sVCAM-1, sICAM-1, TNF-α and IL-6 levels in bipolar disorder type I: Acute, longitudinal and therapeutic implications.

OBJECTIVES: To explore the serum levels of soluble vascular cell adhesion molecule-1 (sVCAM-1), soluble intercellular cell adhesion molecule-1 (sICAM-1), tumour necrosis factor-α (TNF-α) and interleukin-6 (IL-6) in patients with bipolar disorder (BD), with regard to acute episode characteristics, course of the disorder and treatment. METHODS: The study group consisted of 83 patients diagnosed with BD type I. The control group consisted of 73 healthy individuals, matched with the study group according to age, gender and body mass index. The serum levels of sVCAM-1, sICAM-1, TNF-α and IL-6 were measured by ELISA. RESULTS: Compared with healthy controls, significantly elevated levels of IL-6 and sICAM-1 and significantly lower levels of TNF-α and sVCAM-1 were identified in acute and remission phases of BD. The acute serum levels of sVCAM-1 were associated with the type and severity of acute mood symptoms as well as with course of illness characteristics. TNF-α was associated with duration of untreated disorder and type of treatment. CONCLUSIONS: BD is related to both acute and long-term alterations of immune mediators, including adhesion molecules. The potential immunomodulatory role of pharmacotherapeutic treatment is also to be considered in BD.

Predictive value of sICAM-1 and sVCAM-1 as biomarkers of affective temperaments in healthy young adults.

BACKGROUND: Affective temperaments are intermediate phenotypes for major affective disorders and are reported to have a neuroimmune etiopathogenesis. Here we investigated the role of soluble intercellular cell adhesion molecule-1 (sICAM-1) and soluble vascular cell adhesion molecule-1 (sVCAM-1) in affective temperaments and mood symptoms in healthy adults. METHODS: Healthy adults (n=94) were screened for psychiatric disorders using the nonpatient version of the Structured Clinical Interview for DSM-IV-I and II. Subjects with medical conditions associated with changes in inflammatory response were excluded, deriving the final sample (n=68). Affective temperaments were evaluated with Temperament Evaluation of Memphis, Pisa, Paris and San Diego-Autoquestionnaire (TEMPS-A). State mood symptoms were assessed using the Young Mania Rating Scale and Montgomery-Åsberg Depression Rating Scale. Serum sICAM-1 and sVCAM-1 levels were measured using enzyme-linked immunosorbent assay. RESULTS: After adjusting for confounders (age, gender, BMI, and smoking habits), a high negative correlation between depressive and irritable temperament TEMPS-A scores and sVCAM-1 levels was detected. Although we identified no association between sICAM-1 levels and affective temperament scores, sICAM-1 was related to the state severity of manic symptoms. In a multiple linear regression model, sVCAM-1 remained a significant predictor of depressive but not irritable temperament scores. LIMITATIONS: The temperaments were estimated on the basis of self-report questionnaire. CONCLUSIONS: Our findings suggest that sVCAM-1 is related to affective temperaments, and it is a trait marker for liability to mood disorders. This relationship between alterations in cellular adhesion and affective temperament may be important for vulnerability to affective disorders.

Neutrophil-to-lymphocyte ratio predicting suicide risk in euthymic patients with bipolar disorder: Moderatory effect of family history.

