[Physical activity has an acute effect on depression and anxiety syndromes]. / Fysisk aktivitet kan ha omedelbar effekt på depression och ångest.

Physical activity has a preventive and an acute effect on both depression and anxiety syndromes. The effect of just physical activity, usually 3 times/week for 8-12 weeks, is equal to treatment with psychotherapy or antidepressants for mild to moderate depression, according to several meta-analyses. Addition of physical exercise to psychotherapy has a significantly greater effect than psychotherapy alone. Few high-quality studies on anxiety syndromes have been performed regarding the treatment effect of physical activity. In anxiety syndromes, physical activity for 10-12 weeks has a better effect than no treatment. Yet, psychotherapy or pharmacological treatment has a better effect than physical exercise in panic disorder. The article describes a variety of positive physiological, neurobiological and psychological mechanisms of physical activity.

Asthma and allergy patterns over 18 years after severe RSV bronchiolitis in the first year of life.

BACKGROUND: An increased prevalence of asthma/recurrent wheeze (RW), clinical allergy and allergic sensitisation up to age 13 years has previously been reported in subjects hospitalised with respiratory syncytial virus (RSV) bronchiolitis in their first year of life compared with matched controls. A study was undertaken to examine whether these features persist into early adulthood, to report longitudinal wheeze and allergy patterns, and to see how large and small airway function relates to RSV infection and asthma. METHODS: Follow-up at age 18 years was performed in 46 of 47 subjects with RSV and 92 of 93 controls. Assessments included questionnaire, clinical examination, skin prick tests, serum IgE antibodies to inhaled allergens, blood eosinophils, fraction of exhaled nitric oxide (FeNO), spirometry, multiple breath washout (lung clearance index, LCI) and dry air hyperventilation challenge. RESULTS: Increased prevalence of asthma/RW (39% vs 9%), clinical allergy (43% vs 17%) and sensitisation to perennial allergens (41% vs 14%) were present at age 18 in the RSV cohort compared with controls. Persistent/relapsing wheeze associated with early allergic sensitisation predominated in the RSV cohort compared with controls (30% vs 1%). Spirometric function was reduced in subjects with RSV with or without current asthma, but not in asthmatic controls. LCI was linked only to current asthma, airway hyperresponsiveness and FeNO. CONCLUSIONS: Severe early RSV bronchiolitis is associated with an increased prevalence of allergic asthma persisting into early adulthood. Small airway dysfunction (LCI) is related to current asthma and airway inflammation but not to RSV bronchiolitis. Reduced spirometry after RSV may reflect airway remodelling.

Association between Gm allotypes and asthma severity from childhood to young middle age.

Immunoglobulin constant heavy G chain (IGHG) gene polymorphisms are associated with atopy and can be determined by the serum Gm allotypes. We studied whether certain polymorphisms are related to asthma severity and to the extent or intensity of allergic sensitization in asthmatic subjects followed from childhood to young middle age. Fifty-five subjects (28 males) with childhood asthma were all followed-up prospectively on six occasions from a mean age of 9 to 35 years in a study including asthma severity scoring, spirometry, skin prick, and specific serum IgE antibody testing. At the last visit, extended lung function tests and a cold air challenge were performed, and IGHG gene polymorphisms were identified by the alternative serum IgG subclass allotypes, employing ELISA and double immunodiffusion. The 19 subjects with the homozygous IGHG*bf/*bf genotype (originating from the IGHG3*b and the IGHG1*f alleles, which are in strong linkage disequilibrium), showed significantly higher asthma scores, lower airway function, and greater bronchodilator responses from childhood to adulthood, and in middle age greater airway hyperresponsiveness, compared to the subjects with the IGHG*bf/*ga or IGHG*ga/*ga genotypes. Among the subjects sensitized to animal danders, those with the IGHG*bf/*bf genotype showed the highest specific IgE levels. In conclusion, IGHG gene polymorphisms were associated with the severity and outcome of childhood asthma, and with the intensity of allergic sensitization.

[Physical activity is just as good as CBT or drugs for depression]. / Fysisk aktivitet lika bra som KBT eller läkemedel vid depression.

In this article on the effect of physical activity on depression, data have been drawn from several meta-analyses, in particular, the latest Cochrane review entitled ¼Exercise for depression« published in 2013. The results show that physical activity can help prevent the onset and relapse of depression. Depressed people should be recommended aerobic or muscular strength training. There is clear evidence that physical activity alone is beneficial for the treatment of mild and moderate depression and can reduce symptoms of mild to moderate depression to the same extent as standard treatments (psychotherapy and antidepressant medication). Combining physical activity with these treatments may yield additional benefits. Individuals with depression should be recommended physical activity in adjunct to psychotherapy and medication.

Severe respiratory syncytial virus bronchiolitis in infancy and asthma and allergy at age 13.

We have prospectively studied wheezing disorder and allergy in 47 children hospitalized with respiratory syncytial virus (RSV) bronchiolitis in infancy and 93 matched control subjects. Subjects with at least three episodes of wheezing were defined as recurrent wheezers and as having asthma if the episodes were doctor verified. Here we report the outcome at age 13 years in 46/47 children with RSV and 92/93 control subjects. Wheezing disorder and clinical allergy were estimated using a questionnaire. Skin prick tests were performed and serum IgE antibodies measured. Spirometry was undertaken at rest, after dry air challenge, and after beta2-agonist inhalation. The occurrence of symptoms over the previous 12 months was significantly higher in the RSV group than among the control subjects, 43% versus 8% for asthma/recurrent wheezing and 39% versus 15% for allergic rhinoconjunctivitis. Sensitization to common inhaled allergens was more frequent in the RSV group than in the control subjects, judged by skin prick tests (50% versus 28%; p = 0.022), or by serum IgE antibodies (45% versus 26%; p = 0.038). Compared with the control subjects, the RSV group showed mild airway obstruction both at rest and after bronchodilation, and had slightly more reactive airways. RSV bronchiolitis in infancy severe enough to cause hospitalization is a risk factor for allergic asthma in early adolescence.

Controlled withdrawal of selective serotonin reuptake inhibitor drugs in elderly patients in nursing homes with no indication of depression.

OBJECTIVE: The aim of the investigation was to study the effects of withdrawing selective serotonin reuptake inhibitor (SSRI) drugs in nursing home patients, who had no documented diagnosis or symptoms of depression. SETTING: The setting of the study was in 11 nursing homes in the county of Stockholm, Sweden. PARTICIPANTS: Participants were patients without dementia or history of depression who had received treatment with SSRI drugs for more than 6 months and who had no indications of anxiety disorder or major depression DESIGN: The included patients ( n=70) were randomized to either the intervention group (withdrawal of SSRI) or the control group (no change in treatment), 35 patients to each group. MAIN OUTCOME MEASURES: The patients were subjected to assessment using the following instruments: Montgomery-Asberg depression rating scale, global assessment for functioning, health index and a symptom assessment form. Assessment was made at the start of the study and at the 3-month and 6-month follow-ups. RESULTS: We found no significant difference between the intervention and control groups in any outcome measure. CONCLUSION: Treatment with SSRI drugs in patients without clinical major depression or anxiety disorder is often unjustified and should be discontinued.