Eveningness chronotype and depressive affective temperament associated with higher high-sensitivity C-reactive protein in unipolar and bipolar depression.

BACKGROUND: Several studies investigated the role of inflammation in the etiopathogenesis of mood disorders. The aim of our cross-sectional study is evaluating baseline high-sensitivity C-reactive-protein (hsCRP) levels in a cohort of unipolar and bipolar depressive inpatients, in relation with psychopathological, temperamental and chronotype features. METHODS: Among 313 screened inpatients, we retrospectively recruited 133 moderate-to-severe depressive patients who were assessed for hsCRP levels, chronotype with Morningness-Eveningness Questionnaire (MEQ) and affective temperament with Temperament Evaluation of Memphis, Pisa, Paris and San Diego (TEMPS). LIMITATIONS: The cross-sectional and retrospective design of the study, the small sample size, the exclusion of hypomanic, maniac and euthymic bipolar patients. RESULTS: hsCRP levels were significantly higher among those with previous suicide attempt (p = 0.05), death (p = 0.018) and self-harm/self-injury thoughts (p = 0.011). Linear regression analyses, adjusted for all covariates, demonstrated that higher scores at the TEMPS-M depressive, while lower scores at the hyperthymic and irritable affective temperaments [F = 88.955, R2 = 0.710, p < 0.001] and lower MEQ scores [F = 75.456, R2 = 0.405, p < 0.001] statistically significantly predicted higher hsCRP. CONCLUSION: Eveningness chronotype and a depressive affective temperament appeared to be associated with higher hsCRP levels during moderate-to-severe unipolar and bipolar depression. Further longitudinal and larger studies should better characterise patients with mood disorders by investigating the influence of chronotype and temperament.

C-Reactive Protein (CRP): A Potent Inflammation Biomarker in Psychiatric Disorders.

An increasing number of studies have investigated the role of inflammation in psychiatric disorders, by demonstrating how an altered/dysfunctional immunological and inflammatory system may underpin a psychiatric condition. Particularly, several studies specifically investigated the role of a neuroinflammatory biomarker, named C-reactive protein (CRP), in psychiatric disorders. Overall, even though scientific literature so far published still does not appear definitive, CRP is more likely reported to be elevated in several psychiatric disorders, including schizophrenia, mood disorders, anxiety disorders and post-traumatic stress disorder. Moreover, a low-grade inflammation (CRP >3 mg/L) has been more likely observed in a subgroup of patients affected with a more severe psychopathological symptomatology, more treatment resistance and worst clinical mental illness course, strengthening the hypothesis of the need for a different clinical and prognostic characterization based on this concomitant neuroinflammatory predisposition. However, even though further research studies are needed to confirm this preliminary evidence, CRP may represent a potential clinical routine biomarker which could be integrated in the clinical routine practice to better characterize clinical picture and course as well as address clinicians towards a personalized treatment.

Foreign Nationality, Family Psychiatry History and Pregestational Neoplastic Disease as Predictors of Perinatal Depression in a Cohort of Healthy Pregnant and Puerperal Women during the COVID-19 Pandemic.

Background: Perinatal depression (PND) represents one of the most common mental disorders in the pregnancy and/or postpartum period, with a 5-25% prevalence rate. Our aim was to investigate predictors associated with PND in a cohort of pregnant and puerperal women based in an Italian setting during the COVID-19 pandemic. Methods: We retrospectively recruited 199 (55 pregnant and 144 puerperal) women, afferent to our Perinatal Mental Outpatient Service of Ancona (Italy). Participants were administered an ad hoc case-report form, Whooley Questions (WQ), the General Health Questionnaire-12 (GHQ-12), the Stress Holmes-Rahe scale (HR) and the Edinburgh Postnatal Depression Scale (EPDS). Results: Around 10% of the sample had a confirmed PND. Being a foreigner woman (RR = 3.8), having a positive psychiatric family history (RR = 5.3), a pre-pregnancy medical comorbidity (RR = 1.85) and a comorbid medical illness occurring during the pregnancy (RR = 2) were much likely associated with PND. Multiple linear regression analysis demonstrated that GHQ, medium- and high-risk at the HR, foreign nationality, positive family psychiatric history, and neoplastic disease before conception significantly predicted EPDS [F(1, 197) = 10.086, R2 = 0.324, p < 0.001]. Limitations: The sample size, poor heterogeneity in terms of socio-demographic, clinical and gynecological-obstetric characteristics, the cross-sectional design of the study. Conclusions: Our study showed a set of predictors associated with a higher risk for the PND onset, including gestational and pregestational medical disease. Our findings outline the need to screen all fertile women, particularly in gynecological and medical settings, in order to identify at-risk women for PND and promptly suggest a psychiatric consultation.

Schizophrenia: A Narrative Review of Etiopathogenetic, Diagnostic and Treatment Aspects.

