Brain-Derived Neurotrophic Factor (BDNF) and First-Episode Psychosis. A longitudinal one-year prognosis study.

The brain-derived neurotrophic factor (BDNF) is a neurotrophin that has been linked to the schizophrenia neurodevelopmental hypothesis.

Factor neurotrófico derivado del cerebro y primeros episodios psicóticos. Estudio pronóstico de un año / Brain-derived neurotrophic factor (bdnf) and first-episode psychosis. a longitudinal one-year prognosis study

Introducción. El factor neurotrófico derivado del cerebro(BDNF) es una neurotrofina que se ha relacionado con la hipótesis del neurodesarrollo de la esquizofrenia. Varios estudios confirman que los niveles de BDNF en el primer episodio psicótico (PEP) son más bajos que en los controles sanos. Sin embargo, los datos al respecto de la evolución de los niveles tras un PEP y el valor pronóstico de dichos niveles son controvertidos. Método. Se compararon los niveles séricos de BDNF al ingreso de 28 pacientes hospitalizados con PEP con 28controles sanos. También se midió el BDNF al momento del alta, a los tres, seis, nueve y doce meses. Los niveles de BDNF se presentan en ng/ml. Se buscó correlación con la sintomatología psicótica medida con la Escala de Síndrome Positivo y Negativo (PANSS) y se evaluó en valor pronóstico de los niveles basales para predecir mala funcionalidad (medida por la Evaluación Global del Funcionamiento) y/o recaída, así como el diagnóstico ulterior de un trastorno psicótico crónico. Resultados. Al ingreso, los niveles de BDNF de los pacientes fueron significativamente más bajos que los niveles de los controles sanos (18,52±4,51 vs. 26,55±3,22, p<0,001). Al altalos niveles de PEP aumentaron hasta niveles de los controles sanos (25,95±3,96 vs. 26,55±3,22, p=0,539). En las siguientes determinaciones, los niveles de BDNF en PEP disminuyeron, alcanzando los valores de ingreso y siendo significativamente más bajos que los controles sanos y los niveles al alta(pacientes: tres meses: 19,68±3,88; seis meses: 19,02±4,13;nueve meses: 17,64±5,24; doce meses:17,51±3,45 vs. controles sanos: 26,55±3,22, todos p<0,001). Se encontró una correlación negativa entre el BDNF al ingreso y las puntuaciones de la subescala de síntomas negativos de la PANSS con una tendencia hacia la significación (r=-0,303, p=0,093). ... (AU)

Introduction. The brain-derived neurotrophic factor(BDNF) is a neurotrophin that has been linked to the schizophrenia neurodevelopmental hypothesis. Several studiesconfirm that the BDNF levels in first-episode psychosis (FEP)are lower than in healthy controls (HC). However, data aboutevolution of BDNF levels after a FEP and about the prognostic value of these levels are controversial. Method. Serum BDNF levels at admission of 28 inpatients with FEP were compared with 28 HC. BDNF was also measured at discharge, three, six, nine and twelve months. BDNF levels are presented in ng/ml. We looked for correlation of BDNF levels with the psychotic symptomatology measuredwith the Positive and Negative Syndrome Scale (PANSS) andalso the prognostic value of basal levels was evaluated topredict poor functionality (measured by the Global Assessment of Functioning) and/or relapse, as well as the subsequent diagnosis of a chronic psychotic disorder. Results. At admission, patients BDNF levels were significantly lower than HC levels (18.52±4.51 vs. 26.55±3.22,p<0.001). At discharge FEP levels increase until HC levels(25.95±3.96 vs. 26.55±3.22, p=0,539). Upon the following determinations, BDNF FEP levels decreased, reaching the admission values, and being significantly lower than the HC andthe levels at discharge (patients: three months: 19.68±3.88;six months: 19.02±4.13; nine months: 17.64±5.24; twelve months: 17.51±3.45 vs. HC: 26.55±3.22, all p<0.001). A negative correlation was found between admission BDNF levels and the PANSS negative symptoms subscale score with a trend towards significance (r=-0.303, p=0.093). BDNF levels at admission of patients with por functionality and/orrelapse at 12 months were lower than BDNF levels of patients with goof functionality and without relapse, this difference had a trend towards significance. (15.38±4.72 vs.19.57±4.06; p=0.071). (AU)

Serum s100b protein levels as a neuroinflammatory biomarker of acutely relapsed paranoid schizophrenia patients.

