Stressor-Specific Microbiota Intervention.

To date, mental disorders are diagnosed and treated by the subjective judgment of psychiatrists based on diagnostic criteria and treatment guidelines, respectively. Mental disorders are heterogeneous illnesses with a substantial treatment-refractory rate. Thus, there is a great need for novel treatment approaches. This article proposes a treatment approach centered on the concept of the gut-brain axis. There is mounting evidence indicating an association between stressors, microbiota, microglia, and mental disorders. Stressors might facilitate dysbiosis, inflammation, and the occurrence of mental disorders. This novel treatment approach is based on the idea that stressor types instead of the heterogeneous psychiatric diagnosis might be closer to the neurobiological underpinnings of mental disorders. First of all, patients with treatment-resistant mental disorders will be asked to describe their major stressors. Then, clinicians will calculate the total threat score and the total deprivation score. Subsequently, treatment tailored to the major stressor type will be administered to restore a healthy gut microbiome. Presumably, treatment will be aimed at increasing microbiota diversity in those who mainly have deprivation stressors and boosting Actinobacteria in those who have mainly threat stressors. Large-scale clinical trials are warranted to test this hypothetical approach.

Romance Scams: Romantic Imagery and Transcranial Direct Current Stimulation.

Love has an enormous effect on mental health. One does not need an actual romantic relationship to be in love. Indeed, romantic love can be built upon without frequent or real-life encounters, such as with a stranger from a matching website. With the advancement of the Internet and the influence of coronavirus disease, it is believed that these distant romantic relationships and related romance scams are burgeoning. Often, the victims of scams keep emotionally attached to the scammer even after the lie is revealed, which is hypothesized to be attributed to the aberrantly exaggerated romantic imagery of the victims. It is observed that many victims suffer from symptoms similar to a post-traumatic stress disorder, and some even consider suicide. However, there is scant literature on this topic. In this article, it is further postulated that the aberrant romantic imagery might be associated with impulsive acts such as suicide once the ideal but fake romantic relationship is dissolved. Thereafter, it is further speculated that manipulation of the visual network, possibly by transcranial direct current stimulation (tDCS), might be a promising treatment.

Romantic Relationship Dissolution, Microbiota, and Fibers.

Microbiota inhabit nearly every part of our body with the gut microbiota representing the greatest density and absolute abundance. The gut-microbiota-brain axis facilitates bidirectional communication between gut microbiota and the brain. For instance, romantic relationship not only brings joy, it is also associated with increased gut microbiota diversity and health benefits whereas reduced microbiota diversity is related to obesity, cardiac disease, type 2 diabetes, and inflammatory disorders. Research has shown that dietary fibers may increase microbiota diversity and exert antidepressant effect. Among a plethora of life stressors, romantic relationship dissolution is a relatively common and painful experience that people encounter from time to time. Depressed mood, social isolation and poor intake are all associated with romantic relationship dissolution. In this article, it is hypothesized that romantic relationship dissolution is accompanied by decreased gut microbiota diversity which could be corrected with the ingestion of dietary fibers with an additional antidepressant benefit.

Oxytocin and Three Kinds of Dangerous Behaviors in a Romantic Relationship: Playing, Suffering, and Stalking.

Romantic relationships are an essential element of healthy living. Although difficulties in love are encountered often, it seems that three kinds of behaviors in a romantic relationship are more susceptible to physical or psychiatric disorders: playing (sexually transmitted disease), suffering (major depressive disorder or suicide), and stalking (violence or homicide). Oxytocin plays an important role in pair-bonding. Elevated plasma oxytocin concentrations have been observed in new lovers when compared with singles. It is hypothesized that those who display these dangerous behaviors in a romantic relationship might possess specific oxytocin receptor gene aberrancy and the resultant deviant pair-bonding pattern is likely to recur in successive relationships. It is postulated that a blunted oxytocin surge might be observed in playing, whereas exaggerated oxytocin surge might be observed in suffering and stalking. The distinction between suffering and stalking might stem from the difference in their aggression tendencies. Those who suffer displays aggression toward self, while those who stalk displays aggression toward others. The exaggerated oxytocin concentrations in people who suffer and people who stalk might not be suppressed by the discouraging attitudes of their partners and might be maintained by rumination. Considering the whole-body influence of oxytocin, intranasal oxytocin application or gene therapy should be used exclusively for those who display these dangerous behaviors and not for the general population. Future research is warranted to confirm this hypothesis with analysis of modifiers such as gender.

