Major depressive disorder (MDD) is a complex psychiatric disorder that, presented alone or with other comorbidities, requires different adjustments of antidepressant treatments. Some investigations have demonstrated that psychoactive drugs, such as serotonin and norepinephrine reuptake inhibitors (SNRIs), can exert more effective and faster antidepressant effects than other common medications used, such as serotonin selective reuptake inhibitors (SSRIs), although these differences are still controversial. During the last five years, the SNRI duloxetine has shown favorable results in clinical practice for the treatment of MDD, anxiety, and fibromyalgia. Through an online self-completed survey, in the present article, we collected information from 163 psychiatrists regarding the use of duloxetine and its comparison with other psychiatric drugs, concerning psychiatrists' knowledge and experience, as well as patients' preferences, symptoms, and well-being. We discussed and contrasted physicians' reports and the scientific literature, finding satisfactory concordances, and finally concluded that there is agreement regarding the use of duloxetine, not only due to its tolerability and effectiveness but also due to the wide variety of situations in which it can be used (e.g., somatic symptoms in fibromyalgia, diabetes) as it relieves neuropathic pain as well.
Psychosis is a complex entity characterized by psychological, behavioral, and motor alterations resulting in a loss of contact with reality. Although it is not common, pregnancy can be a period in which a first episode of psychosis can manifest, entailing detrimental consequences for both the fetus and the mother. The pathophysiological basis and study of maternofetal wellbeing need to be further elucidated. Lipid peroxidation and ferroptosis are two phenomena that are tightly linked to the placental dysfunction commonly observed in different complications of pregnancy. In the present study, we aim to explore the histopathological and gene expression of different markers of lipid peroxidation and ferroptosis in the placentas of women who underwent a first episode of psychosis during their pregnancy (n = 22). The aim is to then compare them with healthy pregnant women (n = 20). In order to achieve this goal, iron deposits were studied using Prussian Blue staining. In addition, the protein/gene expression of a transferrin receptor (TFRC), as well as an acyl-CoA synthetase long-chain family member 4 (ACSL-4), arachidonate lipoxygenase-5 (ALOX-5), malondialdehyde (MDA), and glutathione peroxidase 4 (GPX4) were all analyzed through gene expression (RT-qPCR) and immunohistochemical procedures. Our results demonstrate an increased presence of iron deposits that are accompanied by a further expression of TFRC, ACSL-4, ALOX-5, MDA, and GPX4-all of which are observed in the placenta tissue of women who have suffered from a first episode of psychosis. Therefore, in our study, a histopathological increase in lipid peroxidation and ferroptosis markers in the affected women is suggested. However, further studies are needed in order to validate our results and to establish possible consequences for the reported alterations.
Ferroptosis , Psychotic Disorders , Humans , Female , Pregnancy , Lipid Peroxidation , Ferroptosis/genetics , Placenta/metabolism , Phospholipid Hydroperoxide Glutathione Peroxidase/metabolism , Iron/metabolism , Psychotic Disorders/genetics , Psychotic Disorders/metabolism
Major depressive disorder (MDD) is a complex, multifactorial disorder of rising prevalence and incidence worldwide. Nearly, 280 million of people suffer from this leading cause of disability in the world. Moreover, patients with this condition are frequently co-affected by essential nutrient deficiency. The typical scene with stress and hustle in developed countries tends to be accompanied by eating disorders implying overnutrition from high-carbohydrates and high-fat diets with low micronutrients intake. In fact, currently, coronavirus disease 2019 (COVID-19) pandemic has drawn more attention to this underdiagnosed condition, besides the importance of the nutritional status in shaping immunomodulation, in which minerals, vitamins, or omega 3 polyunsaturated fatty acids (ω-3 PUFA) play an important role. The awareness of nutritional assessment is greater and greater in the patients with depression since antidepressant treatments have such a significant probability of failing. As diet is considered a crucial environmental factor, underlying epigenetic mechanisms that experience an adaptation or consequence on their signaling and expression mechanisms are reviewed. In this study, we included metabolic changes derived from an impairment in cellular processes due to lacking some essential nutrients in diet and therefore in the organism. Finally, aspects related to nutritional interventions and recommendations are also addressed.
