Combining inflammatory miRNA molecules as diagnostic biomarkers for depression: a clinical study.

Background: Inflammation has been implicated in core features of depression pathophysiology and treatment resistance. Therefore, new challenges in the discovery of inflammatory mediators implicated in depression have emerged. MicroRNAs (miRNAs) have been found aberrantly expressed in several pathologies, increasing their potential as biomarkers and therapeutical targets. In this study, the aim was to assess the changes and biomarker potential of inflammation-related miRNAs in depression patients. Methods: Depression diagnosis was performed according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). 40 healthy controls and 32 depression patients were included in the study. The levels of inflammatory cytokines were measured in plasma, and expression levels of cytokines and inflammation-related miRNAs were evaluated in peripheral blood mononuclear cells (PBMCs). Results: Depression patients were found to have a pro-inflammatory profile in plasma, with significantly higher levels of TNF-α and CCL2 compared with controls. In PBMCs of depression patients, TNF-α and IL-6 expression levels were significantly up and downregulated, respectively. Moreover, miR-342 levels were found upregulated, while miR-146a and miR-155 were significantly downregulated. miR-342 expression levels were positively correlated with TNF-α. Importantly, when analyzed as a diagnostic panel, receiver operating characteristics (ROC) analysis of miR-342, miR-146a, miR-155 in combination, showed to be highly specific and sensitive in distinguishing between depression patients and healthy controls. Conclusion: In summary, these findings suggest that inflammation-related miRNAs are aberrantly expressed in depression patients. Moreover, we show evidences on the potential of the combination of dysregulated miRNAs as a powerful diagnostic tool for depression.

Bipolar Disorder Related Hospitalizations - a Descriptive Nationwide Study Using a Big Data Approach.

Bipolar Disorder (BD) is a mental disorder which frequently requires long hospitalizations and need for acute psychiatric care. The aim of this study was to describe a nationwide perspective of BD related hospitalizations and to use a BigData based approach in mental health research. We performed a retrospective observational study using a nationwide hospitalization database containing all hospitalizations registered in Portuguese public hospitals from 2008-2015. Hospitalizations with a primary diagnosis of BD were selected based on International Classification of Diseases version 9, Clinical Modification (ICD-9-CM) codes of diagnosis 296.xx (excluding 296.2x; 296.3x and 296.9x). From 20,807 hospitalizations belonging to 13,300 patients, around 33.4% occurred in male patients with a median length of stay of 16.0 days and a mean age of 47.9 years. The most common hospitalization diagnosis in BD has the code 296.4x (manic episode) representing 34.3% of all hospitalizations, followed by the code 296.5x (depressed episode) with 21.4%. The mean estimated hospitalization charge was 3,508.5€ per episode, with a total charge of 73M€ in the 8-year period of this study.This is a nationwide study giving a broad perspective of the BD hospitalization panorama at a national level. We found important differences in hospitalization characteristics by sex, age and primary diagnosis.

Living conditions of patients with schizophrenia spectrum disorders in the region of 'Tâmega e Sousa' (Portugal).

BACKGROUND: Schizophrenia spectrum disorders (SSD) are the most impairing psychiatric disorders and are a major cause of social exclusion. Despite that, there are only two studies published assessing the socioeconomic characteristics of SSD patients living in Portugal. AIMS: The purpose of this study is to assess the degree of social and family support for SSD patients living in the region of 'Tâmega e Sousa', in northern Portugal. METHOD: We conducted a cross-sectional observational study using patients under home-based care provided by the Department of Psychiatry and Mental Health of Centro Hospitalar do Tâmega e Sousa. We retrieved sociodemographic data from clinical records. The study was approved by the Hospital Ethics Committee. RESULTS: Our sample consists on 67 patients with SSD, mostly men (74.6%). Although the majority was single (69.2%) and childless (85.7%), only a minority lived alone (21.2%). In relation to their professional status, only 5.0% were employed and 78.3% got a disability pension. Among the patients that lived accompanied, 68% lived with their parents or grandparents, and a quarter lived with family members affected by psychiatric disorders. CONCLUSIONS: These findings highlight the dependence of SSD patients on their family's support. Lack of labour market integration, economic dependence and difficulty establishing stable relationships further aggravate their social exclusion. Although our results are consistent with a previous observational study held in Portugal, our patients display a worse functional status. Even considering the possible patient selection bias, there is evidence supporting the need for more investment in psychosocial rehabilitation that should take into account the sociodemographic idiosyncrasies of this Portuguese region.

Encefalitis sensible a esteroides asociada con tiroiditis autoinmune como paradigma del diagnóstico diferencial neuropsiquiátrico: informe de caso y revisión / Steroid-responsive auto-immune encephalitis as a paradigm of neuropsychiatric differential diagnosis: case report and review

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[Mirtazapine-Induced Mania: A Case Report]. / Mania Induzida por Mirtazapina: Um Caso Clínico.

