIONS: Our data support that the cortisol/DHEA-S index is higher in pregnant women with high anxiety levels as compared with healthy pregnant women.

Serum testosterone levels in bipolar and unipolar depressed female patients and the role of medication status.

Objective: to compare testosterone levels between female depressed patients and female bipolar patients.Methods: Sixty-one female patients with major depressive disorder (MDD) (n = 23) or bipolar disorder (BD) (n = 38) between 18 and 45 years old were included in the study. Participants were evaluated during a depressive or manic episode with the Hamilton depression rating scale (HDRS) or Young mania rating scale (YMRS), respectively. No patients in the MDD group were taken valproate while in the BD group 14 (36.84%) were taken valproate. Total testosterone (TT) and free testosterone (FT) levels were quantified during the early follicular phase of the cycle, with radioimmunoassay or solid phase enzyme-linked immunoassay. Data were collected from May 2016 to February 2017.Results: Mean TT serum levels were significantly higher in BD patients in comparison to MDD patients. Although age and diagnosis were related to TT levels, however when we added valproate use in the analysis, only the relation between TT and valproate use remained significant.Conclusions: In this sample, TT levels were related to valproate use in patients with BD. More studies regarding the role of testosterone in affective symptoms should be conducted to clarify the relation between testosterone, affective disorders, and medication.KeypointsWe observed that testosterone levels were significant higher in bipolar women compared to women with MDD.The use of valproate could be associated with the testosterone levels in female patients with BD.Evaluation of women suffering BD should include a testosterone levels determination, particularly when they are taking valproate.

Evaluation of trait and state anxiety levels in a group of peri- and postmenopausal women.

Our objective was to evaluate levels of trait and state anxiety in a group of peri- and postmenopausal women and to explore the relation of hormonal therapy to levels of anxiety. Peri- (n = 63) and postmenopausal (n = 236) women were evaluated between March and September 2013. The assessed variables were menopausal status, anxiety (using the state and trait anxiety inventory), and sociodemographic and clinical variables. Use of psychotropic medications and hormone therapy was also ascertained. The mean age of the participants was 51.9 years, ranging from 31 to 69 years. The mean state anxiety scores, as well as the mean trait anxiety scores, were higher in perimenopausal than postmenopausal women. High state anxiety (above the 75th percentile), but not high trait anxiety, was related to perimenopausal status. Anxiety levels appeared to be higher among perimenopausal than postmenopausal women, as also occurs with depressive symptoms. Anxiety state provides data about recent anxiety symptoms in women; however, anxiety trait could be present in some women before perimenopause. Our findings suggest that perimenopause is a period with increased anxiety levels in some women.

The role of gamma-aminobutyric acid in female depression / El papel del ácido gamma-aminobutírico en la depresión de la mujer

Depression is a common psychiatric disorder and a leading cause of disability worldwide. Multiple and diverse factors are involved in its cause although biologic factors are prominent. The present study reviews the evidence about the role that gamma-aminobutyric acid plays in the complex pathogenesis of depression, particularly in women. The implication of gamma-aminobutyric acid (GABA) is based mainly from animal models whereas clinical studies in depressed patients show alterations of GABA levels in plasma and cerebrospinal fluid. Neuroimaging studies using spectroscopy indicate also decreased GABA levels in different brain areas which in turn may normalize after antidepressant therapy, and these findings translate into clinical response. It has been observed that depression has a higher prevalence among women which suggests a link between depression and hormonal changes. Similarly, gonadal hormones have a regulatory effect on the hypothalamic­pituitary­adrenal axis through GABA receptors making women more vulnerable to suffer stress and depression. Therefore, the implication of GABA in the neurobiology of depression should be explored in order to search for new therapeutic strategies.

