Immunity, coping and depression.

BACKGROUND: On the one hand, this psycho-immunological theory makes it possible to forge links between immunity and depression. On the other hand, we know that coping strategies are an important variable in the model of vulnerability to depression. Our study weighs the influence of cellular immunity and coping strategies on the severity of depression. SUBJECTS AND METHOD: 498 inpatients with major depressive disorder were enrolled in an open-label trial. In addition to a socio-demographic questionnaire, they answered a Cousson's coping test and the Beck Depression Inventory (BDI). RESULTS: In terms of immunity, there are correlations between the BDI and percentages of CD8 (p=0.000; r=0.163), CD19 (p=0.046; r=0.090), CD16&56 (p=0.011; r=0.282), ratio CD4/CD8 (p=0.003; r=-0.135). A linear regression model for immune variables explained 25% of the BDI. In terms of coping, there is a correlation between severity of depression and ea (escape avoidance) (p=0.000; r=0.218), pr (positive reappraisal) (p=0.000; r=-0.265) and pps (planful problem solving) (p=0.000; r=-0.296). However, there is no correlation between the severity of depression and d (distancing). A linear model for coping strategies explained 12% of the BDI. Finally, there are correlations between distancing and CD8 (p=0.005; r=-0.119), CD19 (p=0.017; r=-0.102) and CD 16&56 (p=0.029; r=-0.227) but also CD3 (p=0.008; r=-0.114) and CD4 (p=0.027; r=-0.095) but not between those immune variables and the other coping strategies. In this case, a linear regression for distancing explained 10.3% of immune variables. CONCLUSION: Every coping strategy has an impact on depression. But not in the same way. Ea, pps and pr strategies influence directly the risk of depression while distancing influences the immune variables themselves. Knowing that those variables impact the risk of depression, distancing has then an indirect effect on depression.

Comparison of components of the depression of hospitalized patients admitted through the emergency department or consultations.

BACKGROUND: In a previous study, we investigated the risk of admission to emergency (ER) of depressed patients prior to their hospitalization in psychiatry in comparison with hospitalized patients transferred from the consultations department (Cdpt). In the present study, we compare among the same patients variables affecting the intensity of depression in each group. METHOD: All patients with Major depressive disorder admitted in our department through emergencies (N=146) or consultations (N=2172) between January 1, 2010 and December 31, 2012 were included in an open study. They completed the Beck Depression Inventory (BDI), analogical visual scales about stress levels (in professional, social, family, married life, over the past year and the past month), the Multidimensional Health Locus of Control and the Olson Family Adaptation and Cohesion Scale and the Ways of coping. RESULTS: The depression (t=1.438; p=0.90) is similar in both samples. Although some variables such as gender, internality, coping mechanisms and stress factors influence the intensity of depression in both groups of patients (linear regression p<0.000, r=0.593), other factors play a role only in either one or the other group. The factors of patients' age, number of children, elements of family dynamics, couple life, and the belief in luck do influence the intensity of depression only in patients hospitalized through Cdpt (linear regression p<0.000, r=0.366). The intensity of depression of patients admitted through ER, is specifically dependent on the number of collateral factors (p=0.045, r=0.304), the number of living relatives (p=0.036, r=0.276) and the belief in the power of others (p=0.022, r=-0.16). CONCLUSIONS: Although Both samples are comparable in terms of intensity of depression, patients admitted through the Cdpt are more dependent on the quality of family relationships whereas those coming from emergencies are most influenced by their concrete social and family situation. Alongside these specific variables it remains that stress and coping mechanisms account for the largest percentage of variance of the intensity of depression.

Hormonal and developmental influences on adolescent suicide: a systematic review.

BACKGROUND: Teen suicide is a major public health problem. In the United States, it is the third cause of death among the 10-24 year olds. Adolescence involves numerous changes, whether physical, social, emotional or hormonal. At a neurobiological level, a teenager's nervous system is also affected and undergoes significant modifications. SUBJECTS AND METHODS: We conducted a systematic review of electronic literature published between January 1990 and August 2014 via MEDLINE, PubMED and PsychINFO to list articles concerning the risk of teen depression and suicide risks in adolescents as well as those relating to the adolescent's neuro-anatomical brain and the effect that puberty has on it. RESULTS AND DISCUSSION: When analyzing the various studies, it is clear that all support the idea that adolescence is a special period, both at neuroanatomical and biological levels. The risk of impulsiveness and depression is explained, anatomically, by a faster maturation of the limbic system, and biologically, by a higher sensitivity of the serotoninergic system and to glucocorticoids, which themselves are influenced by the specific hormonal environment during this period. Moreover and above all, adolescence is a vulnerable time for many reasons: physical, hormonal, social, cognitive, and emotional changes, self-development, etc. We should not restrict it to structural neurological changes without taking into account the other factors or compartmentalize young people into a reductive model based on determinism. CONCLUSIONS: Adolescence is a time of change, transformation, and adaptation. The hormonal events that occur during this period have significant effects on brain development, neuro-cerebral chemistry, adolescent behavior and risks of depression. It is important to try to prevent suicide and depression in adolescents considering its entirety and complexity but also by paying attention to neuro-biological factors even if, at present, many research projects are currently underway to develop an appropriate drug therapy strategy.

