RESUMEN

Neurons within the anterior cingulate cortex (ACC) orchestrate the co-occurrence of chronic pain and anxiety. The ACC hyperactivity plays a crucial role in the emotional impact of neuropathic pain. Astrocyte-mediated neuroinflammatory is responsible for regulating the balance between excitation-inhibition (E/I) in the brain. However, there is limited understanding of the possible contributions of astrocytes in the ACC to comorbidity of anxiety and chronic inflammatory pain. This paper aims to investigate the possible contribution of astrocytes in the ACC to the comorbidity between anxiety and chronic inflammatory pain, as well as their involvement in the E/I imbalance of pyramidal cells. Our results show that CFA rats displayed allodynia and anxiety-like behaviors. The E/I balance in the ACC shifts to excitement in comorbidity of chronic pain and anxiety by western blotting, and electrophysiological recording. Result of RNA-Seq also indicated that E/I imbalance and neuroinflammation of ACC were involved in pain-anxiety comorbidity. Then, positive cells of GFAP but not Iba1 in the contralateral ACC were increased; the mRNA expression of GFAP and its activation-related proinflammatory cytokines (TNF-α, IL-6, and IL-1ß) in the contralateral ACC were also elevated. Furthermore, specific chemogenic inhibition of ACC astrocytes reversed comorbid pain and anxiety and suppressed high ACC excitability. Our data suggest that astrocytes participate in comorbid pain and anxiety and excitation-inhibition imbalance in ACC. Inhibition astrocyte activation can reduce anxiety related to pain and restore the imbalance in the ACC. These findings shed light on the involvement of astrocytes in comorbid conditions, offering valuable insights into a potential therapeutic approach for the co-occurrence of chronic pain and anxiety.

Asunto(s)

Ansiedad , Astrocitos , Dolor Crónico , Giro del Cíngulo , Inflamación , Ratas Sprague-Dawley , Astrocitos/metabolismo , Animales , Giro del Cíngulo/metabolismo , Giro del Cíngulo/patología , Dolor Crónico/metabolismo , Dolor Crónico/complicaciones , Masculino , Inflamación/patología , Ratas , Hiperalgesia/metabolismo , Citocinas/metabolismo , Comorbilidad

RESUMEN

OBJECTIVE: To explore the independent and combined effects of smoking and passive smoking during pregnancy on maternal depression, anxiety and depressive anxiety comorbidities. METHODS: From August 2020 to February 2022, women who underwent 42-day postpartum examination in Changfeng Women's Center and Shuangfeng Hospital of Hefei were recruited. Their depression and anxiety symptoms were assessed using EPDS Scale and GAD Scale, respectively, and smoking and passive smoking status during pregnancy were collected. Multivariate Logistic regression was used to analyze the independent and combined effects of smoking and passive smoking during pregnancy on postpartum depression, anxiety and depression and anxiety comorbidities. RESULTS: A total of 2 447 parturients were included, whose mean age was(29.23±4.20) years old.58.6% of parturients lived in urban areas.97.2% parturients had unassisted reproduction and 73.5% pregnancy intention was spontaneous. Among them, 362(14.8%) had depression, 523(21.4%) had anxiety, and 270(11.0%) had depression and anxiety comorbidities. In an independent analysis of effects, maternal smoking during pregnancy was statistically associated with postpartum depression(OR=3.86, 95%CI 2.37-6.28), anxiety(OR =2.58, 95%CI 1.60-4.17) and depressive anxiety comorbidity(OR = 3.34, 95%CI 2.00-5.71). Maternal passive smoking during pregnancy was also positively associated with the risk of postpartum depression(OR = 1.56, 95%CI 2.00-5.71), anxiety(OR=1.71, 95%CI 1.24-2.37) and depression and anxiety comorbidities(OR = 1.52, 95%CI 1.02-2.28), and the higher the frequency of exposure to passive smoking, the higher risk of depression, anxiety, and depressive and anxiety comorbidities. No interaction between smoking during pregnancy and passive smoking exposure on postpartum depression(RERI = 0.69, 95%CI-4.62-6.00; AP = 10.84, 95%CI-73.37-95.04; S= 0.58, 95%CI 0.02-15.18), anxiety(RERI=0.27, 95%CI 0.05-0.49; AP=4.02, 95%CI-0.52-8.57; S=0.78, 95%CI 0.64-0.94) and depression and anxiety comorbidities(RERI = 0.07, 95%CI-0.25-0.39; AP=1.74, 95%CI-6.03-9.52; S=0.93, 95%CI 0.68-1.27)was observed. CONCLUSION: Both smoking and passive smoking during pregnancy were positively associated with the risk of postpartum depression, anxiety and depressive anxiety comorbidity.