BACKGROUND: Neutrophil-to-lymphocyte ratio (NLR) has been independently related to bipolar disorder (BD) and factors associated with suicidal risk. The aim of our study was to explore the relationship between NLR and suicide risk in euthymic BD patients. We also sought to propose a model of interaction between NLR and stress-diathesis factors, leading to suicidal risk in BD. METHODS: The study group consisted of 83 patients diagnosed with BD (36 suicide attempters; 47 suicide non-attempters), compared to the healthy control group (n=73) and matched according to age, gender, and body mass index (BMI). NLR was measured according to the complete blood count. Mood symptoms have been assessed by Young Mania Rating Scale and Montgomery-Asberg Depression Rating Scale. Early trauma and acute stress were evaluated by Early Trauma Inventory Self Report-Short Form and List of Threatening Experiences Questionnaire, respectively. Suicide risk has been assessed by Suicide Behaviors Questionnaire-Revised (SBQ-R). RESULTS: Significant correlation was found between NLR and SBQ-R score. The main effects of suicide attempts on NLR, after covarying for confounders, were observed, indicating increased NLR in BD suicide attempters compared to healthy controls. We found significant moderatory effects of family history on NLR relationship to suicidal risk, with NLR being significant positive predictor of suicidal risk only in the patients with positive family history of suicide attempts. CONCLUSIONS: The results suggest an enhancing effect of positive family history of suicide attempts on predictive effect of NLR on suicide risk. Our data support the idea that immune markers can predict suicide attempt risk in BD, but only in the subpopulation of BD patients with family history of suicide attempts. This could lead to prevention in suicide behavior in the patient population at particular risk of suicide.

Role of sICAM-1 and sVCAM-1 as biomarkers in early and late stages of schizophrenia.

Schizophrenia (SZ) is a neuroprogressive disorder presenting with biochemical, functional, and structural changes, which differ from early to late stages of the illness. We explored the differences in serum levels of soluble intercellular cell adhesion molecule-1 (sICAM-1) and soluble vascular cell adhesion molecule-1 (sVCAM-1) between early and late stages of SZ, in regard to clinical characteristics and treatment application. Serum levels of sICAM-1 and sVCAM-1 were measured in 80 patients with SZ (40 early stage; 40 late stage), and compared with 80 healthy controls, matched by age, gender, body mass index, and smoking habits with each SZ group. Serum levels of sICAM-1 and sVCAM-1 were measured using ELISA. The severity of psychopathology was assessed using the Clinical Global Impression Scale and five-factor Positive and Negative Symptoms in Schizophrenia Scale. After adjustment for confounders, we noticed normal levels of sICAM-1 in the early stage, and elevated levels of sICAM-1 in the late stage of SZ. sVCAM-1 levels were decreased in both stages of SZ. Higher sICAM-1 levels have been related to more pronounced cognitive deficit and excitement symptoms in the early stage of SZ and to favorable characteristics of treatment application in both stages. SZ is associated with changes in the levels of adhesion molecules that vary from early to late stages of the illness. This implies that the concept of biochemical staging is applicable in SZ, at least for markers of cellular adhesion.

Knowledge: a possible tool in shaping medical professionals' attitudes towards homosexuality.

BACKGROUND: The attitudes of medical professionals towards homosexuals can influence their willingness to provide these individuals with medical help. The study evaluated the medical professionals' knowledge about homosexuality and their attitudes towards it. SUBJECTS AND METHODS: The sample consisted of 177 participants (physicians n=79 and students n=98). The study respondents anonymously completed three questionnaires (socio-demographic questionnaire, the questionnaire on knowledge, and the questionnaire on attitudes towards homosexuals). RESULTS: Male and religious participants showed a lower level of knowledge and a greater tendency to stigmatize. Furthermore, the subjects who knew more about homosexuality tended to hold less stigmatizing attitude. Age group, specialty (psychiatry, gynecology, internal medicine and surgery), and student's/physician's status had no effect on stigmatization. The study showed that the final year students/ residents had more knowledge than the second year students/specialists did. Knowledge had significant negative predictive effect on attitudes in the analyzed predictive model. CONCLUSIONS: To our knowledge, this has been the first study in Serbia and Eastern Europe, which provides information on knowledge and attitudes of health professionals towards homosexuality. We would like to point out the degree of knowledge on homosexuality as a possible, but not exclusive tool in shaping the attitudes towards homosexuals and reducing stigmatization. However, regardless of the personal attitude, knowledge and variable acceptance of the homosexuals' rights, medical professionals' main task is to resist discriminative behavior and provide professional medical help to both homosexual and heterosexual patients.

[Significance of perfectionism in understanding different forms of insomnia].