OBJECTIVE: The s100b inflammatory protein is involved in schizophrenia pathophysiology. We aim at studying the evolution of the s100b serum levels in acutely relapsed paranoid schizophrenia patients at three different time points (admission, discharge and 3 months after hospital discharge 3MAHD). METHODS: Twenty-three paranoid schizophrenia inpatients meeting DSM-IV criteria participated in the research. Twenty-three healthy subjects matched by age, gender and season acted as the control group. Psychopathology was measured with the Positive and Negative Syndrome Scale (PANSS). Serum s100b levels were determined at 12:00 and 24:00 h with an enzyme-linked immunoassay kit. RESULTS: Patients had significant higher serum s100b levels at admission and discharge (12:00 h) than the group of healthy subjects. At admission and discharge, s100b serum levels at 24 h had decreased compared to the 24:00 h s100b levels of the healthy subjects. At 3MAHD patients and healthy subjects had similar levels of serum s100b protein. Positive and negative PANSS scores decreased significantly between admission and discharge. Positive and negative PANSS scores decreased between discharge and 3MAHD, but these changes had no statistical significance. CONCLUSIONS: Our study confirms that the acute inflammatory response produced in acutely relapsed patients is reversed after 3 month of hospital discharge. The variations of serum s100b concentrations when the patients suffer from an acute relapse may be a useful predictor of disease evolution.

Psychosis in Epilepsy vs Late-Onset Schizophrenia: A Case Report.

Psychotic disorders can have a primary or secondary origin. Primary psychosis includes pathologies such as paranoid schizophrenia, acute psychotic episodes, schizoaffective disorder, and other chronic psychiatric disorders. However, in secondary psychosis, there is an organic cause that explains the appearance of psychotic symptoms, such as those secondary to the consumption of psychoactive substances or some neurological or systemic diseases. Psychosis in epilepsy falls under secondary psychosis. It may present as hallucinations and delirium reminiscent of some primary psychoses such as schizophrenia. We present the case of a 57-year-old female suffering from temporal lobe epilepsy who developed psychotic symptoms and whose definitive diagnosis was a challenge given the similarities between some alternative diagnoses, mainly between interictal psychosis of epilepsy and late-onset schizophrenia. We also review the relevant literature. We consider that more studies are required to clarify the relationship between epilepsy and psychosis.

Acute paranoid schizophrenia relapsed inpatients present summer/ winter but not day/night changes in serum S100B concentrations.

Healthy subjects present higher summer than winter S100B protein concentrations. There is no available information regarding if schizophrenia patients present the same pattern. The aim of this research is to study if patients with schizophrenia present seasonal changes in serum S100B concentrations.

Pacientes ingresados por recaída aguda de esquizofrenia paranoide: cambios estacionales, pero no circadianos, en los niveles séricos deproteína S100B / Patients admitted for acute relapse of paranoid schizophrenia: seasonal, but not circadian, changes in serum levels of S100B protein