La depresión es un trastorno psiquiátrico frecuente e incapacitante. Es causada por diferentes factores, entre los que figura el aspecto neurobiológico. En el presente trabajo presentamos evidencias acerca del papel del ácido gamma-aminobutírico (GABA) en la etiopatogenia de la depresión, con énfasis en la mujer. Los estudios en animales fundamentan la implicación del GABA en la depresión, mientras que los estudios clínicos han demostrado que el GABA se encuentra disminuido en líquido cefalorraquídeo (LCR) y plasma en pacientes con depresión. Estudios con espectroscopia muestran una disminución del GABA en diferentes áreas cerebrales. Tras la administración de antidepresivos, se incrementa y se observa mejoría clínica. Se ha visto que la depresión se presenta con mayor frecuencia en las mujeres que en los hombres, y se ha sugerido que existe una relación entre la depresión y los cambios hormonales. De igual manera, se ha visto que las hormonas gonadales tienen un efecto regulador del estrés sobre el eje hipotálamo-hipófisis-adrenal mediante receptores GABAérgicos, haciendo a las mujeres más vulnerables a sufrir estrés y por tanto depresión. Por lo anterior, se propone estudiar con mayor profundidad la implicación del GABA en la depresión, para buscar nuevas estrategias terapéuticas.

Gonadal hormone levels and platelet tryptophan and serotonin concentrations in perimenopausal women with or without depressive symptoms.

INTRODUCTION: The etiology of depressive symptoms associated with the transition to menopause is still unknown; hormonal changes, serotonergic system or insomnia, could be a trigger to depressive symptomatology. The aim of the present study was to evaluate gonadal hormonal levels, platelet serotonin concentrations and platelet tryptophan concentrations in a group of depressed perimenopausal women and their healthy counterparts. METHODS: A total of 63 perimenopausal women between 45 and 55 years old were evaluated; of these, 44 were depressed patients, and 19 were perimenopausal women without depression. The instruments that were applied included the Center for Epidemiologic Studies Depression Scale (CES-D), the Hamilton Depression Rating Scale (HDRS) and the Green Climacteric Scale (GCS); gonadal hormone levels and platelet tryptophan and serotonin concentrations were measured in all participants. Differences in hormonal levels and tryptophan and serotonin concentrations were evaluated with respect to specific symptoms, such as insomnia, hot flashes, nervousness, depressed mood and loss of interest. RESULTS: No differences between groups were observed with respect to hormonal levels and tryptophan and serotonin concentrations; mean sleep hours and insomnia were significantly correlated with platelet tryptophan concentrations. CONCLUSIONS: In this sample, all symptoms of depression could not be explained by platelet tryptophan and serotonin concentrations and hormonal levels; differences were observed only when we evaluated insomnia and hot flashes.

Benzodiazepine Consumption, Functionality, Cognition, and Somnolence in Older Adults at a Tertiary Care Psychiatric Hospital in Mexico City.

BACKGROUND: The aging population in Mexico, particularly those aged 60 and above, faces challenges in healthcare, including potentially inappropriate prescriptions of benzodiazepines. Physiological changes in older adults make precise drug prescriptions crucial. OBJECTIVE: This study aims to evaluate and compare functionality, cognition, and daytime somnolence in older adults using benzodiazepines versus non-users. Additionally, it outlines the demographic and clinical characteristics of both groups. METHODS: A cross-sectional study enrolled 162 participants aged 60 and above, categorized as benzodiazepine consumers or non-consumers. Assessment tools included Lawton's Index, Montreal Cognitive Assessment, Epworth Sleepiness Scale, and Benzodiazepine Dependence Questionnaire. Statistical analysis employed t-tests and chi-square tests. RESULTS: Benzodiazepine users (n=81) exhibited lower cognitive scores, increased sleepiness, and reduced daily living activities compared to non-users (n=81). Demographically, BZD users had lower education levels. CONCLUSION: Benzodiazepine use in older adults is associated with cognitive decline, daytime somnolence, and functional limitations, emphasizing the need for cautious prescription practices and continual monitoring. This study contributes insights into the impact of benzodiazepines on the cognitive health of older adults in Mexico.

Human olfactory neural progenitor cells reveal differences in IL-6, IL-8, thrombospondin-1, and MCP-1 in major depression disorder and borderline personality disorder.

