BDNF或5HTTLPR与抑郁症的研究

抑郁症是以抑郁为主要临床表征的一种精神疾病,近年抑郁症发病率正呈逐年上升趋势,如不加以干预,对患者及患者家庭、社会都会产生重大影响.对于抑郁症发病机制目前尚无定论,现有研究均停留在假说阶段.众多假说中脑源性神经营养因子(BDNF)和5-羟色胺转运体基因连锁多肽性区域(5-HTTLPR)参与抑郁症的病理生理过程,分别发挥重要作用,其基因也是抑郁症的候选基因,本研究对BDNF、5-HTTLPR在抑郁症及抗抑郁治疗等方面的作用进行文献综述.     

Cortisol diurnal patterns,associations with depressive symptoms,and the impact of intervention in older adults: Results using modern robust methods aimed at dealing with low power due to violations of standard assumptions

Advances in salivary bioscience enable the widespread integration of biological measures into the behavioral and social sciences. While theoretical integration has progressed, much less attention has focused on analytical strategies and tactics. The statistical literature warns that common methods for comparing groups and studying associations can have relatively poor power compared to more modern robust techniques. Here we illustrate, in secondary data analyses using the USC Well Elderly II study (n = 460, age 60–95, 66% female), that modern robust methods make a substantial difference when analyzing relations between salivary analyte and behavioral data. Analyses that deal with the diurnal pattern of cortisol and the association of the cortisol awakening response with depressive symptoms and physical well-being are reported. Non-significant results become significant when using improved methods for dealing with skewed distributions and outliers. Analytical strategies and tactics that employ modern robust methods have the potential to reduce the probability of both Type I and Type II errors in studies that compare salivary analytes between groups, across time, or examine associations with salivary analyte levels.     

Focus: Health Equity: Predictors of Depressive Symptoms Based on the Human Capital Model Approach: Findings From the Indonesia Family Life Survey

Depression is the leading factor of disability and the overall global burden of diseases. The human capital model provides an appropriate conceptual model for managing human health. This study aimed to determine the association between human capital (including social, emotional, physical, financial, and intellectual capital) and depressive symptoms among productive age groups in Indonesia. A cross-sectional study was conducted by analyzing data of 9,858 respondents aged 15-59 years that were obtained from the Indonesia Family Life Survey 5 (IFLS 5). Multivariate logistic regression was used to assess the association between human capital components and depressive symptoms. Among respondents, 23.65% had higher depressive symptoms. Social trust and social networks (part of social capital) were significantly related to depressive symptoms. Self-reported satisfaction (part of emotional capital) were also related to depressive symptoms, as well as self-rated health, sleep quality, a number of chronic disease, body mass index (BMI), and physical functioning (part of physical capital). Log income (part of financial capital) and education level (part of intellectual capital) were related to depressive symptoms after controlling for other variables. Of all the components of human capital, physical capital has the most attributes associated with the risk of depressive symptoms. Therefore, depression prevention programs can be prioritized on attributes related to physical capital.     

拉莫三嗪与丙戊酸钠治疗癫痫合并抑郁障碍患者的疗效比较

目的:探讨拉莫三嗪和丙戊酸钠治疗癫痫合并抑郁障碍的疗效,为其临床治疗提供依据。方法:选择2011年2月~2015年2月在我院接受治疗的癫痫合并抑郁障碍患者60例,根据随机数字表法将患者分为观察组(30例)和对照组(30例),观察组给予拉莫三嗪治疗,对照组给予丙戊酸钠治疗,于治疗前、治疗后8周末和16周末采用HAMD-17和MADRS量表进行评分,并比较两组患者的临床疗效和不良反应。结果:治疗8周末和16周末两组患者的HAMD-17和MADRS量表评分较治疗前均降低,且观察组降低幅度大于对照组,差异均有统计学意义(P0.05)。治疗16周末观察组患者的总有效率为86.67%显著高于对照组的63.33%,差异有统计学意义(P0.05)。两组患者的不良反应主要为皮疹、嗜睡、恶心呕吐等,发生率低,差异无统计学意义(P0.05)。结论:拉莫三嗪和丙戊酸钠均可改善抑郁状态,但拉莫三嗪的疗效优于丙戊酸钠,且不会增加患者不良反应,值得临床推广应用。     

Potential hormonal mechanisms of Attention-Deficit/Hyperactivity Disorder and Major Depressive Disorder: A new perspective