Asunto(s)

Depresión Posparto , Contaminación por Humo de Tabaco , Embarazo , Femenino , Humanos , Adulto , Depresión Posparto/epidemiología , Depresión Posparto/diagnóstico , Contaminación por Humo de Tabaco/efectos adversos , Fumar/epidemiología , Ansiedad/epidemiología , Periodo Posparto , Depresión/epidemiología , Depresión/diagnóstico

RESUMEN

ObjectiveTo observe the efficacy and safety of sertraline combined with low-dose olanzapine in the treatment of depression and anxiety comorbidity and its effect on sleep quality， so as to provide references for the related clinical treatment. MethodsA total of 121 patients who met the diagnostic criteria of International Classification of Diseases， tenth edition （ICD-10） for depressive episode and generalized anxiety disorder in The Third People's Hospital of Tianshui and the Sanatorium for Mental Illness of Veterans in Tianshui from October 2019 to August 2020 were enrolled， and they were divided into two groups according to the random number table method. Study group （n=61） received sertraline combined with low-dose olanzapine， while control group （n=60） received sertraline only. Then the disease severity degree， sleep quality and adverse reactions were assessed using Hamilton Depression Scale - 17 item （HAMD-17）， Hamilton Anxiety Scale （HAMA）， Pittsburgh Sleep Quality Index （PSQI） and Treatment Emergent Symptom Scale （TESS） at the baseline， 1st， 2nd， 4th， 6th and 8th weekend， respectively. ResultsPost-treatment HAMD-17， HAMA and PSQI scores in both groups were lower than those before treatment （P<0.05）. At each time point after treatment， HAMD-17， HAMA and PSQI scores of study group were lower than those of control group， with statistical significance （P<0.05）. ConclusionSertraline alone and its combination with low-dose olanzapine are both effective in the treatment of depression and anxiety comorbidity， while the combination therapy achieves better efficacy and higher safety in alleviating anxiety and insomnia symptoms.

RESUMEN

The evidence for efficacy of many currently available treatments for bipolar disorder is based on studies of nonrefractory patients with bipolar disorder. Therefore, not surprisingly, most treatment recommendations and guidelines for the treatment of bipolar disorder and its many comorbidities depend heavily on data from placebo controlled randomized clinical trials (RCTs), but these RCTs provide little direction for the clinician as to what next steps might be optimal in non- or partial-responders and in those with ongoing medical and psychiatric comorbidities. Given this and the paucity of RCTs at later treatment junctures, we thought it appropriate to begin a discussion of the quality of the data that some experts in the field might consider using in choosing and sequencing drugs and their combination. We acknowledge that many other clinical investigators may prefer very different sequences, but thought the suggestions offered here might be useful to some clinicians in the field, might start discussions of other options in the literature, and, at the same time, provide a preliminary outline for a new round of much-needed clinical trials to better inform clinical practice. Given the very wide range of the quality of the data and clinical principles on which the current suggestions are based, only minimal references are included and a comprehensive review of the literature supporting each option would be outside the scope of this manuscript.

Asunto(s)

Anticonvulsivantes/uso terapéutico , Antimaníacos/uso terapéutico , Antipsicóticos/uso terapéutico , Trastorno Bipolar/terapia , Psicoterapia , Ancirinas/genética , Trastornos de Ansiedad/terapia , Canales de Calcio Tipo L/genética , Enfermedades Cardiovasculares , Toma de Decisiones Clínicas , Comorbilidad , Monitoreo de Drogas , Quimioterapia Combinada , Terapia Electroconvulsiva , Medicina Basada en la Evidencia , Antagonistas de Aminoácidos Excitadores/uso terapéutico , Pruebas Genéticas , Homocistinuria/genética , Humanos , Ketamina/uso terapéutico , Compuestos de Litio/uso terapéutico , Metilenotetrahidrofolato Reductasa (NADPH2)/deficiencia , Metilenotetrahidrofolato Reductasa (NADPH2)/genética , Espasticidad Muscular/genética , Guías de Práctica Clínica como Asunto , Trastornos Psicóticos/genética , Prevención Secundaria , Cese del Hábito de Fumar , Trastornos Relacionados con Sustancias/terapia , Estimulación Magnética Transcraneal

