Immune response to stress induction as a predictor of cognitive-behavioral therapy outcomes in adolescent mood disorders: A pilot study

Preliminary results of anti-inflammatory cytokine concentrations predicting therapy outcome in panic disorder

Background

Patients with panic disorder (PD) show alterations of the immune reactivity to acute stress, which could serve as a marker for effective treatment. Nevertheless, the effect of immune reactivity under acute stress before treatment on therapy outcome remains unclear.

Methods

A total of N = 16 PD patients performed the Trier Social Test. Blood sample collection of anti-inflammatory cytokine IL-10 accompanied the TSST. The Mobility Inventory was handed out for the assessment of avoidance behavior before and after treatment. Area under the curve with respect to the ground (AUCG) and increase (AUCI) were calculated for assessed cytokine levels and were used as predictors for therapy outcome in regression analyses.

Results

AUCG significantly predicts avoidance behavior in company after treatment (β = -0.007, p = .033) but not avoidance behavior alone (β = -0.003, p = .264). AUCI does not significantly predict therapy outcome.

Conclusion

Higher concentrations of anti-inflammatory cytokine IL-10 under acute stress before treatment predicts less avoidance behavior in company after therapy. Immune markers seem to play a crucial role in the maintenance of mental disorders such as PD. Underlying mechanisms and IL-10 as a marker for individualized treatments should be investigated in future studies.

The effect of cognitive-behavioral group therapy on reducing depression and anxiety in patients with mood disorders: experimental research

Mood disorders are one of the most common psychiatric disorders that manifest as a low mood in depressed people or a high mood in manic people. The cognitive-behavioral therapy group is one of the most effective forms of intervention available for patients with mood disorders. This research aimed to evaluate the effect of cognitive-behavioral group therapy in reducing depression and anxiety in patients with mood disorders.

CASE PRESENTATION

The study was a semi-experimental study with a pretest-post-test design with a control group. The research subjects were 60 patients hospitalized in the psychiatric department of Razi Hospital in Tehran, who were randomly divided into two experimental (N:30) and control (N:30) groups. Both groups took medicine as usual. Before the therapeutic intervention, both groups were evaluated with Beck's depression questionnaire and the Zung anxiety scale. In addition to drug therapy, the experimental group participated in ten sessions of the cognitive-behavioral therapy group, and in the control group, no psychological intervention was performed except for drug therapy. At the end of the nonpharmacological treatment intervention, both groups were evaluated again with the aforementioned tests. The obtained data were analyzed using independent and dependent t-tests.

CLINICAL DISCUSSION

The research findings showed that the cognitive-behavioral therapy group was significantly (P<0.05) effective in reducing the depression of hospitalized patients with mood disorders, but this method did not have much effect in reducing the anxiety of the patients.

CONCLUSION

Cognitive-behavioral group therapy can be effective in reducing depression in hospitalized patients with mood disorders.

Effects of Cannabidiol on Innate Immunity: Experimental Evidence and Clinical Relevance

Cannabidiol (CBD) is the main non-psychotropic cannabinoid derived from cannabis (Cannabis sativa L., fam. Cannabaceae). CBD has received approval by the Food and Drug Administration (FDA) and European Medicines Agency (EMA) for the treatment of seizures associated with Lennox-Gastaut syndrome or Dravet syndrome. However, CBD also has prominent anti-inflammatory and immunomodulatory effects; evidence exists that it could be beneficial in chronic inflammation, and even in acute inflammatory conditions, such as those due to SARS-CoV-2 infection. In this work, we review available evidence concerning CBD's effects on the modulation of innate immunity. Despite the lack so far of clinical studies, extensive preclinical evidence in different models, including mice, rats, guinea pigs, and even ex vivo experiments on cells from human healthy subjects, shows that CBD exerts a wide range of inhibitory effects by decreasing cytokine production and tissue infiltration, and acting on a variety of other inflammation-related functions in several innate immune cells. Clinical studies are now warranted to establish the therapeutic role of CBD in diseases with a strong inflammatory component, such as multiple sclerosis and other autoimmune diseases, cancer, asthma, and cardiovascular diseases.