Background: Discovering biological markers is essential for understanding and treating mental disorders. Despite the limitations of current non-invasive methods, neural progenitor cells from the olfactory epithelium (hNPCs-OE) have been emphasized as potential biomarker sources. This study measured soluble factors in these cells in Major Depressive Disorder (MDD), Borderline Personality Disorder (BPD), and healthy controls (HC). Methods: We assessed thirty-five participants divided into MDD (n=14), BPD (n=14), and HC (n=7). MDD was assessed using the Hamilton Depression Rating Scale. BPD was evaluated using the DSM-5 criteria and the Structured Clinical Interview for Personality Disorders. We isolated hNPCs-OE, collected intracellular proteins and conditioned medium, and quantified markers and soluble factors, including Interleukin-6, interleukin-8, and others. Analysis was conducted using one-way ANOVA or Kruskal-Wallis test and linear regression. Results: We found that hNPCs-OE of MDD and BPD decreased Sox2 and laminin receptor-67 kDa levels. MASH-1 decreased in BPD, while tubulin beta-III decreased in MDD compared to controls and BPD. Also, we found significant differences in IL-6, IL-8, MCP-1, and thrombospondin-1 levels between controls and MDD, or BPD, but not between MDD and BPD. Conclusions: Altered protein markers are evident in the nhNPCs-OE in MDD and BPD patients. These cells also secrete higher concentrations of inflammatory cytokines than HC cells. The results suggest the potential utility of hNPCs-OE as an in vitro model for researching biological protein markers in psychiatric disorders. However, more extensive validation studies are needed to confirm their effectiveness and specificity in neuropsychiatric disorders.

[Factors that predict depression in medical students]. / Factores que predicen depresión en estudiantes de medicina.

INTRODUCTION: High prevalence of depression and anxiety symptoms has been observed in medical students. OBJECTIVE: To identify predictors of depressive symptoms according to CES-D in students during their first year of medical education. METHODS: We evaluated 517 students in their first year of medical education with the following instruments: Centers for Epidemiology Studies for Depression Scale, State-Trait anxiety inventory, and stressors list. A linear regression analysis was carried out to evaluate variables predicting high CES-D scores. RESULTS: We observed that anxiety and depressive symptoms were more frequent in women, as well as stressors. Predictors of depression were state of anxiety, stressors, and low socioeconomic level. CONCLUSIONS: It is important to implement support measures for students who live with stress factors, suffering anxiety, or with a low socioeconomic level.

Is brain perfusion correlated to switching mood states and cognitive impairment in bipolar disorder type I? A longitudinal study using perfusion imaging approach.

Type I Bipolar disorder (BD-I) is a neuropsychiatric disorder characterized by manic or mixed-featured episodes, impaired cognitive functioning, and persistent work and social functioning impairment. This study aimed to investigate within-subject; (i) differences in brain perfusion using Single-photon emission computed tomography (SPECT) between manic and euthymic states in BD-I patients; (ii) explore potential associations between altered brain perfusion and cognitive status; and (iii) examine the relationship between cerebral perfusion and mania symptom ratings. Seventeen adult patients diagnosed with BD-I in a manic episode were recruited, and clinical assessments, cognitive tests, and brain perfusion studies were conducted at baseline (mania state) and a follow-up visit 6 months later. The results showed cognitive impairment during the manic episode, which persisted during the euthymic state at follow-up. However, no significant changes in brain perfusion were observed between the manic and euthymic states. During mania, trends toward decreased perfusion in the left cerebellum and right superior parietal lobule were noted. Additionally, trends indicated a higher perfusion imbalance in the left superior and middle frontal gyrus during mania and the right superior and middle frontal gyrus during euthymia. No significant correlations existed between brain perfusion, mania symptom ratings, and cognitive performance, indicating that symptomatology might represent more than neural hemodynamics. These findings suggest that cognitive impairment may persist in BD-I patients and highlight the need for therapeutic interventions targeting cognitive deficits. More extensive studies with extended follow-up periods are warranted further to investigate brain perfusion and cognitive functioning in BD-I patients.

[Women's reproductive related disorders: a new proposal for the mental health field]. / Los trastornos mentales relacionados a la edad reproductiva de la mujer: una nueva propuesta en el campo de la salud mental.