Although schizophrenia is currently conceptualized as being characterized as a syndrome that includes a collection of signs and symptoms, there is strong evidence of heterogeneous and complex underpinned etiological, etiopathogenetic, and psychopathological mechanisms, which are still under investigation. Therefore, the present viewpoint review is aimed at providing some insights into the recently investigated schizophrenia research fields in order to discuss the potential future research directions in schizophrenia research. The traditional schizophrenia construct and diagnosis were progressively revised and revisited, based on the recently emerging neurobiological, genetic, and epidemiological research. Moreover, innovative diagnostic and therapeutic approaches are pointed to build a new construct, allowing the development of better clinical and treatment outcomes and characterization for schizophrenic individuals, considering a more patient-centered, personalized, and tailored-based dimensional approach. Further translational studies are needed in order to integrate neurobiological, genetic, and environmental studies into clinical practice and to help clinicians and researchers to understand how to redesign a new schizophrenia construct.

Fear and anxiety related to COVID-19 pandemic may predispose to perinatal depression in Italy.

The COVID-19 pandemic situation significantly affected the mental health of the general and clinical population. However, few studies investigated which COVID-19-related psychopathological determinants may predispose to perinatal depression. We evaluated the impact of COVID-19 related anxiety and fear on perinatal depression in Italy. We retrospectively screened 184 perinatal outpatients afferent to Perinatal Mental Health outpatient service, during March 2020-March 2021, by administering the Edinburgh Postnatal Depression Scale (EPDS), the Fear of COVID-19 (FCV-19-S) and the Coronavirus Anxiety Scale (CAS). Among these, 85 patients agreed to be recruited in the present study. The mean EPDS score was 9.0, experiencing a clinically relevant perinatal depression in 45.7% of the sample. The mean FCV-19-S score was 15.0 and CAS was 1.7. Linear regression analyses demonstrated that FCV-19-S and CAS scores statistically significantly predicted EPDS total scores. A positive significant correlation was reported between FCV-19-S and EPDS and between CAS and EPDS. During the COVID-19 pandemic, women in their perinatal period, independently of previous psychiatric history, experienced increased levels of anxiety, fear and psychological distress, due to subsequent isolation, quarantine, lockdown and deprivation of their normal social support. Further preventive and screening strategies should be implemented in order to early identify at-risk pregnant and puerperal women during the COVID-19 pandemic.

Recognizing, Managing and Treating Acute Agitation in Youths.

Acute agitation is common in youths presenting to emergency departments, and, in some cases, may escalate into aggression and violence. Therefore, acute agitation in youths should be immediately and appropriately recognized and treated to avoid the consequences of its escalation. Agitation is widespread in youths, reported in around 7% of all youths admitted to emergency departments due to psychiatric reasons. Overall, the most frequent causes of youth acute agitation include the exacerbation of neurodevelopmental disorders, such as ADHD, autism, or intellectual disabilities, or the onset of mood and psychotic disorders. Substance abuse is also common in adolescents and young adults with acute agitation. Management of agitation should be individualized, multidisciplinary, and collaborative. Along with a diagnostic assessment, the needs of the young patients should be understood and addressed, and de-escalation strategies should be immediately prompted. Rapid recognition and management are warranted, in order to assure the safety of the patient and healthcare staff jeopardized by the acute crisis. Firstly, environmental and de-escalation strategies should be acted with the aim to reduce agitation and, if possible, avoid the use of physical restraint. In case these strategies fail to succeed, pharmacological treatment should be rapidly implemented. Although youth agitation and aggression is transdiagnostic, prior diagnosis of psychiatric disorder should guide the choice of the tranquilizing medication whenever possible. This review will examine these aspects in detail and provide guidance on how to recognize, manage, treat and resolve acute agitation in youths.

C-Reactive Protein as a Biomarker for Major Depressive Disorder?

The etiopathogenesis of depression is not entirely understood. Several studies have investigated the role of inflammation in major depressive disorder. The present work aims to review the literature on the association between C-Reactive Protein (CRP) and depression. A systematic review was performed for the topics of 'CRP' and 'depression' using the PubMed database from inception to December 2021. Fifty-six studies were identified and included in the review. Evidence suggested the presence of dysregulation in the inflammation system in individuals with depression. In most studies, higher blood CRP levels were associated with greater symptom severity, a specific pattern of depressive symptoms, and a worse response to treatment. Moreover, about one-third of depressed patients showed a low-grade inflammatory state, suggesting the presence of a different major depressive disorder (MDD) subgroup with a distinct etiopathogenesis, clinical course, treatment response, and prognosis, which could benefit from monitoring of CRP levels and might potentially respond to anti-inflammatory treatments. This work provides robust evidence about the potential role of CRP and its blood levels in depressive disorders. These findings can be relevant to developing new therapeutic strategies and better understanding if CRP may be considered a valuable biomarker for depression.

The role of digital tools in providing youth mental health: results from an international multi-center study.