Hormonal influences on the organization of behavior are apparent to neuroendocrinologists but under-examined in relation to childhood and adolescent mental disorders. A central mystery in the field of developmental psychopathology is the preferential male vulnerability to behavior disorders in childhood and female vulnerability to emotional disorders in adolescence. Relative neglect of a hormonal explanation may be due to lack of simple or unifying conceptual paradigms to guide studies. This paper seeks to stimulate research in this area by drawing upon clinical psychology and neuroscience literatures to offer a heuristic paradigm for clinical research. Two syndromes are selected here for illustration: Attention-Deficit/Hyperactivity Disorder (ADHD) and Major Depressive Disorder (MDD), because they have opposite gender risk profiles. Two guiding theories are evaluated. First, prenatal organizational effects of testosterone may modulate striatally-based dopaminergic circuits in such a way as to place boys at greater risk for early developing inattention and disruptive behavioral disorders. Second, activational effects of estradiol at puberty may modulate amygdalar and other circuitry, with particular effects on serotonergic pathways, in such a way as to place girls at greater risk for internalizing and mood disorders. Hypotheses from these theories are evaluated based on the current available literature, and limitations of, and future directions for, this literature are discussed.     

Genetic and epigenetic factors associated with depression: An updated overview

Depression is a complex psychiatric disturbance involving many environmental, genetic, and epigenetic factors. Until now, genetic, and non-genetic studies are still on the way to understanding the complex mechanism of this disease, and there are still many questions that have not yet been answered. Depression includes a large spectrum of heterogeneous symptoms correlated to the deficit of a range of psychological, cognitive, and emotional processes, and it affects various age groups. It is classified into several types according to the severity of symptoms, time of occurrence, and time. Following the World Health Organization (WHO), depression attacks near 350 million persons globally. Several factors overlap in causing depression, including genetic and epigenetic factors, environmental conditions, various stresses, lack of some nutrients to which people are exposed, and excessive stress and abuse in childhood. This study included conducting surveys on depression and new treatment trends based on epigenetic factors associated with the occurrence of the disease. Epigenetic factors provide a completely novel dimension to therapeutic approaches as most diseases are not monogenic, and it is likely that the environment has a significant contribution. Epigenetic inheritance is included in many mental and psychiatric disorders such as depression. In general, epigenetic modifications could be summarized in 3 major points: DNA methylation, histone modification, and non-mediated regulation of RNA (ncRNA). This study also describes some genes associated with one of the depressive disorders using bioinformatics tools and gene bank and had the genes: SLC6A4, COMT, TPH2, FKBP5, MDD1, HTR2A, and MDD2. As in this study, the awareness of Saudi society about depression and its genetic and non-genetic causes was estimated. The results showed that an encouraging percentage of more than half of the research sample possessed correct information about this disorder.     

Modulation of induced frontocentral theta (Fm-θ) event-related (de-)synchronisation dynamics following mindfulness-based cognitive therapy in Major Depressive Disorder

Depressive severity has been associated with attenuated neocortical frontal midline theta (Fm-θ) power/evoked activity. Mindfulness-Based Cognitive Therapy (MBCT) has shown to be a successful novel intervention for Major Depressive Disorder (MDD), albeit precise working mechanisms remain elusive. We examined the hypothesis that MBCT would have modulating effects upon evoked Fm-θ power, in addition to investigating possible mediation of induced event-related de/synchronisation (ERD/ERS) dynamics. Fifty one patients with a primary diagnosis of MDD (26 exposed to MBCT vs. 25 wait-list/WL controls) undertook a Go/NoGo task consisting of positive, negative and neutral words, further stratified into abstract versus trait adjective matrices. Depressive symptom severity and rumination were also examined. A pattern of enhanced induced Fm-θ synchronisation during the latter 400–800 ms temporal-window pre-to-post MBCT was observed; the contrary in the WL. Modulated ERD/ERS dynamics correlated to amelioration in depressive and rumination symptoms in the MBCT group. We propose the primary action pathway alluded to a neural disengagement mechanism enacting upon tonic neuronal assemblies implicated in emotional and self-related processing. Due to the complexity and presently undiscovered complete unified scientific understanding of neuro-oscillatory-dynamics, and associated clinical interplays; we hypothesise that the electro-cortical and connected clinical working pathways of MBCT in depression are multi-levelled constituting nonlinear and interdependent mechanisms, represented by mediated EEG synchronisation dynamics.     