Recently, a research group has suggested the existence of women's disorders that may be grouped together as reproductive-related disorders, characterized by their timing (related to reproductive processes), shared vulnerability, and a common pathophysiology. Symptoms of reproductive-related disorders could be different among women, but are consistent within each individual woman and always present during reproductive-life periods including pregnancy, postpartum, and the premenstrual and perimenopausal periods. An association between hormonal changes and affective disorders is suggested as a physiopathology process of reproductive-related disorders, with an abnormal adaptation to hormonal changes in vulnerable women. In this paper we describe some characteristics of premenstrual dysphoria disorder, postpartum depression, and perimenopausal depression. A proposed pathophysiology of these disorders is described and pharmacologic options for treatment are also reviewed.

Association between depressive symptoms and reproductive variables in a group of perimenopausal women attending a menopause clinic in México City.

The aim of this study was to explore the association between depressive symptoms and some variables related to the reproductive life, such as history of premenstrual dysphoric disorder, antecedent of postpartum depression, previous use of hormonal contraceptives, and current hot flushes, in a group of perimenopausal women attending a menopause clinic. Perimenopausal women, 45 to 55 years old, who had not received hormonal replacement therapy and/or psychotropic medication, were invited to participate in this study. 141 perimenopausal women were included; we obtained their psychiatric and gynecological data, and we evaluated their depressive symptomatology using the CES-D scale. There were a significantly higher number of cases of previous depressive episodes, PMDD and PPD history in depressed patients compared with non-depressed women; current hot flushes prevalence was similar between depressed and non-depressed women. Patients with a PMDD history were more likely to have experienced previous depressive episodes, a PPD history and high levels of depression. Variables associated with the level of depression were a previous history of PMDD, current hot flushes, and previous depressive episodes. The occurrence of perimenopausal depression is related to a previous history of PMDD, PPD, and depressive episodes; hot flushes only increase the severity of the depressive episode.

Brain perfusion during manic episode and at 6-month follow-up period in bipolar disorder patients: Correlation with cognitive functions.

BACKGROUND: Patterns of altered cerebral perfusion and cognitive dysfunction have been described in Bipolar Disorder (BD) acute episodes and euthymia. Knowledge of the relationship between cognitive function and perfusion in a manic state and status when followed up is still limited. OBJECTIVE: To describe brain perfusion alterations and its relationship with cognitive impairment in patients with BD during manic episodes and after 6 months. METHODS: Observational-prospective study in 10 type I BD adults during moderate-severe manic episodes. We assessed sociodemographic data and clinical variables as well as cognitive function through Screening for Cognitive Impairment in Psychiatry (SCIP-S). Finally, we performed a Brain Perfusion SPECT using a Tc99m-ethyl cysteine dimer. RESULTS: During manic episodes, patients showed cognitive impairment with a mean SCIP-S score of 63.8 ± 17.16. This was positively correlated with perfusion measured as relative reuptake index (RRI) at the right temporal pole (ρ = 0.65 p = .0435) and negatively correlated with right the orbitofrontal cortex (ρ = -0.70 p = .0077) and the right subgenual cingulate cortex (ρ = -0.70 p = .0256). Episode severity measured by the Young Mania Rating Scale (YMRS) positively correlated with RRI at the right temporal pole (ρ = 0.75, p = .01). At follow-up, six patients were taking treatment and were euthymic, we found a negative correlation with the YMRS and RRI at the bilateral orbitofrontal cortex (ρ = -0.8827, p = .019). They did not show significant improvement in cognitive performance at SCIP-S, and there was negative correlation with the following of the SCIP-S subscales; processing speed with the bilateral dorsolateral prefrontal, the bilateral medial prefrontal, the left temporal pole cortex RRI, and verbal fluency with the bilateral anterior cingulate cortex RRI. CONCLUSION: Cognitive impairment was correlated with brain perfusion patterns at baseline and follow-up. Large sample size studies with longer follow-up are needed to describe the changes in perfusion and cognitive functions in BD.

Depressive symptoms in pregnant women with high trait and state anxiety during pregnancy and postpartum.

