Psychological intervention based on psychoneuroimmunology improves clinical evolution, quality of life, and immunity of children with leukemia: A preliminary study.

We conducted a non-randomized, open-label clinical trial to assess whether a psychoneuroimmunology-based intervention enhanced immunity in children with acute lymphoblastic leukemia undergoing chemotherapy. In total, 16 children (44% female) received psychoneuroimmunology-based intervention, whereas 12 (50% female) received health psychoeducation (controls). The primary outcome was immunity markers, being clinical conditions the secondary outcome. Psychoneuroimmunology-based intervention increased immune markers (CD8+ T, B, and natural killer cells, serum immunoglobulin A, and immunoglobulin M) and quality of life, whereas it shortens the duration of fever and use of antipyretics, antibiotics, analgesics, and respiratory therapy. Immunity markers correlated with clinical conditions. Thus, psychoneuroimmunology-based intervention could reduce hospital cost and increase patient well-being.

Reduced GABA neurotransmission underlies hyperalgesia induced by repeated forced swimming stress.

We determined if cutaneous hyperalgesia and pain-induced c-Fos overexpression in the spinal cord produced by repeated forced swimming (FS) stress in the rat were related to changes in GABA neurotransmission by studying spinal release of GABA and the effect of positive modulation of GABA-A receptors with diazepam. Male rats were daily submitted to 10-20 min of either forced swimming or sham swimming (SS) for 3 consecutive days. Two days later, spinal GABA release was estimated by in vivo microdialysis. In other set of rats, either diazepam (2 mg/kg, i.p.) or saline was administered 1h before either SS or FS and inflammatory nociception was assessed with the formalin test; it was followed by removal of lumbar spinal cords for c-Fos immunocytochemistry. Basal and pain-evoked release of GABA in the spinal cord was lower in FS rats than in SS rats. In contrast, pain scores during formalin test late phase and pain-induced c-Fos expression in laminae I-VI of ipsilateral dorsal horn were significantly higher in FS rats than in SS rats. In FS rats, diazepam did not have effect on GABA release but reduced pain scores and overexpression of c-Fos whereas flumazenil (0.1 mg/kg, i.p.), an antagonist of the benzodiazepine binding site, reversed these effects. When diazepam was given only 1h before the formalin test, it slightly but significantly reduced pain scores during late phase in FS rats but not in SS rats. In conclusion, stress-induced reduction in GABA-A receptor activation is involved in the development of FS stress-induced hyperalgesia.

[The Zung's autoscale for depression as predictor of sensorial and autonomic alterations to pain]. / Autescala de Zung para depresión como predictor de la respuesta sensorial y autonómica al dolor.

Clinical and experimental evidence support a relationship between susceptibility to chronic pain and a subjacent depression. Nevertheless, it's not clear if the currently available clinical evaluation instruments for depression allow for linking both disorders. Thus, we evaluated a Zung's autoscale for depression and its different categories: affective, physiological, motor and psychological, as possible predictors of sensorial and autonomic alterations and vulnerability to clinical chronic pain. In 32 healthy controls and 11 subjects with minor depression and free of treatment, ischemic pain was first induced by applying a tourniquet on the dominant arm, and then followed by paresthesias during the reperfusion of arm as the tourniquet is released. Ischemic muscular pain, post-ischemic paresthesias and associated cardiovascular responses were recorded throughout the experimental procedure. The affective category's score was correlated linearly in individual form with the greatest number of variables and it was adjusted to a model of multiple regressions that almost explained the variance in 100% with a contribution of the sensorial and autonomic variables of a 70% and 30%, respectively. In addition, the affective category was 50% greater in subjects with persistent clinical pain. The Zung's index and the other categories had a smaller number of individual linear correlations and models of multiple correlations that only explained between 30-70% of the variance, with a more predominant contribution of the autonomic variables (20-50%), especially in the psychological category. This suggests that the affective category predicts cutaneous-muscular sensorial alterations with greater effectiveness than the Zung's total index.

Role of mu-opioid and NMDA receptors in the development and maintenance of repeated swim stress-induced thermal hyperalgesia.

Repeated exposure to swimming stress induces a long-lasting hyperalgesia in the rat by mechanisms to be elucidated. Since opioid and glutamate neurotransmitter systems modulate pain, we now evaluated the effect of pharmacological blockade of opioid and glutamate receptors subtypes on forced swimming stress-induced hyperalgesia. Male rats were daily subjected to 10-20 min of forced or sham swimming for 3 days and thermal nociception was estimated twice, before each behavioral conditioning and 24 h after the last, using hot plate test. Selective opioid and NMDA receptor antagonists were administered i.p. either before each conditioning session or before the second nociception assessment. Unlike sham swimming rats, forced swimming rats showed significant reductions in hot plate response latencies (hyperalgesia) after the last swimming session, as compared to pre-stress values. Rats treated with the opioid receptor antagonists naloxone (0.1 mg/kg, non-subtype-selective) and naloxonazine (5 mg/kg, mu(1)-subtype-selective), before each forced swimming, did not become hyperalgesic, whereas those treated before the second post-stress assessment of nociception developed hyperalgesia. Naltrindole (0.5 mg/kg, delta-subtype-selective) and nor-binaltorphimine (0.5mg/kg, kappa-subtype-selective) were inactive in both administration schedules. The efficacy of morphine (3-7.5 mg/kg) to produce analgesia in forced swimming rats was lower than in sham swimming rats. Rats treated with the NMDA antagonist ketamine (5 mg/kg) before the forced swimming or the second post-stress assessment of nociception did not have hyperalgesia. Thus, swim stress-induced hyperalgesia might be initiated by the repeated stimulation of mu-opioid and NMDA receptors but maintained only by the activity of NMDA receptors.

