N-acetylcysteine in a Double-Blind Randomized Placebo-Controlled Trial: Toward Biomarker-Guided Treatment in Early Psychosis.

Biomarker-guided treatments are needed in psychiatry, and previous data suggest oxidative stress may be a target in schizophrenia. A previous add-on trial with the antioxidant N-acetylcysteine (NAC) led to negative symptom reductions in chronic patients. We aim to study NAC's impact on symptoms and neurocognition in early psychosis (EP) and to explore whether glutathione (GSH)/redox markers could represent valid biomarkers to guide treatment. In a double-blind, randomized, placebo-controlled trial in 63 EP patients, we assessed the effect of NAC supplementation (2700 mg/day, 6 months) on PANSS, neurocognition, and redox markers (brain GSH [GSHmPFC], blood cells GSH levels [GSHBC], GSH peroxidase activity [GPxBC]). No changes in negative or positive symptoms or functional outcome were observed with NAC, but significant improvements were found in favor of NAC on neurocognition (processing speed). NAC also led to increases of GSHmPFC by 23% (P = .005) and GSHBC by 19% (P = .05). In patients with high-baseline GPxBC compared to low-baseline GPxBC, subgroup explorations revealed a link between changes of positive symptoms and changes of redox status with NAC. In conclusion, NAC supplementation in a limited sample of EP patients did not improve negative symptoms, which were at modest baseline levels. However, NAC led to some neurocognitive improvements and an increase in brain GSH levels, indicating good target engagement. Blood GPx activity, a redox peripheral index associated with brain GSH levels, could help identify a subgroup of patients who improve their positive symptoms with NAC. Thus, future trials with antioxidants in EP should consider biomarker-guided treatment.

Self-report of eating disorder symptoms among women with and without infertility.

OBJECTIVE: To compare eating disorder (ED) symptoms in women seeking treatment for infertility to women receiving routine primary care. DESIGN: A cross-sectional comparative design. SETTING: Women were recruited from two infertility centers and a general hospital primary care setting. PARTICIPANTS: Participants included 51 women seeking treatment for ovulatory and unexplained infertility and 34 women attending routine primary care. MEASURES: Participants completed a battery of standardized rating scales measuring self-reported ED symptoms, drive for thinness, bulimic symptoms, body dissatisfaction, and related clinical characteristics. RESULTS: Multivariate analysis of covariance confirmed that women seeking treatment for infertility had significantly greater scores on measures of drive for thinness (p = .001) and bulimic symptoms (p = .002) than those receiving routine primary care. However, the comparison group had significantly greater scores on measures of body dissatisfaction (p < .001) and dietary restraint (p = .001) than the infertility group. Both groups had elevated rates of lifetime ED diagnoses compared to national prevalence rates. CONCLUSIONS: Results demonstrated that women seeking treatment for ovulatory and unexplained infertility have greater drive for thinness and bulimic symptoms but not body dissatisfaction or dietary restraint compared to women seeking primary care. The results suggest that infertility and routine health care visits may provide opportunities for early identification and treatment of women with ED symptomatology. Future studies may benefit from further elucidation of the potential role of ED symptoms in the etiology and maintenance of infertility in, particularly, normal-weight women.

Postpartum depression treatment rates for at-risk women.

BACKGROUND: Despite growing awareness of postpartum depression (PPD), screening is not yet standard care and evidence that screening produces improved health outcomes remains limited. OBJECTIVES: To examine mental health treatment rates at 3 and 4 months postpartum for women who were identified with PPD symptoms at 2 to 4 weeks after delivery. METHODS: A secondary analysis of data from a mother-infant intervention study for women with PPD symptoms was conducted. Postpartum women were screened for PPD symptoms; women with positive PPD screens were assessed at 2, 3, and 4 months postpartum. Research nurses monitored symptoms and encouraged and assisted women who experienced moderate to severe PPD symptoms to seek evaluation and mental health referral from their primary care providers. RESULTS: From the screening of a community-based population of 1,215 postpartum women, 122 women identified as having PPD enrolled in the clinical trial and 117 participated in all assessments. At 3 and 4 months postpartum, only 14 women (12%) received psychotherapy and fewer received psychopharmacologic treatment. In comparison to women with low PPD symptoms, significantly more women with high PPD symptoms were in therapy at 3 and 4 months. DISCUSSION: The inadequacy of treatment rates among a sample of at-risk women raises grave concern. Possible barriers to referral and treatment include clinician and healthcare system, third-party payment, and personal factors. Evaluating health outcomes from PPD screening and testing approaches designed to increase treatment participation are warranted.