Background: Depression and anxiety are frequent during pregnancy, and epidemiological studies demonstrate high rates of co-morbidity. Aims: To evaluate the association between the trait and state anxiety and depressive symptoms in women during the perinatal period. Method: A transversal study was conducted at the National Institute of Perinatology (INPer, Mexico City) from 2012 and 2015. Pregnant women diagnosed with Major Depressive Disorder (MDD) were included (N=128). Depressive and anxiety symptoms were evaluated using CES-D and STAI, respectively. Patients were sub-classified according to percentile 75 for Low and High Trait Anxiety (LTA, HTA) and Low and High State Anxiety (LSA, HSA); depressive symptoms were compared between pregnant women and women in the postpartum, by state and trait levels. Results: CES-D scores differed according to state and trait anxiety levels: while we observed that depressive scores (CES-D) were higher in HTA patients compared to LTA prenatally (35.9±9,5 vs 21.2±10,8 respectively; p=0.001), this finding was not observed in the postpartum period. In the case of state anxiety depressive scores were elevated among HSA versus LSA groups before delivery (33.0±11.3 vs 14.0±6.7 respectively; p=0.008) and after partum (35.1±8.06 vs 10.0±6.0; p=0.005). Conclusions: Patients showed higher scores of depressive symptoms when high trait or state anxiety comorbidity is present during the perinatal period. In the postpartum period, even low trait anxiety scores were associated with high depressive scores.

Bibliometric analysis of peer-reviewed literature on perinatal depression in Mexico / Análisis bibliométrico de la literatura revisada por pares sobre depresión perinatal en México

Abstract Background Perinatal depression (PND) is a clinical disease developed in any stage during the pregnancy and postpartum period with serious health and economic implications. Objective The aim of this work was to analyze via bibliometrics indicators Mexico's production on PND to provide a view of the academic landscape and a comprehensive reference for subsequent research in the country. Method The Scopus and Web of Science (WoS) databases were used to perform a search for peer reviewed papers related to PND in México. The search was made following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The extracted data were processed with VOS Viewer to examine link strength and clusters associations of diverse bibliometrics variables. Results A total of 132 records were retrieved and we included 70 studies in the bibliometric analysis after application of the exclusion criteria. The authors with more papers were Navarrete L., and Asunción Lara M. The institutions with more papers were the National Institute of Perinatology, Ramón de la Fuente National Institute of Psychiatry, and National Institute of Public Health of Mexico. A diminution of the research considered in PND is observed in the last two years. Four keyword clusters were identified related to PND: symptoms, prevalence, pregnancy. Discussion and conclusion The scarce literature concerning PND in Mexico compared with other countries could be due the limited collaboration between the health institutes. An urgent need to increase research on PND in Mexico is evident to be applicable in the management of resources in the healthcare system.

Resumen Antecedentes La depresión perinatal (PND) es una enfermedad clínica que se desarrolla en cualquier etapa del embarazo y posparto con graves implicaciones sanitarias y económicas. Objetivo El objetivo de este trabajo fue analizar a través de indicadores bibliométricos la producción de México sobre PND, para brindar una visión del panorama académico y un referente integral para investigaciones posteriores en el país. Método Se utilizaron las bases de datos Scopus y Web of Science (WoS) para realizar una búsqueda de artículos revisados por pares relacionados con la PND en México. La búsqueda se realizó siguiendo los elementos de informes preferidos para revisiones sistemáticas y metaanálisis (PRISMA). Los datos extraídos se procesaron con VOS Viewer para examinar la fuerza de los enlaces y las asociaciones de grupos de diversas variables bibliométricas. Resultados Se recuperaron un total de 132 registros y se incluyeron 70 estudios en el análisis bibliométrico después de la aplicación de los criterios de exclusión. Los autores con más artículos fueron Navarrete L. y Asunción Lara M. Las instituciones con más artículos fueron el Instituto Nacional de Perinatología, el Instituto Nacional de Psiquiatría Ramón de la Fuente y el Instituto Nacional de Salud Pública de México. Se observa una disminución de las investigaciones consideradas en el PND en los últimos dos años. Se identificaron cuatro grupos de palabras clave relacionadas con la PND: síntomas, prevalencia y embarazo. Discusión y conclusión La escasa literatura sobre PND en México en comparación con otros países podría deberse a la limitada colaboración entre los institutos de salud. Se evidencia una necesidad urgente de realizar más investigaciones sobre PND en México que sean aplicables y útiles en la gestión de recursos en el sistema de salud.