Proposing concurrent alcohol and tobacco withdrawal. Analysis of the perceptions of Belgian nurses in the alcoholism unit.

INTRODUCTION: Dual tobacco-alcohol addiction is common, but the literature often considers only the issue of withdrawal from one substance at a time and emphasises that the assessment of tobacco use seems to be neglected in psychiatry. SUBJECT AND METHODS: In this study, we analysed the perceptions of nurses working in alcoholism units before and after motivational interviewing trainingon proposing concurrent alcohol-tobacco withdrawal to patients. RESULTS: Nurses, unlike psychiatry postgraduates, were able to achieve acomprehensive and systematic history of substance abuse, but bothtended not to recommend concurrent tobacco-alcohol withdrawal. Training in motivational interviewing was inclined to reverse this tendency. DISCUSSION: Reducing feelings of helplessness that carers experience when patientsrelapse is one of the factors to change. CONCLUSION: Recommendations for the development of concurrent alcohol tobacco withdrawal programmes.

Preventing toxicomania and addictive behaviour in adolescence.

OBJECTIVES: Drug addicts are more and more stigmatized in our society. Recent data show a connection between substance abuse and other behaviors considered normal, such as passionate love. Adolescence is characterized by a biopsychosocial, cognitive and neurodevelopmental immaturity. This article aims to understand if these subjects are more likely to develop addictions to certain products or addictive behaviors such as passionate love. It also offers a better understanding of the current models for prevention of substance abuse during adolescence. METHODS: After defining the roles played, in the brain, by dopamine and by the reward circuit, as well as the different stages of development of the human brain, we compared neurobiological data and imaging studies both in cases of passionate love and substance addiction during adolescence. RESULTS: The brain imaging studies highlight the role of the prefrontal cortex in the cognitive and behavioral aspects of the addictive phenomenon. Now, the maturation of the prefrontal cortex occurs during adolescence, as do significant peaks in the expression of dopamine. These studies also suggest an increase in cortical activation (nucleus accumbens and amygdala) when processing emotional information, which is also increased during adolescence. CONCLUSION: Taken together, the results show a parallel between addiction and love relations, both at the level of neuroscience and imaging. A greater emotional lability and sensitivity may play a role in the higher incidence of substance abuse and dependence in love observed at this age. Preventing the use of illegal substances among young people therefore requires a very specific approach.

Management of marked liver enzyme increase during olanzapine treatment: a case report and review of the literature.

OBJECTIVES: Atypical antipsychotics commonly cause isolated asymptomatic increase in the aminotransferase levels. Furthermore, the strategy in the choice of antipsychotic agent must take into account hepatic tolerance because of the non-negligible incidence of liver disorders among the psychiatric population. The aim of this article is to better understand the strategy to adopt during an increase of liver enzymes in a psychotic patient under atypical neuroleptic treatment. METHOD: A clinical case is presented of a female patient treated for psychotic decompensation with increase of liver enzymes (Olanzapine). Her treatment was changed several times over a period of 7 years and laboratory investigations were conducted simultaneously. RESULTS: It seems that the increase of liver enzymes is slightly more frequent with Clozapine and Olanzapine than Risperidone, Perazine and Haloperiol. CONCLUSION: The different mechanisms of hepatotoxicity are unknown at present but it seems that the hypersensibility mechanism is likely to be dose dependent. During an increase of enzymes, it is important to combine a control of hepatic enzymes with a reduction of neuroleptic dosage. Discontinuation should be considered if a continued increase of enzymes above certain values is shown or if a clinical symptom appears. We note also that some risk factors were found, including geriatric or pedopsychiatric age, obesity, and association with active ingredients or addictive substances responsible for hepatic disorders.