Introducción: El objetivo de esta investigación es estudiar si los pacientes esquizofrénicos presentan niveles másaltos de proteína S100B en verano que en invierno, como seha descrito en sujetos sanos.Método. Se estudiaron 52 pacientes caucásicos que ingresaron por recaída aguda y que cumplían con los criteriosDSM-IV de esquizofrenia paranoide. La proteína S100B ensuero se midió a las 12:00 y las 00:00 horas el día despuésdel ingreso. Los pacientes fueron reclutados durante nuevemeses (julio-marzo) y se agruparon por estación, según lafecha de ingreso, como grupo de verano, otoño o invierno.Los niveles séricos de S100B se midieron con un ELISA.Resultados. Los pacientes ingresados en invierno presentaron niveles séricos de proteína S100B significativamentemás altos a las 12:00 y 00:00 horas que los pacientes ingresados en verano (12:00, invierno: 287,5 ± 264,9 vs. verano: 33,7 ± 22,6, p < 0,05; 00:00, invierno: 171,2 ± 143,8 vs.verano: 23,3 ± 18,6, p < 0,05). Las concentraciones séricasde S100B en otoño no fueron significativamente diferentesde las concentraciones de verano o invierno (12:00: 128,7 ±208,8, 00:00: 102,2 ± 153,2). No hubo diferencias significativas por estación entre las concentraciones diurnas y nocturnas de proteína S100B.Conclusiones. Los pacientes esquizofrénicos hospitalizados por una descompensación aguda presentan concentraciones séricas de proteína S100B significativamente másaltas en invierno que en verano, al contrario de lo descritoen sujetos sanos, tanto a las 12:00 horas como a las 00:00horas. Al estudiar este biomarcador en la esquizofrenia esrecomendable controlar el cambio de estación como fuentede sesgo en los diseños experimentales. (AU)

Introduction: Healthy subjects present higher summerthan winter S100B protein concentrations. There is no available information regarding if schizophrenia patients presentthe same pattern. The aim of this research is to study if patients with schizophrenia present seasonal changes in serumS100B concentrations.Methods. In fifty-two Caucasian schizophrenia paranoidinpatients meeting DSM-IV criteria, serum S100B protein wasmeasured at 12:00 h and 00:00 h the next day after admission.Patients were recruited for a period of nine months (July-March)and were grouped as summer, autumn or winter group according to the date of admission. Serum S100B levels were measuredwith an enzyme-linked immunoassay (ELISA) kit.Results. Patients admitted in winter had significantly higher serum S100B concentrations at 12:00 h and 00:00 h than patients admitted in summer (12:00, winter: 287.5±264.9 vs.summer: 33.7±22.6, p < 0.05; 00:00, winter: 171.2±143.8 vs.summer: 23.3±18.6, p < 0.05). Autumn serum S100B concentrations were not significantly different from the summer or winter concentrations (12:00: 128.7±208.8, 00:00:102.2±153.2). There were no significant differences between12:00 and 00:00 serum S100B concentrations in any season.Conclusions. Acutely relapsed paranoid schizophreniainpatients present significantly higher serum S100B concentrations in winter than summer, the opposite pattern described in healthy subjects, both at midday and midnight.Controlling this seasonal change as source of bias in experimental designs is strongly advisable. (AU)

Melatonin and melatonin agonists as treatments for benzodiazepines and hypnotics withdrawal in patients with primary insomnia. A systematic review.

BACKGROUND: Hypnotics (HYP) and benzodiazepines (BZD) are medicines prescribed for the insomnia treatment. Many patients present difficulties in discontinuing the treatment once established. Melatonin (MLT) has been prescribed as a treatment for BZD/HYP detoxification. AIMS: The primary objective of this systematic review is to assess the efficacy of MLT and MLT agonists (melatoninergics) in improving the rate of BZD and/or HYP discontinuation among adults with primary insomnia attempting to discontinue BZD and/or HYP. The secondary objective is to evaluate the partial efficacy of melatoninergic drugs in the discontinuation of BZD and/or HYP consumption in subjects that could not stop their consumption. METHOD: A search on Web of Science and Scopus was carried out from database inception to July 1st, 2019. RESULTS: Three hundred and forty-nine articles were identified but only four were included in the final review. Two were cohort prospective, one placebo-control double blind and one double blind placebo-control cross-over designed study. Total withdrawal (TW) ranged from 0% to 25% in the placebo arm and from 64.3% to 77.8% in the MLT arm. In cohort studies TW figures ranged from 30.8% to 65%. Partial withdrawal ranged between 20% and 30.8% of patients that did not achieve TW with reduction figures of diazepam equivalent dose ranging from 25% to 75%. CONCLUSION: MLT has a place in the physician armamentarium to treat the suspension/reduction of BZD/HYP consumption in patients with primary insomnia.

Descriptive study of diving injuries in the Canary Islands from 2008 to 2017.