RESUMEN

PURPOSE: To characterize semiology and EEG features of praxis-induced (PI) myoclonia and to describe the subjective perception of juvenile myoclonic epilepsy (JME) patients with this reflex trait. METHODS: Patients with JME who presented myoclonia during a Video-EEG Neuropsychological Protocol were selected. We analyzed the semiology of upper limbs myoclonia and the ictal EEG patterns on Video-EEG. We explored the subjective aspects of PI by performing a semi-structured interview to each patient. RESULTS: 15 patients experienced 59 upper limbs myoclonia. Jerks were more frequently asymmetric or unilateral (32/59); a bilaterally symmetric pattern of all myoclonia was observed in only five patients. Ictal pattern was polyspike-wave (PSW) in 31/59 myoclonic seizures and spike-and-wave (SW) in 28/59. Six patients started perceiving myoclonia while learning a new skill or practicing a previously learned skill in a more stressful context. For most patients, PI-myoclonia were a source of anxiety. PI persisted despite antiepileptic medications in 10 patients. CONCLUSIONS: Electroclinical features of PI-myoclonia were more heterogeneous than traditionally described. Ictal pattern of SW was almost as frequent as classical PSW. Patients described the influence of learning new skills and anxiety on PI. Their subjective perception let us understand the impact of this reflex trait.

Asunto(s)

Encéfalo/fisiopatología , Electroencefalografía , Destreza Motora/fisiología , Epilepsia Mioclónica Juvenil/fisiopatología , Epilepsia Mioclónica Juvenil/psicología , Adolescente , Adulto , Ansiedad/complicaciones , Ansiedad/epidemiología , Comorbilidad , Femenino , Lateralidad Funcional , Humanos , Entrevistas como Asunto , Masculino , Epilepsia Mioclónica Juvenil/complicaciones , Epilepsia Mioclónica Juvenil/epidemiología , Estrés Psicológico/complicaciones , Estrés Psicológico/epidemiología , Estrés Psicológico/fisiopatología , Extremidad Superior/fisiopatología , Grabación en Video , Adulto Joven

RESUMEN

Anxiety disorders represent a prevalent psychiatric comorbidity in both adults and children with epilepsy for which the etiology remains controversial. Neurobiological contributions have been suggested, but only limited evidence suggests abnormal brain volumes particularly in children with epilepsy and anxiety. Since the brain develops in an organized fashion, covariance analyses between different brain regions can be investigated as a network and analyzed using graph theory methods. We examined 46 healthy children (HC) and youth with recent onset idiopathic epilepsies with (n = 24) and without (n = 62) anxiety disorders. Graph theory (GT) analyses based on the covariance between the volumes of 85 cortical/subcortical regions were investigated. Both groups with epilepsy demonstrated less inter-modular relationships in the synchronization of cortical/subcortical volumes compared to controls, with the epilepsy and anxiety group presenting the strongest modular organization. Frontal and occipital regions in non-anxious epilepsy, and areas throughout the brain in children with epilepsy and anxiety, showed the highest centrality compared to controls. Furthermore, most of the nodes correlating to amygdala volumes were subcortical structures, with the exception of the left insula and the right frontal pole, which presented high betweenness centrality (BC); therefore, their influence in the network is not necessarily local but potentially influencing other more distant regions. In conclusion, children with recent onset epilepsy and anxiety demonstrate large scale disruptions in cortical and subcortical brain regions. Network science may not only provide insight into the possible neurobiological correlates of important comorbidities of epilepsy, but also the ways that cortical and subcortical disruption occurs.