Background: current findings in the etiopathogenesis of eating disorders (ED) do not allow the formulation of a unique causal model. Currently, the main hypotheses about the etiopathogenesis are based on a multifactorial approach, considering both genetic and environmental factors. The aim of this study is to analyze the relationship between sociodemographic and behavioral factors, as well as self-esteem, in students of the first cycle of middle school and the probability of belonging to the risk group of eating disorders (ED) measured through the EAT-26 scale. Methods: The study target population consists of students of the first cycle of middle school. The instruments applied to the population consisted in: (1) a survey of sociodemographic data and behavioral variables; (2) Rosenberg's self-esteem test; and (3) EAT Test (Eating Attitudes Test 26). Results: Of a total of 656 students belonging to eight educational centers in Madrid who were offered to participate in the study, 88.6% (n = 579) answered the whole questionnaire. The mean age of the participants was 13.7 years old. Of the participating adolescents, 57.3% were male and the remaining 42.7% (n = 260) were female. A significant relationship was observed between self-esteem and belonging to an ED risk group, with an OR = 0.910 (CI 95% 0.878−0.943). Hence, each one-point increase on the self-esteem dimension decreased the risk of belonging to an ED risk group by 9.5%. In the variables considered in the area of dysfunctional feeding patterns, the variables 'number of meals' (p < 0.01), 'dieting' (p < 0.01), and 'drug consumption to lose weight' (p < 0.01) were found to be related to the risk of belonging to the ED group. Conclusions: The results obtained in our research can help to establish explanatory models that include the understanding of the interaction of the different factors that influence the appearance and development of EDs. Therefore, these should be taken into consideration when developing ED preventive programs.
Feeding and Eating Disorders , Adolescent , Feeding Behavior , Female , Humans , Male , Risk Factors , Self Concept , Students , Surveys and Questionnaires
Major Depressive Disorder (MDD) represents a major global health concern, a body-mind malady of rising prevalence worldwide nowadays. The complex network of mechanisms involved in MDD pathophysiology is subjected to epigenetic changes modulated by microRNAs (miRNAs). Serum free or vesicles loaded miRNAs have starred numerous publications, denoting a key role in cell-cell communication, systematically and in brain structure and neuronal morphogenesis, activity and plasticity. Upregulated or downregulated expression of these signaling molecules may imply the impairment of genes implicated in pathways of MDD etiopathogenesis (neuroinflammation, brain-derived neurotrophic factor (BDNF), neurotransmitters, hypothalamic-pituitary-adrenal (HPA) axis, oxidative stress, circadian rhythms...). In addition, these miRNAs could serve as potential biomarkers with diagnostic, prognostic and predictive value, allowing to classify severity of the disease or to make decisions in clinical management. They have been considered as promising therapy targets as well and may interfere with available antidepressant treatments. As epigenetic malleable regulators, we also conclude emphasizing lifestyle interventions with physical activity, mindfulness and diet, opening the door to new clinical management considerations.
Major depressive disorder (MDD) is a complex and common disorder, with many factors involved in its onset and development. The clinical management of this condition is frequently based on the use of some pharmacological antidepressant agents, together with psychotherapy and other alternatives in most severe cases. However, an important percentage of depressed patients fail to respond to the use of conventional therapies. This has created the urgency of finding novel approaches to help in the clinical management of those individuals. Nutraceuticals are natural compounds contained in food with proven benefits either in health promotion or disease prevention and therapy. A growing interest and economical sources are being placed in the development and understanding of multiple nutraceutical products. Here, we summarize some of the most relevant nutraceutical agents evaluated in preclinical and clinical models of depression. In addition, we will also explore less frequent but interest nutraceutical products which are starting to be tested, also evaluating future roads to cover in order to maximize the benefits of nutraceuticals in MDD.