INTRODUCTION: This research reports the epidemiology of diving injuries managed in the Hyperbaric Medicine Unit of the Canary Islands University Hospital. METHODS: Data were extracted from the clinical records of all divers injured and admitted to the unit for treatment of dysbaric diving injuries between 2008 and 2017, inclusive. RESULTS: One-hundred and thirty diving injuries were recorded. Most (71%) occurred in men and 43% were foreigners. Eighteen per cent either had no diving certification or that information was not recorded in the clinical chart. Only a third of the 40% of divers who had some form of on-site first aid treatment received oxygen and oral rehydration. Type 1 decompression sickness (DCS) was diagnosed in 56 divers (43%) and Type 2 in 67 (52%), whilst seven were treated for omitted decompression. At discharge, 122 (94%) were asymptomatic, whilst 5% experienced some residual sensory or other changes. One diver who presented late remained quadriparetic and one, admitted in a state of coma, died. Only 76% of the injured divers had specific diving accident insurance and, of those, 58% were foreign divers. CONCLUSIONS: Over half of the injured divers did not receive any on-site first aid. The majority (94%) of treated injured divers were discharged without sequelae. Based on these data, several public health recommendations for the Canary Islands are made.

Síntomas siquiátricos y diferencias relacionadas con el sexo en pacientes con infarto de miocardio con arterias coronarias no obstructivas / Psychiatric symptoms and sex-related differences in patients with myocardial infarction with nonobstructive coronary arteries

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Day/Night and Summer/Winter Changes in Serum Total Antioxidant Capacity.

BACKGROUND: Seasonal and circadian changes are two factors described to affect blood levels of some biological molecules. The Total Antioxidant Capacity (TAC) is one global measure of the antioxidant capacity of a system. There is no agreement about the existence of day/night changes in TAC levels as well as there is no information about seasonal changes in TAC levels. OBJECTIVE: The aims of this research are studying if there are summer/winter changes in TAC concentrations or if TAC concentrations have day/night changes. METHOD: Ninety-eight healthy subjects took part in the summer study of whom 64 participated in the winter one. Blood was sampled at 09:00, 12:00 and 00:00 h. TAC was measured by the ABTS radical cation technique. Results are expressed in mmol/L of trolox equivalents. RESULTS: The subjects had significantly higher TAC levels in summer than winter at the three-time point studied. Summer 09:00 TAC concentration was significantly higher than the 12:00 and 00:00 h concentrations (1.34±0.26 vs 0.83±0.19, 0.75±0.18). Summer TAC 12:00 h concentrations were significantly higher than the 00:00 h concentrations (0.83±0.19 vs. 0.75±0.18). Winter 09:00 TAC concentrations were significantly higher than the 12:00 and 00:00 h concentrations (1.24±0.16 vs. 0.73±0.10, 0.67±0.13). There were no significant differences between the 12:00 and 00:00 h TAC concentrations. CONCLUSION: Strong methodological biases may be made if the seasonal and circadian changes in serum TAC concentration are not taken into account when researching in this area.

A three-month longitudinal study of changes in day/night serum total antioxidant capacity in paranoid schizophrenia.

Free radicals and an oxidant/antioxidant imbalance have been involved in the schizophrenia pathophysiology. The total antioxidant capacity (TAC) is a measure of the antioxidant capacity of a system. Day/night changes are a biological characteristic of hormones such as melatonin or cortisol. There is little information about TAC day/night changes in schizophrenia patients. The aim of this research is to study if there are day/night changes in serum TAC levels of schizophrenia patients. Thirty-two DSM-IV schizophrenia paranoid patients were studied. Blood was sampled at 12:00 and 00:00 h at admission, discharge and three months after hospital discharge (TMAHD). TAC results are expressed as mmol of Trolox/L. Patients did not have day/night TAC differences at admission (12:00: 0.67±0.12 vs. 00:00: 0.61±0.14, p>0.14) or discharge (12:00: 0.65±0.15 vs. 00:00: 0.65±0.12, p>0.99). At TMHD, patients had significantly higher TAC levels at midday than midnight (12:00: 0.83±0.10 vs. 00:00: 0.74±0.12, p<0.006) as it has been reported in healthy subjects. There were no significant TAC differences at 12.00 and 00:00 between admission and discharge. At TMAHD, patients had significantly higher TAC levels than at admission and discharge, both at 12:00 and 00:00 h. In conclusion, the absence of day/night serum TAC changes when clinically relapsed and the normalization of day/night serum TAC changes at TMHD can be considered as a biological marker of schizophrenia evolution.