Manic and hypomanic states associated with antidepressant treatments are relatively common; however, when specifically considering mirtazapine, those side effects are infrequent. The authors report a clinical case regarding a manic episode with dysphoric features in a patient with no personal or family previous psychiatric history. It began two weeks after starting treatment with mirtazapine up to 30 mg/day. This episode was treated discontinuing mirtazapine and initiating olanzapine (10 mg), with symptomatic remission. Mirtazapine has a specific pharmacodynamics, blocking not only post-synaptic serotonergic receptors but also α2-presynaptic adrenergic receptors. Taking this into consideration, it was hypothesized that this case could be attributed to a noradrenergic syndrome, characterized by dysphoria, irritability, insomnia and psychomotor agitation.

O desenvolvimento de estados maníacos e hipomaníacos associado ao uso de antidepressivos é relativamente comum. Contudo, no caso da mirtazapina, este é um efeito secundário raro. Os autores descrevem um caso clínico de um episódio maníaco de características disfóricas, num doente sem antecedentes psiquiátricos pessoais ou familiares, com instalação duas semanas após início de tratamento com mirtazapina até 30 mg/dia. Uma vez suspensa a mirtazapina e iniciada olanzapina (10 mg) verificou-se remissão sintomática. A mirtazapina apresenta uma farmacodinâmica particular, sendo antagonista não só de recetores serotoninérgicos póssinápticos, mas também de recetores adrenérgicos pré-sinápticos α2. Neste sentido, colocou-se a hipótese de se tratar de uma síndrome noradrenérgica, caracterizada por disforia, irritabilidade, insónia e agitação psicomotora.

Un caso de comorbilidad de síndrome de Capgras y síndrome de Fregoli / A case of comorbid Capgras and Fregoli syndromes

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Depression and psychodynamic psychotherapy

Depression is a complex condition, and its classical biological/psychosocial distinction is fading. Current guidelines are increasingly advocating psychotherapy as a treatment option. Psychodynamic psychotherapy models encompass a heterogeneous group of interventions derived from early psychoanalytic conceptualizations. Growing literature is raising awareness in the scientific community about the importance of these treatment options, as well as their favorable impact on post-treatment outcomes and relapse prevention. Considering the shifting paradigm regarding treatment of depressive disorder, the authors aim to provide a brief overview of the definition and theoretical basis of psychodynamic psychotherapy, as well as evaluate current evidence for its effectiveness.

Depression and psychodynamic psychotherapy.

Depression is a complex condition, and its classical biological/psychosocial distinction is fading. Current guidelines are increasingly advocating psychotherapy as a treatment option. Psychodynamic psychotherapy models encompass a heterogeneous group of interventions derived from early psychoanalytic conceptualizations. Growing literature is raising awareness in the scientific community about the importance of these treatment options, as well as their favorable impact on post-treatment outcomes and relapse prevention. Considering the shifting paradigm regarding treatment of depressive disorder, the authors aim to provide a brief overview of the definition and theoretical basis of psychodynamic psychotherapy, as well as evaluate current evidence for its effectiveness.

Melkersson-Rosenthal Syndrome: A Case Report With a Psychosomatic Perspective.

Context • The Melkersson-Rosenthal syndrome (MRS) is a rare condition characterized by a triad of symptoms: (1) recurrent and/or persistent orofacial swelling, (2) recurrent facial paralysis, and (3) a fissured tongue. Although various contributing factors have been suggested, the etiology and mechanisms of the syndrome have not been fully elucidated. Objective • The aim of the current study was to examine for the first time some psychosomatic aspects of the syndrome and to evaluate the benefits of a brief psychotherapeutic process in which the research team worked to reintegrate the complex bio-psycho-social functioning of the patient. Design • The research team performed a case study. Setting • The study took place at the outpatient clinic for psychiatric services of the Alto Minho Local Health Unit (Viana do Castelo, Portugal). Participant • The participant was a 26-y-old woman suffering from MRS who received services at the clinic for depression. Her clinical history revealed that significant life events had acted as triggers for her syndrome, both at the start and during several exacerbations of her symptoms. Intervention • The intervention consisted of 15 weekly sessions focused on insight promotion. Outcome Measures • The case study measured changes in the patient's condition through her verbal self-reports about her physical and mental state, and the research team's clinical evaluation. Results • The treatment allowed remission of her depression and diminished the frequency of her relapses of MRS. Conclusions • The current case study offers the first report that describes how significant affective phenomena can act as triggers in the MRS. It also opens the possibility of providing psychiatric and psychological therapeutic interventions to help prevent relapses and exacerbations of that syndrome.

A skin-picking disorder case report: a psychopathological explanation / Um caso clínico sobre skin-picking disorder: uma explicação psicopatológica

We describe the case of a 44-year-old woman, without known previous psychiatric history, hospitalized after a significant hemorrhage caused by self-inflicted deep facial dermal lesions (with muscle exposition). Psychopathological possible explanations of this case, as in similar reviewed ones, are related to frustration, aggression, and impulsivity.

Descrevemos um caso clínico de uma senhora de 44 anos de idade, sem antecedentes psiquiátricos prévios, internada após hemorragia significante causada por uma lesão facial autoinfligida (com exposição de músculo). Possíveis explicações psicopatológicas deste caso, tal como em casos similares, relacionam-se com frustração, agressividade e impulsividade.