Since the traditional mental health system showed significant limitations in the early identification, diagnosis and treatment of the current new youth psychopathological trajectories, by substantially failing in targeting the needs of the current young generation, there is the demand to redesign and digitally adapt youth mental health care and systems. Indeed, the level of digital literacy and the level of digital competency and knowledge in the field of digital psychiatry is still under-investigated among mental health professionals, particularly in youth mental health. Therefore, we aimed at: (a) carrying out a post-hoc analysis of an international multi-centre study, to investigate the opinions of mental health professionals regarding the feasibility, efficacy and clinical experience in delivering digital mental health interventions (DMHIs) in youths; (b) providing a comprehensive overview on the integrated digitally-based youth mental health care models and innovations. Mental health professionals declared the lack of a formal training in digital psychiatry, particularly in youth mental health. Subjects who received a formal theoretical/practical training on DMHIs displayed a statistical trend towards a positive feasibility of digital psychiatry in youth mental health (p = 0.053) and a perceived increased efficacy of digital psychiatry in youths (p = 0.051). Respondents with higher Digital Psychiatry Opinion (DPO) scores reported a positive perceived feasibility of DMHIs in youths (p < 0.041) and are more prone to deliver DMHIs to young people (p < 0.001). Respondents with higher knowledge scores (KS) declared that DMHIs are more effective in youth mental health (p < 0.001). Overall, the digitalisation indeed allowed young people to keep in touch with a mental health professional, facilitating a more dynamic and fluid mental health care access and monitoring, generally preferred and considered more feasible by post-Millennial youngsters. Accordingly, our findings demonstrated that mental health professionals are more prone to offer DMHIs in youth mental health, particularly whether previously trained and knowledgeable on the topic.

A Systematic Review on TeleMental Health in Youth Mental Health: Focus on Anxiety, Depression and Obsessive-Compulsive Disorder.

Background and Objectives: The Internet is widely used and disseminated amongst youngsters and many web-based applications may serve to improve mental health care access, particularly in remote and distant sites or in settings where there is a shortage of mental health practitioners. However, in recent years, specific digital psychiatry interventions have been developed and implemented for special populations such as children and adolescents. Materials and Methods: Hereby, we describe the current state-of-the-art in the field of TMH application for young mental health, focusing on recent studies concerning anxiety, obsessive-compulsive disorder and affective disorders. Results: After screening and selection process, a total of 56 studies focusing on TMH applied to youth depression (n = 29), to only youth anxiety (n = 12) or mixed youth anxiety/depression (n = 7) and youth OCD (n = 8) were selected and retrieved. Conclusions: Telemental Health (TMH; i.e., the use of telecommunications and information technology to provide access to mental health assessment, diagnosis, intervention, consultation, supervision across distance) may offer an effective and efficacious tool to overcome many of the barriers encountering in the delivery of young mental health care.

Severe and persistent mental illness (SPMI) in pregnancy and breastfeeding: focus on second-generation long acting injectable antipsychotics.

Introduction: Pregnant women and fetuses are more likely than ever to be exposed to antipsychotic drugs (APs) during pregnancy and postpartum period. Second-generation APs (SGA) are increasingly used among women in reproductive age. Key outcomes (i.e., congenital malformations, pregnancy and maternal outcomes, neonatal/infant risks, and developmental/long-term outcomes) following the exposure to APs remain limited in number and size and yield of inconsistent findings overall, particularly regarding long-acting injectable AP (LAI-APs) formulations.Areas covered: The review aims at providing a summary of current knowledge on potential risks and safety profile of LAI-APs during pregnancy and breastfeeding, specifically focusing on SGA.Expert opinion: The management of safety and tolerability of long-acting injectable AP (LAI-APs) is far from having solid scientific evidence. In fact, due to ethical reasons, there is a lack of randomized clinical trials that limits the reliability and generalizability of the available data on LAI-APs safety profile during the perinatal period, being limited in the scientific literature only to isolated case reports. Therefore, it seems to be important for the future pathways to perinatal mental health care, providing a network of specialized clinicians and systematically collecting data of pregnant/puerperal women on oral and/or LAI APs-therapy about mother and infant outcomes.

The 'collateral side' of mood stabilizers: safety and evidence-based strategies for managing side effects.

INTRODUCTION: Adverse events (AEs) monitoring of mood stabilizers (MS) is essential during the treatment of mood disorders as safety and tolerability profiles of MS may greatly influence treatment adherence, patient's compliance, and discontinuation rate. Therefore, clinicians should be aware of their AEs profile and tapering a variety of strategies to manage them, according to an evidence-based approach. AREAS COVERED: We aimed at critically summarizing the tolerability and safety profile for each nonantipsychotic MS, providing evidence-based strategies able to manage these AEs, in order to increase clinically useful strategies which may allow clinicians enhancing adherence and therapeutic compliance, the impact on quality of life and treatment efficacy in psychiatric conditions. EXPERT OPINION: The management of the safety and tolerability profile of each MS comprises an initial assessment of the symptoms/signs to be observed/measured during the therapy, including a psychoeducational activity, a periodical monitoring with a specific timing depending on clinical parameters and each prescribed MS, but also an evaluation if a treatment modification (in terms of dose adjustment, discontinuation or additional medication to be prescribed) is required as well as which combination therapy is allowed and which caution should be posed by clinicians in some special conditions, including pregnancy and breastfeeding.