Asunto(s)

Trastornos de Ansiedad/diagnóstico por imagen , Encéfalo/diagnóstico por imagen , Interpretación Estadística de Datos , Epilepsias Parciales/diagnóstico por imagen , Epilepsia Generalizada/diagnóstico por imagen , Red Nerviosa/diagnóstico por imagen , Adolescente , Amígdala del Cerebelo/diagnóstico por imagen , Trastornos de Ansiedad/epidemiología , Corteza Cerebral/diagnóstico por imagen , Niño , Comorbilidad , Epilepsias Parciales/epidemiología , Epilepsia Generalizada/epidemiología , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino

RESUMEN

Comorbid anxiety is common in bipolar spectrum disorders [BPSD], and is associated with poor outcomes. Its clinical relevance is highlighted by the "anxious distress specifier" in the revised criteria for Bipolar Disorders in the Diagnostic and Statistical Manual 5th Edition [DSM-5]. This article reviews evidence for the effectiveness of psychological therapy for anxiety in adults with BPSD (bipolar I, II, not otherwise specified, cyclothymia, and rapid cycling disorders). A systematic search yielded 22 treatment studies that included an anxiety-related outcome measure. Cognitive behavioural therapy [CBT] for BPSD incorporating an anxiety component reduces anxiety symptoms in cyclothymia, "refractory" and rapid cycling BPSD, whereas standard bipolar treatments have only a modest effect on anxiety. Preliminary evidence is promising for CBT for post-traumatic stress disorder and generalised anxiety disorder in BPSD. Psychoeducation alone does not appear to reduce anxiety, and data for mindfulness-based cognitive therapy [MBCT] appear equivocal. CBT during euthymic phases has the greatest weight of evidence. Where reported, psychological therapy appears acceptable and safe, but more systematic collection and reporting of safety and acceptability information is needed. Development of psychological models and treatment protocols for anxiety in BPSD may help improve outcomes.

Asunto(s)

Trastornos de Ansiedad/complicaciones , Trastornos de Ansiedad/terapia , Trastorno Bipolar/complicaciones , Trastorno Bipolar/terapia , Psicoterapia/métodos , Humanos

RESUMEN

BACKGROUND: The high comorbidity rate between bipolar disorder (BP) and anxiety disorder (AD) has been studied in depth. This comorbidity is not as high in Han Chinese in Taiwan. Therefore, we explored the genetic effects BP comorbid with AD. METHODS: We recruited 1316 participants: 286 with BP-I, 681 with BP-II, and 349 healthy Controls. Genotypes of the BDNF Val66Met and DRD3 Ser9Gly polymorphisms were determined using polymerase chain reactions plus restriction fragment length polymorphism analysis. RESULTS: The DRD3 Ser9Gly polymorphism was associated with BP-II comorbid with AD (BPII(+AD)), and the BDNF Val66Met polymorphism was associated with BP-I comorbid with AD (BPI(+AD)). An interaction between the Val/Val genotype of the BDNF Val66Met and Gly/Gly polymorphism of the DRD3 Ser9Gly was found in BPII(+AD), but not in BP-II not comorbid with AD (BPI(-AD)) compared with healthy Controls. LIMITATION: The low comorbidity rate of AD in both BP subtypes, especially BP-I, limit generalizing our findings. CONCLUSION: The involvement of the dopaminergic pathway in AD was confirmed, particularly with BP-II rather than BP-I. Because the Val/Val genotype of the BDNF Val66Met polymorphism, rather than the other two polymorphisms, has been associated with anxiety, it seems to affect BP-I comorbid with AD without the involvement of the DRD3 Seg9Gly polymorphism, but may modify the involvement of DRD3 Gly/Gly in BP-II comorbid with AD.

Asunto(s)

Trastornos de Ansiedad/genética , Trastorno Bipolar/genética , Factor Neurotrófico Derivado del Encéfalo/genética , Polimorfismo de Nucleótido Simple/genética , Receptores de Dopamina D3/genética , Adulto , Trastornos de Ansiedad/epidemiología , Pueblo Asiatico/genética , Trastorno Bipolar/epidemiología , Estudios de Casos y Controles , Comorbilidad , Femenino , Predisposición Genética a la Enfermedad , Genotipo , Humanos , Masculino , Taiwán/epidemiología