Current depression among adult cancer survivors: Findings from the 2010 Behavioral Risk Factor Surveillance System

BackgroundA cancer diagnosis and subsequent treatments constitute a significantly increased psychological burden among cancer patients. This study examined the prevalence of current depression and the risk factors associated with a high burden of depression among cancer survivors in the US.MethodsWe analyzed data from 3550 cancer survivors (aged ≥18 years) and 26,917 adults without cancer who participated in the 2010 Behavioral Risk Factor Surveillance System. Depressive symptoms were assessed by the Patient Health Questionnaire-8 diagnostic algorithm. Participants with a total depression severity score of ≥10 were defined as having current depression. Prevalence and prevalence ratios were estimated by conducting log-linear regression analysis while controlling for potential confounders.ResultsOverall, 13.7% of cancer survivors (vs. 8.9% of adults without cancer, P < 0.001) reported having current depression; the prevalence varied significantly by cancer category. Among cancer survivors, after multivariate adjustment for covariates, cancer diagnosis within a year, being in ‘other’ racial/ethnic group, divorced, separated, widowed, or never married, current or former smoker, or having histories of diabetes, disability, or depression were associated with significantly higher prevalence ratios for current depression; whereas being at an advanced age (≥60 years old), attaining educational levels of >high school graduate, or engaging in leisure-time physical activity were associated with significantly lower prevalence ratios for current depression.ConclusionOur results indicate that cancer survivors are at increased risk of current depression. Targeting cancer survivors at high risk of depressive issues may be especially important for clinical support and interventions aimed at improving mental well-being.     

Systemic inflammation,depression and obstructive pulmonary function: a population-based study

Background

Levels of Interleukin-6 (IL-6) and C-creative protein (CRP) indicating systemic inflammation are known to be elevated in chronic diseases including chronic obstructive pulmonary disease (COPD) and depression. Comorbid depression is common in patients with COPD, but no studies have investigated whether proinflammatory cytokines mediate the association between pulmonary function and depressive symptoms in healthy individuals with no known history of obstructive pulmonary diseases.

Methods

In a population-based sample (n = 2077) of individuals aged 55 and above with no known history of obstructive pulmonary disease in the Singapore Longitudinal Ageing Study (SLAS), we analyzed the relationships between IL-6 and CRP, depressive symptoms (GDS-15 ≥5) and obstructive pulmonary function (FEV1% predicted and FEV1/FVC% predicted).

Results

High serum levels of IL-6 and CRP were associated with greater prevalence of depressive symptoms (p < 0.05). High IL-6, high CRP and depressive symptoms were independently associated with decreased FEV1% predicted and FEV1/FVC% predicted after adjusting for smoking status, BMI and number of chronic inflammatory diseases. Increasing grades of combination of inflammatory markers and/or depressive symptoms was associated with progressive increases in pulmonary obstruction. In hierarchical models, the significant association of depressive symptoms with pulmonary obstruction was reduced by the presence of IL-6 and CRP.

Conclusions

This study found for the first time an association of depressive symptoms and pulmonary function in older adults which appeared to be partly mediated by proinflammatory cytokines. Further studies should be conducted to investigate proinflammatory immune markers and depressive symptoms as potential phenotypic indicators for chronic obstructive airway disorders in older adults.     

急性心肌梗死患者PCI治疗后抑郁对心率变异性、内皮功能及不良心血管事件发生率的影响

目的:探讨急性心肌梗死(AMI)患者经皮冠状动脉介入(PCI)治疗后抑郁对心率变异性(HRV)、内皮功能及不良心血管事件(MACE)发生率的影响。方法:选择2017年1月-2018年12月期间在本院接受PCI治疗的AMI患者117例作为研究对象,根据PCI术后出院当日的抑郁自评量表(SDS)评分值将其分为抑郁组(评分值≥53分)41例、非抑郁组(评分值<53分)76例。对比两组患者HRV相关指标[正常RR间期标准差(SDNN)、5 min内正常RR间期平均值标准差(SDANN)、相邻正常RR间期差值均方的平方根(RMSSD)、总功率(TP)、低频功率(LF)、高频功率(HF)、低频功率与高频功率比值(LF/HF)]、内皮功能指标[内皮依赖性血管舒张功能(FMD)、非内皮依赖性血管舒张功能(NMD)]水平差异,记录两组随访期内MACE发生情况。结果:PCI术后出院当日,抑郁组患者的HRV时域指标SDNN、SDANN、RMSSD水平低于非抑郁组患者;频域指标中LF、LF/HF的水平高于非抑郁组,HF的水平低于非抑郁组(P<0.05),两组患者TP水平的差异无统计学意义(P>0.05)。抑郁组患者的FMD、NMD水平均低于非抑郁组患者,差异有统计学意义(P<0.05)。随访期内,抑郁组患者的MACE总发生率、再发心肌梗死发生率高于非抑郁组,差异有统计学意义(P<0.05)。两组患者顽固性心绞痛、新发心肌梗死、心力衰竭、心源性死亡发生率的差异无统计学意义(P>0.05)。结论:AMI患者PCI后合并抑郁可能对心血管系统造成负面影响并最终增加MACE的发生风险。