INTRODUCTION: Studies consistently show a connection between perfectionism as a multidimensional construct with various psychological and psychopathological states and characteristics. However, studies that analyze the connection between this concept and sleep disturbances, especially modalities of insomnia, are rare. OBJECTIVE: The aim of this study was to examine whether dimensions of perfectionism can explain different forms of insomnia; difficulties initiating sleep (insomnia early), difficulties during the sleep (insomnia middle), waking in early hours of the morning (insomnia late) and dissatisfaction with sleep quality (subjective insomnia). METHODS: The sample consisted of 254 students of the School of Medicine in Belgrade. Predictive significance of nine perfectionism dimensions, measured by Frost's and Hewitt's and Flett's scales of multi-dimensional perfectionism, related to four modalities of insomnia, measured by a structured questionnaire, was analyzed by multiple linear regression method. RESULTS: Perfectionism dimensions are significant predictors of each of the tested forms of insomnia. Doubt about actions significantly predicts initial insomnia; to other-oriented perfectionism in the negative pole and socially prescribed perfectionism underlie the difficulties during the sleep, while organization and parental criticism underlie late insomnia. Significant predictors of subjective insomnia are personal standards and organization and to other-oriented perfectionism on the negative pole. Three of nine analyzed dimensions were not confirmed as significant; concern over mistakes, parental expectations and self-oriented perfectionism. CONCLUSION: Various aspects of perfectionism can be considered as a vulnerability factor for understanding some forms of insomnia. Out of all forms of insomnia tested, perfectionism as the personality trait proved to be the most significant for understanding subjective insomnia.

[Social cognition in schizophrenia].

Patients with schizophrenia display alterations in social cognition, as well as in the realm of neurocognition. It is still unclear to what extent these two cognitive domains represent two separate dimensions or different expressions of a unified deficit. Tasks used to assess social cognition subcomponents cover basic social cognition, such as mentalisation, data collection and making conclusions, source monitoring and characteristics of life-styles. The variety of findings of various studies is probably related to the fact that most studies considered social cognition as one-dimensional construct represented, for example, by unique measurements of emotional recognition. Research results dealing with social cognition suggest that the impairment of social cognition is the characteristic feature of schizophrenia and have important implications for the development, course and outcome of this disorder.

[Executive functions in young patients with unipolar depression].

Neuropsychological deficits associated with unipolar depression are seen in a broad range of cognitive domains. Executive deficits may be prominent in depression. Investigation of executive functions in younger adult patients with unipolar depression has been the focus of our study. Twenty-two consecutively depressive inpatients (24-36 years) and 21 healthy control subjects, matched on age, gender, education and verbal IQ were included in the study. Neuropsychological tests for executive functions were applied to all subjects. Unipolar young depressives showed significantly reduced number of completed categories and more trials for completion of the first category on Wisconsin Card Sorting Test (WCST). No difference of tasks assessing the short-term memory, total errors on WCST, perseverative and non-perseverative errors, and of both phonemic and semantic conditions of verbal fluency was found between groups. The results suggested that unipolar depressives had specific cognitive style characterized by "negative cognitive set" (stronger negative reaction to negative feedback) and by failure to use negative feedback to improve their performance.

[Neuropsychological profile of patients with bipolar depression in remission].

AIM: To determine if the patients with bipolar affective disorder, after the depressive phase, would exhibit cognitive impairment in remission. METHODS: Twenty-three euthymic patients with bipolar disorder were matched, on a case-by-case basis, to twenty-one healthy subjects in the control group, for the presence of the symptoms of depression. The patients and the control group were tested with a battery of neuropsychological tests. RESULTS: Impairments were found in the patients compared with the control group in tests of verbal learning and memory and in tests of executive function. Verbal learning and memory, as well as executive functions, did not correlate either with the clinical indices of patients, or with the demographic and baseline clinical measures of depression. CONCLUSION: Impaired verbal learning and memory and executive functions may represent a trait rather than the state variables in bipolar disorder.