Day/night changes in serum S100B protein concentrations in acute paranoid schizophrenia.

There are day/night and seasonal changes in biological markers such as melatonin and cortisol. Controversial changes in serum S100B protein levels have been described in schizophrenia. We aim studying whether serum S100B levels present day/night variations in schizophrenia patients and whether S100B levels are related to psychopathology. Sixty-five paranoid schizophrenic inpatients participated in the study. Psychopathology was assessed with the Positive and Negative Syndrome Scale (PANSS) at admission and discharge. Blood was drawn at 12:00 (midday) and 00:00 (midnight) hours at admission and discharge. Sixty-five healthy subjects matched by age, gender and season acted as control group. At admission and discharge patients had significantly higher serum S100B concentrations at midday and midnight than healthy subjects. At admission, patients showed a day/night variation of S100B levels, with higher S100B levels at 12:00 than at 00:00h (143.7±26.3pg/ml vs. 96.9±16.6pg/ml). This day/night difference was not present in the control group. Midday and midnight S100B at admission decreased when compared to S100B at discharge (midday, 143.7±26.3 vs. 83.0±12, midnight 96.9±16.6 vs. 68.6±14.5). There was a positive correlation between the PANSS positive subscale and S100B concentrations at admission. This correlation was not present at discharge. CONCLUSIONS: acute paranoid schizophrenia inpatients present a day/night change of S100B serum levels at admission that disappears at discharge. The correlation between serum S100B concentrations and the PANSS positive scores at admission as well as the decrease of S100B at discharge may be interpreted as an acute biological response to the clinical state of the patients.

Low levels of serum total antioxidant capacity and presence at admission and absence at discharge of a day/night change as a marker of acute paranoid schizophrenia relapse.

BACKGROUND: An oxidant-antioxidant system dysregulation has been described as a schizophrenia pathophysiological base. The total antioxidant capacity (TAC) is one measure of the antioxidant capacity of a system. Day/night concentration changes is a biological characteristic of hormones such as melatonin or cortisol. There is no information about TAC day/night changes in schizophrenia. AIMS: Studying the existence of a day/night TAC change in schizophrenia. METHOD: Forty-three DSM-IV paranoid schizophrenia inpatients participated in the study. Thirty healthy subjects matched by age and gender acted as control group. Blood was sampled at 12:00 and 00:00h the day after admission and the day before discharge. Serum TAC was measured by the ABTS radical cation technique and expressed in Trolox mmol/L. RESULTS: Patients had significantly lower TAC levels at admission and discharge (12:00 and 00:00) than controls. At admission patients had a TAC day/night change, with higher day-time than night-time levels (0.66±0.14 vs 0.60±0.15) as well as healthy subjects (0.83±0.07 vs 0.77±0.11). At discharge patients had a similar TAC level at 12:00 and 00:00 (0.64±0.15 vs 0.63±0.14). CONCLUSION: Schizophrenic patients present a deficit of the antioxidant system. The initial presence and the later absence of a day/night change deserves future studies.

Síntomas psiquiátricos y dimensiones de personalidad en pacientes menores de 65 años ingresados por un síndrome coronario agudo / Psychiatric symptoms and personality dimensions in patients younger than 65 years admitted for acute coronary syndrome

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Chronotype as modulator of morning serum melatonin levels.