Adolescent Major Depressive Disorder: Neuroimaging Evidence of Sex Difference during an Affective Go/No-Go Task.

Compared to female major depressive disorder (MDD), male MDD often receives less attention. However, research is warranted since there are significant sex differences in the clinical presentation of MDD and a higher rate of suicide in depressed men. To the best of our knowledge, this is the first functional magnetic resonance imaging (fMRI) study with a large sample addressing putative sex differences in MDD during adolescence, a period when one of the most robust findings in psychiatric epidemiology emerges; that females are twice as likely to suffer from MDD than males. Twenty-four depressed and 10 healthy male adolescents, together with 82 depressed and 24 healthy female adolescents, aged 11-18 years, undertook an affective go/no-go task during fMRI acquisition. In response to sad relative to neutral distractors, significant sex differences (in the supramarginal gyrus) and group-by-sex interactions (in the supramarginal gyrus and the posterior cingulate cortex) were found. Furthermore, in contrast to the healthy male adolescents, depressed male adolescents showed decreased activation in the cerebellum with a significant group-by-age interaction in connectivity. Future research may consider altered developmental trajectories and the possible implications of sex-specific treatment and prevention strategies for MDD.

Aberrant brain responses to emotionally valent words is normalised after cognitive behavioural therapy in female depressed adolescents.

BACKGROUND: Depression in adolescence is debilitating with high recurrence in adulthood, yet its pathophysiological mechanism remains enigmatic. To examine the interaction between emotion, cognition and treatment, functional brain responses to sad and happy distractors in an affective go/no-go task were explored before and after Cognitive Behavioural Therapy (CBT) in depressed female adolescents, and healthy participants. METHODS: Eighty-two Depressed and 24 healthy female adolescents, aged 12-17 years, performed a functional magnetic resonance imaging (fMRI) affective go/no-go task at baseline. Participants were instructed to withhold their responses upon seeing happy or sad words. Among these participants, 13 patients had CBT over approximately 30 weeks. These participants and 20 matched controls then repeated the task. RESULTS: At baseline, increased activation in response to happy relative to neutral distractors was observed in the orbitofrontal cortex in depressed patients which was normalised after CBT. No significant group differences were found behaviourally or in brain activation in response to sad distractors. Improvements in symptoms (mean: 9.31, 95% CI: 5.35-13.27) were related at trend-level to activation changes in orbitofrontal cortex. LIMITATIONS: In the follow-up section, a limited number of post-CBT patients were recruited. CONCLUSIONS: To our knowledge, this is the first fMRI study addressing the effect of CBT in adolescent depression. Although a bias toward negative information is widely accepted as a hallmark of depression, aberrant brain hyperactivity to positive distractors was found and normalised after CBT. Research, assessment and treatment focused on positive stimuli could be a future consideration. Moreover, a pathophysiological mechanism distinct from adult depression may be suggested and awaits further exploration.

Brain structural signatures of negative symptoms in depression and schizophrenia.

Negative symptoms occur in several major mental health disorders with undetermined mechanisms and unsatisfactory treatments; identification of their neural correlates might unveil the underlying pathophysiological basis and pinpoint the therapeutic targets. In this study, participants with major depressive disorder (n = 24), schizophrenia (n = 22), and healthy controls (n = 20) were assessed with 10 frequently used negative symptom scales followed by principal component analysis (PCA) of the scores. A linear model with the prominent components identified by PCA was then regressed on gray and white-matter volumes estimated from T1-weighted magnetic resonance imaging. In depressed patients, negative symptoms such as blunted affect, alogia, withdrawal, and cognitive impairment, assessed mostly via clinician-rated scales were inversely associated with gray matter volume in the bilateral cerebellum. In patients with schizophrenia, anhedonia, and avolition evaluated via self-rated scales inversely related to white-matter volume in the left anterior limb of internal capsule/anterior thalamic radiation and positively in the left superior longitudinal fasiculus. The pathophysiological mechanisms underlying negative symptoms might differ between depression and schizophrenia. These results also point to future negative symptom scale development primarily focused on detecting and monitoring the corresponding changes to brain structure or function.

A possible mechanism of sadism.

Sadists enjoy inflicting pain upon others. The pathophysiology of sadism is poorly understood but the traits of major psychiatric disorders have been noted among these people. Because an abnormal threshold for pain occurs in major psychiatric disorders, I here hypothesize that the practice of sadism may be used as self-medication for an inherently aberrant pain pathway. The neurobiological basis of the mechanism and its possible relevance in the treatment of psychiatric disorders await further study.