Circulating sex hormones in women with severe anxiety during pregnancy / Hormonas sexuales circulantes en mujeres con ansiedad severa durante el embarazo

Abstract Introduction Anxiety, mood- and stress-related behaviors are regulated by sex hormones in pregnant and non-pregnant women. Very scarce information exists about the role of sex steroids in pregnant women displaying high levels of anxiety. Objective To determine sex hormones serum levels in pregnant women exhibiting high levels of anxiety symptoms. Method The Hamilton Anxiety Rating Scale (HARS/ HAM-A) was used to assess the intensity of anxiety symptoms in third-trimester pregnant women. Two groups were included in the study, pregnant women exhibiting severe anxiety (ANX; HARS scores ≥ 25; n = 101) and healthy control subjects (CTRL; n = 40) displaying lower scores for anxiety (HARS scores ≤ 7). Estradiol (E2), progesterone (P4), and testosterone (T) serum levels were measured using a standard chemiluminescent immunoassay. Bivariate and partial correlations were performed to detect significant associations between groups, clinical measures, biochemical data, and HARS scores. Results The anxiety group (ANX) showed an increase in E2 and T serum levels (p < .001) compared to CTRL. Conversely, significantly lower P4 levels were found in the symptomatic group (p < .001) as compared to the CTRL hormone values. The P4:E2 index was significantly reduced in pregnant women with high levels of anxiety (p < .001). Negative correlations between anxiety (HARS) scores, P4 serum levels (p = .02), and P4:E2 ratio (p = .04) were found in the symptomatic group. Conversely, T serum levels displayed a positive association (p = .001) with high levels of anxiety symptoms in the same group, after adjusting our data by clinical confounders. Discussion and conclusion Serum levels of sex-steroid hormones are altered in pregnant women exhibiting severe anxiety.

Resumen Introducción La ansiedad, el estado de ánimo y el estrés están regulados por diversos esteroides sexuales. Existe poca información sobre el papel que juegan estos esteroides en mujeres embarazadas con niveles elevados de ansiedad. Objetivo Determinar los niveles séricos de hormonas sexuales en mujeres embarazadas con altos índices de síntomas de ansiedad con respecto a mujeres gestantes sanas. Método Determinación de la intensidad de síntomas ansiosos empleando la escala de Hamilton de Ansiedad (HAM-A) en 141 mujeres embarazadas en el tercer trimestre de gestación. Cuantificación de los niveles séricos de estradiol (E2), progesterona (P4) y testosterona (T) por inmunoensayo estándar. Aplicación de las correlaciones de Pearson para detectar asociaciones entre parámetros clínicos y valores hormonales entre los grupos de estudio. Resultados Las mujeres con ansiedad severa (ANX; n = 101; HAM-A ≥ 25) mostraron niveles séricos más altos de E2 y T (p < .001), así como niveles más bajos de P4 (p < .001) en relación con el grupo control (CTRL, n = 40, HAM-A < 7). Se detectó una disminución significativa en el índice P4:E2 en el grupo de ANX (p < .001) y se observaron correlaciones negativas y positivas entre los puntajes elevados de ansiedad con los niveles circulantes de P4 (p = .02), en la taza P4:E2 (p = .04) y en los niveles séricos de T (p = .001) respectivamente, al ajustar nuestros datos con variables confusoras. Discusión y conclusión Los niveles circulantes de los esteroides sexuales se encontraron alterados en mujeres con ansiedad severa.

