[Bio-psycho-socio or psychotherapeutic medicine - actual development of psychosomatics in clinical practice]

Interplay of G-proteins and Serotonin in the Neuroimmunoinflammatory Model of Chronic Stress and Depression: A Narrative Review

INTRODUCTION

This narrative review addresses the clinical challenges in stress-related disorders such as depression, focusing on the interplay between neuron-specific and pro-inflammatory mechanisms at the cellular, cerebral, and systemic levels.

OBJECTIVE

We aim to elucidate the molecular mechanisms linking chronic psychological stress with low-grade neuroinflammation in key brain regions, particularly focusing on the roles of G proteins and serotonin (5-HT) receptors.

METHODS

This comprehensive review of the literature employs systematic, narrative, and scoping review methodologies, combined with systemic approaches to general pathology. It synthesizes current research on shared signaling pathways involved in stress responses and neuroinflammation, including calcium-dependent mechanisms, mitogen-activated protein kinases, and key transcription factors like NF-κB and p53. The review also focuses on the role of G protein-coupled neurotransmitter receptors (GPCRs) in immune and pro-inflammatory responses, with a detailed analysis of how 13 of 14 types of human 5-HT receptors contribute to depression and neuroinflammation.

RESULTS

The review reveals a complex interaction between neurotransmitter signals and immunoinflammatory responses in stress-related pathologies. It highlights the role of GPCRs and canonical inflammatory mediators in influencing both pathological and physiological processes in nervous tissue.

CONCLUSION

The proposed Neuroimmunoinflammatory Stress Model (NIIS Model) suggests that proinflammatory signaling pathways, mediated by metabotropic and ionotropic neurotransmitter receptors, are crucial for maintaining neuronal homeostasis. Chronic mental stress can disrupt this balance, leading to increased pro-inflammatory states in the brain and contributing to neuropsychiatric and psychosomatic disorders, including depression. This model integrates traditional theories on depression pathogenesis, offering a comprehensive understanding of the multifaceted nature of the condition.

[Effectiveness of in-patient internal-psychosomatic hospital treatment: Evaluation of a treatment-concept in Lower Austria]

Effectiveness of in-patient internal-psychosomatic hospital treatment: Evaluation of a treatment-concept in Lower Austria Background: Medical care for psychosomatic patients in Austria differs from Germany. Besides treatment in psychiatric wards, there are also inpatient programs for psychosomatic patients integrated in internal medical departments. Such an integrated ward in Lower Austria operates for more than 35 years and treats internal-psychosomatic and gastroenterological patients. However, its effectiveness was not yet evaluated. Objective: The aim of the current study was to evaluate the effectiveness of an inpatient program for psychosomatic patients. Method: In total, 184 patients participated in the naturalistic study and filled in questionnaires at admission and discharge from inpatient treatment. Primary endpoint was the difference in global symptom burden, as well as symptom burden in the areas of somatization, anxiety, and depression as measured with the Brief Symptom Inventory (BSI) between admission and discharge. Secondary endpoints were body image (FKB-20) and subjective therapeutic success (BVB-2000). The predictive power of the Structure of Personality (OPD-SF) and adverse childhood experiences (ACE-D) was also investigated. A smaller sample of 59 patients also participated in a four-month follow up assessment. Results: The inpatient treatment was associated with improvement in the primary endpoints that can be interpreted as large effects. The effects were also small to large for the secondary endpoints, however, the improvement was smaller at the follow up time point. Patients with deficits in the dimensions regulation of relationships and internal emotional communication showed less improvement. Discussion: Symptoms improve over the course of the evaluated inpatient treatment program. Specific dimension of the structure of personality predict treatment response and should be considered in treatment planning. Conclusion: This study provides initial evidence for the presented internal-psychosomatic inpatient program. The program might act as model for psychosomatic medical care in Austrian hospitals.