Enhanced central thermal nociception in mildly depressed nonpatients and transiently sad healthy subjects.

UNLABELLED: Evidence of support for sensory changes during minor depression and sadness is scarce and the neural mechanisms are unclear. We assessed central pain processing engaged in nociceptive C-fiber polymodal activity by examining the perception of a non-noxious unpleasant burning sensation induced by a thermal grill illusion, in 26 nonpatients with minor depression (19 females) and 28 healthy subjects (18 females), between 19 and 61 years old and pain free at the study. Controls were also subjected to induction of transient moods. Subjects with depression reported increased pain perception; this increase was more pronounced for the affective dimension of pain (unpleasantness) than for its sensory dimension (intensity). The perception of pain unpleasantness, pain intensity, and overall pain showed positive and linear correlations with depression levels measured by Zung's and Beck's scales. In controls, sad mood induction only increased the scores assigned to negative mood-describing adjectives; the perception of pain intensity, unpleasantness, and overall pain were significantly increased following sad, but not neutral or elevated, mood inductions. Yet, pain intensity and unpleasantness were correlated linearly and reciprocally to positive, instead of negative, mood-describing adjective scores. Thus, there is a central thermal hyperalgesia in subjects with minor depression and sadness. PERSPECTIVE: There is a central thermal hyperalgesia in subjects with minor depression, probably associated with an enhanced central processing of nociceptive C-fiber polymodal activity at anterior cingulate cortex, that is predominately expressed as an increased unpleasantness and that could be in part counteracted by behavioral therapies leading to mood elevation.

Autescala de Zung para depresión como predictor de la respuesta sensorial y autonómica al dolor / The Zung's autoscale for depression as predictor of sensorial and autonomic alterations to pain

Evidencia clínica y experimental apoyan una relación entre la susceptibilidad al dolor crónico y la depresión subyacente. Sin embargo, no está claro si los instrumentos de evaluación clínica para depresión que existen permiten vincular ambos trastornos. Así, se evaluó la autoescala para depresión de Zung y sus diferentes categorías: afectiva, fisiológica, motora y psicológica como posible predictor de alteraciones sensoriales y autonómicas, así como su vulnerabilidad a dolores clínicos crónicos. A 32 controles sanos y 11 sujetos con depresión menor sin tratamiento, se les indujo isquemia mediante un torniquete sobre el brazo dominante, y luego seguido de parestesias durante la reperfusión del brazo al ser liberado el torniquete. El dolor muscular isquémico, las parestesias post-isquémicas y la respuesta cardiovascular fueron monitoreadas durante el procedimiento. El puntaje de la categoría afectiva se correlacionó linealmente en forma individual con el mayor número de variables y se ajustó a un modelo de regresión múltiple que explicaba casi un 100 por ciento la varianza, con una contribución de las variables sensoriales y autonómicas de un 70 por ciento y 30 por ciento, respectivamente. Además, la categoría afectiva fue un 50 por ciento mayor en los sujetos con dolor clínico persistente. El índice total de Zung y las otras categorías tuvieron un menor número de correlaciones lineales individuales y modelos de correlación múltiple que solo explicaban entre 30-70 por ciento de la varianza, con una contribución más predominante de las variables autonómicas (20-50 por ciento), especialmente en la categoría psicológica. Esto sugiere que la categoría afectiva puede predecir alteraciones sensoriales cutáneo-musculares con mayor eficacia que el índice total de Zung.

Diagnóstico retrospectivo de una muestra de pacientes egresados con el diagnóstico de esquizofrenia / Retrospective study from a sample of patients discharged with the diagnosis of schizophrenia

Se realizó el diagnóstico retrospectivo de una muestra de 300 pacientes egresados del Hospital Psiquátrico de Maracaibo (Venezuela), con el diagnóstico clínico de Esquizofrenia. Estas historias fueron evaluadas con los criterios clínicos del DSM-III, utilizando formatos estructurales aplicados por dos psiquiatras. El 46,3% de los pacientes cumplió con los criterios correspondientes al Trastorno Esquizofrénico; del 53,6% restante, el 19,6% no aportó información suficiente para incluirla dentro de esta categoría diagnóstica, y el 34,6% fue clasificado dentro de otros desórdenes psiquiátricos. Los pacientes con Trastorno Esquizofrénico eran, en su mayoría (61,2%), del sexo masculino, solteros, y venezolanos; el 84,9% inició su cuadro clínico durante la segunda o tercera década de la vida; el 89,9% recibió instrucción escolar. La sintomatología predominante fue: deterioro en las relaciones sociales (93,5%), deterioro en la higiene y cuidado personal (92,5%), deterioro en la actividad laboral (87,1%), pensamiento ilógico (86,3%), con predominio del delirio persecutorio, alucinaciones auditivas y diálogo alucinatorio (84,6%), delirio de grandeza (48,2%) y vivencias de cambio corporal (45,3%). Las alteraciones del afecto estuvieron presentes en todos los pacientes y el subtipo predominante correspondió al Paranoide que se observó en un 80,6% de los casos. Los antecedentes familiares positivos se comprobaron en el 41% de los casos. Nuestros hallazgos confirman la necesidad de unificar criterios para el diagnóstico de los trastornos mentales, ya que se hace evidente que la variabilidad diagnóstica dificulta la investigación psiquátrica

Esquizofrenia paranoide: aminoácidos libres en el líquido cefalorraquídeo / Paranoid schizophrenia: free amino acids in cerebrospina

En el presente estudio los autores reportan un incremento de la concentración de glutamina en el líquido cefalorraquídeo de siete pacientes esquizofrénicos paranoides, sin cambios en los niveles de los 20 aminoácidos libres restantes