Factors related to academic performance in medical students / Factores relacionados con el desempeño académico en estudiantes de medicina

Abstract Introduction Academic performance in medical students can be influenced by several factors, including those related to mental health and family relationships. Objective To examine the factors affecting academic performance in medical students, specifically considering potential diagnoses of depression. Method A survey was conducted among 747 fourth-year medical students. The survey included questions on sociodemographic variables, mental health, and well-being. The Patient Health Questionnaire (PHQ) was utilized, encompassing sections on depression, anxiety, panic, eating habits, alcohol consumption, and the Stress Perception Scale. Academic performance was assessed based on students' Grade Point Average (GPA). Descriptive statistics, Pearson correlation coefficients, and a linear regression model were employed for data analysis. Results The study revealed several variables significantly associated with GPA. Age (r = -.388), financial situation (r = .241), relationships with cohabitants (r = .165), and relationships with peers (r = .217) were found to have a correlation with academic performance. Additionally, repeating a course was found to be significantly associated with a person's GPA (r = .518) even after controlling for depression. Discussion and conclusion The findings indicate that robust mental health, a favorable financial situation, and positive interpersonal relationships are crucial for achieving optimal academic performance in medical students. These results emphasize the need to address mental health concerns, promote a supportive social environment, and provide financial assistance to enhance the educational outcomes of medical students.

Resumen Introducción El desempeño académico de los estudiantes de medicina puede verse influenciado por varios factores, entre ellos los relacionados con la salud mental y las relaciones familiares. Objetivo Examinar los factores que afectan el desempeño académico en estudiantes de medicina, considerando específicamente los posibles diagnósticos de depresión. Método Se realizó una encuesta entre 747 estudiantes de cuarto año de la carrera de medicina. La encuesta incluyó preguntas sobre variables sociodemográficas, salud mental y bienestar. Se utilizó el Cuestionario de Salud del Paciente (PHQ), que comprende secciones sobre depresión, ansiedad, pánico, hábitos alimentarios, consumo de alcohol y la Escala de Percepción del Estrés. El desempeño académico se evaluó con base en el promedio de calificaciones (GPA) de los estudiantes. Se emplearon estadísticas descriptivas, coeficientes de correlación de Pearson y un modelo de regresión lineal para el análisis de datos. Resultados El estudio reveló varias variables significativamente asociadas con el GPA. Se encontró que la edad (r = -.388), la situación financiera (r = .241), las relaciones con los convivientes (r = .165) y las relaciones con los compañeros (r = .217) tenían correlación con el rendimiento académico. Además, se encontró que repetir un curso estaba significativamente asociado con el GPA de una persona (r = .518) incluso después de controlar la depresión. Discusión y conclusión Los hallazgos indican que una salud mental sólida, una situación financiera favorable y relaciones interpersonales positivas son cruciales para lograr un desempeño académico óptimo en los estudiantes de medicina. Estos resultados enfatizan la necesidad de abordar los problemas de salud mental, promover un entorno social de apoyo y brindar asistencia financiera para mejorar los resultados educativos de los estudiantes de medicina.

Different gender response to serotonergic and noradrenergic antidepressants. A comparative study of the efficacy of citalopram and reboxetine.

BACKGROUND: It is well established that depressive disorders are more prevalent in women; however gender differences in the pharmacological response to antidepressants are not a consistent finding in all reports. It is considered that this discrepancy can be explained by the fact that in most clinical trials drug use for comparative purposes is not completely different. In this study gender differences in antidepressant response with citalopram (CTP), a selective serotonin reuptake inhibitor and reboxetine (RBX), a selective noradrenaline reuptake inhibitor were evaluated in a group of young men and premenopausal women. METHOD: Eighty-six depressed patients 18 to 40 years old participated in an 8-week double-blind clinical trial. Subjects were divided in four groups according to sex and treatment assignation: females treated with CTP (n = 25) or RBX (n = 23), and males treated with CTP (n = 19) or RBX (n = 19). Response was determined using HDRS and BDI. RESULTS: ANOVA analysis considering change in HDRS scores from baseline to last evaluation found a significant interaction between gender and type of treatment. Females treated with CTP showed a significantly greater response than females treated with RBX, while in men no differences were observed for both drugs. LIMITATIONS: Replication using larger sample size and longer treatment periods is required. CONCLUSIONS: These results support previous findings which show that premenopausal women respond better than men to serotonergic antidepressants. They also support that a plausible interaction between gonadal hormones and serotonin may explain gender differences in antidepressant response.