Objetivos: Evaluar las diferencias clínicas de pacientes obesos con y sin alteraciones de la conducta alimentaria. Pacientes y método: Se estudió a 210 pacientes con obesidad mórbida derivados de forma consecutiva y por diferentes motivos a una consulta de psiquiatría en un hospital general. Se realizó una entrevista clínica, se valoró la presencia de comorbilidad psiquiátrica y se aplicó una serie de escalas de psicopatología y sobre conducta alimentaria: Escala de Depresión de Beck (BDI), Escala de Ansiedad de Beck (BAI), Inventario de Obsesiones-Compulsiones de Maudsley (MOCI), Escala de Impulsividad de Barrat (BIS), Inventario de Trastornos de la Alimentación (EDI), Test de Actitudes hacia la Comida (EAT), Test de Bulimia de Edimburgo (BITE) y Cuestionario sobre la Figura Corporal (BSQ). La muestra se dividió en 2 grupos: pacientes con conductas de atracones según la definición de la Clasificación Internacional de Enfermedades (CIE-10) y el Manual Diagnóstico y Estadístico de los Trastornos Mentales (DSM-IV) y pacientes sin esas conductas. En el primer grupo se incluyó a 14 pacientes con bulimia nerviosa, 32 con criterios de trastorno por atracón y 15 con atracones sin criterios para uno de los dos trastornos citados (total, 61 pacientes con atracones y 149 sin atracones). Resultados: Los pacientes con atracones tenían más alteraciones psicopatológicas, fundamentalmente mayor prevalencia de distimia, eran más impulsivos según la escala BIS y obtenían puntuaciones más elevadas en algunas escalas que valoraban la alteración de la conducta alimentaria. Estos pacientes tenían más antecedentes familiares de trastornos de la conducta alimentaria (TCA) y presentaban mayor insatisfacción corporal a pesar de un menor índice de masa corporal (IMC). Este grupo refería mayores limitaciones funcionales por su obesidad y presentaba mayor obsesión sobre el peso y la comida. Conclusiones: Por lo tanto, los obesos mórbidos con atracones forman un grupo posiblemente homogéneo (independientemente de que tuvieran diagnóstico del trastorno de la conducta alimentaria) y diferenciado del resto de los obesos mórbidos por tener más alteraciones psicopatológicas, fundamentalmente de tipo afectivo, mayor impulsividad y mayor severidad en las escalas que evalúan los síntomas nucleares de los trastornos de la conducta alimentaria e insatisfacción corporal
Objectives: To evaluate clinical differences between morbidly obese patients with and without binge eating. Patients and method: We evaluated 210 morbidly obese outpatients who were consecutively referred for psychiatric evaluation in a general hospital for distinct reasons. We carried out a clinical interview, evaluated psychiatric comorbidity, and applied the following scales: Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Maudsley Obsessive-Compulsive Interview (MOCI), Barrat Impulsiveness Scale (BIS), Eating Disorder Inventory (EDI), Eating Attitudes Test (EAT), Bulimic Investigation Test Edinburgh (BITE), and Body Shape Questionnaire (BSQ). The sample was divided into two groups: patients with binge eating according to ICD-10 and DSM-IV criteria and those without binge eating. There were 61 patients with binge eating (14 patients with bulimia nervosa, 32 with binge eating disorder, and 15 patients with binge eating who did not fulfill the criteria for bulimia or binge eating disorder) and 149 patients without binge eating. Results: Patients with binge eating showed more psychopathology, a greater prevalence of dysthymia, higher impulsivity scores according to the BIS scale and higher scores on some of the scales that evaluated eating disorders. These patients had a greater number of familial antecedents of eating disorders and showed greater body dissatisfaction, despite having a lower body mass index. Patients with binge eating also showed greater obesity-induced functional disability and greater obsessiveness about weight and body shape. Conclusions: The results of this study suggest that morbidly obese patients with binge eating constitute a distinct subgroup (independently of eating disorder diagnosis) among the obese population. Distinguishing features consist of more severe psychopathology, especially affective disorder, greater impulsivity, and greater severity in scales evaluating core symptoms of eating disorders and body dissatisfaction
Humans , Obesity, Morbid/psychology , Hyperphagia/psychology , Feeding and Eating Disorders/psychology , Impulsive Behavior/psychology , Antisocial Personality Disorder
