Inflammatory and oxidative stress markers in post-traumatic stress disorder: a systematic review and meta-analysis.

Post-traumatic stress disorder (PTSD) has been associated with persistent, low-degree inflammation, which could explain the increased prevalence of autoimmune conditions and accelerated aging among patients. The aim of the present study is to assess which inflammatory and oxidative stress markers are associated with PTSD. We carried out a meta-analytic and meta-regression analysis based on a systematic review of studies comparing inflammatory and oxidative stress markers between patients with PTSD and controls. We undertook meta-analyses whenever values of inflammatory and oxidative stress markers were available in two or more studies. Overall, 28,008 abstracts were identified, and 54 studies were included, with a total of 8394 participants. The Newcastle-Ottawa Quality Assessment Scale was used to evaluate the quality of the studies. Concentrations of C-reactive protein (SMD = 0.64; 95% CI: 0.21 to 1.06; p = 0.0031; k = 12), interleukin 6 (SMD = 0.94; 95% CI: 0.36 to 1.52; p = 0.0014; k = 32), and tumor necrosis factor-α (SMD = 0.89; 95% CI: 0.23 to 1.55; p = 0.0080; k = 24) were significantly increased in patients with PTSD in comparison with healthy controls. Interleukin 1ß levels almost reached the threshold for significance (SMD = 1.20; 95% CI: -0.04 to 2.44; p = 0.0569; k = 15). No oxidative stress marker was associated with PTSD. These findings may explain why PTSD is associated with accelerated aging and illnesses in which immune activation has a key role, such as cardiovascular diseases and diabetes. In addition, they pointed to the potential role of inflammatory markers as therapeutic targets.

Pharmacotherapy of bipolar disorder in children and adolescents: an update.

OBJECTIVE: To review the options for acute and maintenance pharmacological treatment of bipolar disorder in children and adolescents, including the treatment of bipolar depression and comorbid attention deficit/hyperactivity disorder (ADHD). METHODS: Narrative review of randomized clinical trials and open-label studies published from 2000 to 2012. The PubMed and PsycINFO websites were queried. Case series were included when a higher level of evidence was not available. RESULTS: Published data from randomized controlled trials (RCTs) in acute mania/hypomania with significant responses are available for lithium, topiramate, risperidone, olanzapine, and aripiprazole. Open trials of lithium and lamotrigine show that these drugs may be effective in the treatment of depressive episodes. No trials of selective serotonin reuptake inhibitors (SSRIs) have been conducted. In the treatment of comorbid ADHD, there are encouraging findings with mixed amphetamine salts and atomoxetine; conflicting results are observed with methylphenidate. CONCLUSIONS: Published RCTs of traditional mood stabilizers are scarce, but the best available evidence (results from meta-analytic regression) suggests that second-generation antipsychotics (SGAs) as a group are more effective in reducing manic symptoms. Risperidone was the only one included in head-to-head comparisons (vs. lithium and divalproex), showing superiority in terms of efficacy, but with more metabolic side effects, which were also more common in most of the SGAs. There are few studies addressing the treatment of ADHD and depression. Brazilian guidelines for the treatment of pediatric bipolar disorder should also include some SGAs (especially risperidone and aripiprazole) as first-line treatment, and these drugs should be provided by the public health services.

Pharmacotherapy of bipolar disorder in children and adolescents: an update

Objective: To review the options for acute and maintenance pharmacological treatment of bipolar disorder in children and adolescents, including the treatment of bipolar depression and comorbid attention deficit/hyperactivity disorder (ADHD). Methods: Narrative review of randomized clinical trials and open-label studies published from 2000 to 2012. The PubMed and PsycINFO websites were queried. Case series were included when a higher level of evidence was not available. Results: Published data from randomized controlled trials (RCTs) in acute mania/hypomania with significant responses are available for lithium, topiramate, risperidone, olanzapine, and aripiprazole. Open trials of lithium and lamotrigine show that these drugs may be effective in the treatment of depressive episodes. No trials of selective serotonin reuptake inhibitors (SSRIs) have been conducted. In the treatment of comorbid ADHD, there are encouraging findings with mixed amphetamine salts and atomoxetine; conflicting results are observed with methylphenidate. Conclusions: Published RCTs of traditional mood stabilizers are scarce, but the best available evidence (results from meta-analytic regression) suggests that second-generation antipsychotics (SGAs) as a group are more effective in reducing manic symptoms. Risperidone was the only one included in head-to-head comparisons (vs. lithium and divalproex), showing superiority in terms of efficacy, but with more metabolic side effects, which were also more common in most of the SGAs. There are few studies addressing the treatment of ADHD and depression. Brazilian guidelines for the treatment of pediatric bipolar disorder should also include some SGAs (especially risperidone and aripiprazole) as first-line treatment, and these drugs should be provided by the public health services. .

Correlação entre os níveis periféricos de fator neurotrófico derivado do cérebro e volume de hipocampo em crianças e adolescentes com transtorno bipolar / Correlation between peripheral levels of brain-derived neurotrophic factor and volume of the hippocampus in children and adolescents with bipolar disorder

O Transtorno Bipolar Pediátrico (TBP) é um transtorno mental grave que afeta o desenvolvimento e o crescimento emocional dos pacientes acometidos. O Fator Neurotrófico Derivado do Cérebro (Brain-Derived Neurotrophic Factor – BDNF) é reconhecido como um dos possíveis marcadores do quadro e de sua evolução. Esta neurotrofina tem reconhecido papel na sobrevivência, diferenciação e crescimento neuronal durante a infância e a idade adulta, atuando em áreas cerebrais envolvidas na patogênese dos transtornos de humor, como a amígdala e o hipocampo. Anormalidades na sinalização do BDNF no hipocampo poderiam explicar o declínio cognitivo visto em pacientes com TB. O estudo de possíveis correlações entre BDNF sérico e volume do hipocampo em pacientes com transtorno bipolar pode trazer importantes contribuições para a compreensão da neurobiologia do Transtorno Bipolar (TB). Assim, nosso objetivo com este estudo é avaliar possíveis mudanças no volume do hipocampo em crianças e adolescentes com TB e avaliar sua associação com os níveis séricos do BDNF. Além disso, avaliamos o desempenho de pacientes com TB em tarefas cognitivas relacionadas ao hipocampo e verificamos se houve correlação com os fatores mencionados acima, ou com o tempo de duração da doença(AU)

Pediatric Bipolar Disorder (PBD) is a serious mental disorder that affects the development and emotional growth of affected patients. The Brain Derived Neurotrophic Factor (Brain-Derived Neurotrophic Factor - BDNF) is recognized as one of the possible markers of the framework and its evolution. This neurotrophin has recognized role in the survival, differentiation and neuronal growth during childhood and adulthood, acting on brain areas involved in the pathogenesis of mood disorders, such as the amygdala and the hippocampus. Abnormalities in BDNF signaling in the hippocampus could explain the cognitive decline seen in patients with TB. The study of possible correlations between serum BDNF and hippocampal volume in patients with bipolar disorder can provide important contributions to the understanding of the neurobiology of Bipolar Disorder (BD).Thus, our aim with this study was to evaluate possible changes in hippocampal volume in children and adolescents with BD, and associate them to serum BDNF. Additionally, we evaluated the performance of cognitive tasks related to the hippocampus and verified if they presented a correlation with the factors mentioned above, or disease duration(AU)