BACKGROUND: The search for biological markers of individual characteristics has produced scanty results. Melatonin (MLT), the main hormonal product of the pineal gland, has been used as a biological marker of neuroticism, introversion-extroversion and morningness-eveningness. Morningness-eveningness indicates preferences associated with morning or evening activities. The goal of this research is to study if serum MLT levels are related to morningness-eveningness preference. METHODS: Twenty-three morning type and twenty-one evening type healthy volunteers took part in the study. Morningness-eveningness was evaluated with the Composite Scale of Morningness. Blood was drawn at 09:00, 12:00 and 00:00 h. MLT levels were measured with an ELISA. RESULTS: At 09:00 h evening type subjects had significantly higher serum MLT levels than morning type subjects (8.4±3.6 pg./ml. vs. 4.6±3.2 pg./ml., p<0.02). CONCLUSIONS: Morning serum MLT may be used as a biological peripheral marker of morningness-eveningness preference. Our results emphasise the convenience of expanding MLT studies until 09:00 h when differences between morning type and evening type subjects may still be found.

El cronotipo como modulador de los niveles séricos diurnos de melatonina / Chronotype as modulator of morning serum melatonin levels

Introducción. La búsqueda de marcadores biológicos que se relacionen con características específicas de las personas no ha producido grandes resultados. Los niveles sanguíneos de la melatonina (MLT), principal producto hormonal de la glándula pineal, han sido utilizados como marcador biológico del neuroticismo, la introversión-extroversión y la matutinidad vespertinidad. El concepto de matutinidad hace referencia a la preferencia de las personas para realizar actividades por las mañanas, mientras que la vespertinidad hace referencia a la preferencia para realizar actividades por la noche. El objetivo de este trabajo consiste en estudiar si los niveles séricos de MLT se relacionan con la matutinidad o vespertinidad. Metodología. La muestra está compuesta por 44 voluntarios sanos, de los cuales 23 son del tipo matutino y 21 del tipo vespertino. La matutinidad-vespertinidad fue valorada con la Escala Compuesta de Matutinidad. Se analizaron 3 muestras de sangre, extraídas a las 09:00, 12:00 y 00:00 h. Los niveles de MLT fueron determinados mediante un ELISA. Resultados. A las 09:00 h, los sujetos vespertinos tenían niveles de MLT significativamente más altos que los sujetos matutinos (8,4±3,6 pg/ml vs 4,6±3,2 pg/ml, p<0,02).Conclusiones. Los niveles séricos de MLT a las 09:00 h. pueden ser usados como un marcador biológico periférico de vespertinidad-matutinidad. Nuestros resultados enfatizan la conveniencia de alargar los estudios de MLT al menos hasta las09:00 h, cuando aun se pueden encontrar diferencias en los niveles séricos de MLT entre los tipos matutinos y vespertinos (AU)

Background. The search for biological markers of individual characteristics has produced scanty results. Melatonin (MLT), the main hormonal product of the pinealgl and, has been used as a biological marker of neuroticism, introversion-extroversion and morningness-eveningness. Morningness-eveningness indicates preferences associated with morning or evening activities. The goal of this research is to study if serum MLT levels are related to morningness eveningness preference. Methods. Twenty-three morning type and twenty-one evening type healthy volunteers took part in the study. Morningness-eveningness was evaluated with the Composite Scale of Morningness. Blood was drawn at 09:00, 12:00 and 00:00 h. MLT levels were measured with an ELISA. Results. At 09:00 h evening type subjects had significantly higher serum MLT levels than morning type subjects (8.4±3.6 pg./ml. vs. 4.6±3.2 pg./ml., p<0.02). Conclusions. Morning serum MLT may be used as a biological peripheral marker of morningness-eveningness preference. Our results emphasise the convenience of expanding MLT studies until 09:00 h when differences between morning type and evening type subjects may still be found (AU)

Role of melatonin in schizophrenia.

Schizophrenia is a chronic mental disease that disturbs several cognitive functions, such as memory, thought, perception and volition. Schizophrenia's biological etiology is multifactorial and is still under investigation. Melatonin has been involved in schizophrenia since the first decades of the twentieth century. Research into melatonin regarding schizophrenia has followed two different approaches. The first approach is related to the use of melatonin as a biological marker. The second approach deals with the clinical applications of melatonin as a drug treatment. In this paper, both aspects of melatonin application are reviewed. Its clinical use in schizophrenia is emphasized.