Cytokine alterations in pediatric internalizing disorders: Systematic review and exploratory multi-variate meta-analysis

Pediatric internalizing disorders are prevalent and characterized by a maladaptive cognitive, emotional response to a perceived stressor. The hypothesized effect of this response is observable changes in behavior mediated by homeostatic inflammatory cytokines. The aim of this study was to synthesize the literature and analyze the effect of cytokines on pediatric internalizing disorders. Influential moderating variables, including mean body mass index, fasting status at blood collection, participant sex, cytokine type, mean age, percentage of sample medicated, and diagnosis, were also assessed. A systematic literature search was performed in electronic databases (Medline, PubMed, and PsycINFO) from January 1, 1980 to June 15, 2022. Case-control studies of pediatric internalizing disorders, specifically anxiety and depression, were reviewed for their association with peripheral cytokine levels. Meta-analyses were performed using a random effects multi-variate model and effect sizes were calculated using Hedge's g for IL-2, CRP, IL-6, TNF-α, IL-1β, IFN-γ, and IL-10. Thirty-three studies were reviewed and 28 studies were included in the meta-analysis (n = 1322 cases and n = 3617 controls). Peripheral cytokine levels were elevated in pediatric internalizing disorders compared to controls (Hedge's g = 0.19, p < 0.001). In the moderator analyses, depression diagnosis (Hedge's g = 0.18, p = 0.009) and non-fasting blood collection (Hedge's g = 0.20, p = 0.006) were significant. The meta-analytic findings are limited by methodological variation between studies, high heterogeneity, and low statistical power. Despite this, the findings suggest that elevated peripheral cytokine levels may play a role in the etiology and/or symptom maintenance of pediatric internalizing disorders.

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Depression diagnosis and non-fasting blood collection were observed to significantly influenced peripheral cytokine levels.

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No individual peripheral cytokines tested were associated with pediatric internalizing disorders.

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Overall, elevated peripheral cytokines were observed in pediatric internalizing disorders compared to controls.

A novel joint index based on peripheral blood CD4+/CD8+ T cell ratio, albumin level, and monocyte count to determine the severity of major depressive disorder

BACKGROUND

Inflammation and immune status are correlated with the severity of major depressive disorder (MDD).The purpose of this study was to establish an optimization model of peripheral blood parameters to predict the severity of MDD.

METHODS

MDD severity in the training and validation cohorts (n = 99 and 97) was classified using the Hamilton Depression Scale, Thirty-eight healthy individuals as controls. Significant severity-associated factors were identified using a multivariate logistic model and combined to develop a joint index through binary logistic regression analysis. The area under the receiver operating characteristic curve (AUC) was used to identify the optimal model and evaluate the discriminative performance of the index.

RESULTS

In the training cohort, lower CD4+/CD8+ T cell ratio, albumin level, and a higher monocyte percentage (M%) were significant as operating sociated with severe disease (P < 0.05 for all). The index was developed using these factors and calculated as CD4+/CD8+ T cell ratio, albumin level, and M%, with a sensitivity and specificity of 90 and 70%, respectively. The AUC values for the index in the training and validation cohorts were 0.85 and 0.75, respectively, indicating good discriminative performance.

CONCLUSION

We identified disease severity-associated joint index that could be easily evaluated: CD4+/CD8+ T cell ratio, albumin level, and M%.

Lifetime stressor exposure, systemic inflammation during pregnancy, and preterm birth among Black American women

Although Black American mothers and infants are at higher risk for morbidity and mortality than their White counterparts, the biological mechanisms underlying these phenomena remain largely unknown. To investigate the role that lifetime stressor exposure, perceived stressor severity, and systemic inflammatory markers might play, we studied how these factors were interrelated in 92 pregnant Black American women. We also compared inflammatory marker levels for women who did versus did not go on to give birth preterm. During the early third trimester, women completed the Stress and Adversity Inventory for Adults to assess the stressors they experienced over their lifetime. Women also provided blood samples for plasma interleukin (IL)-6, IL-8, IL-1β, and tumor necrosis factor (TNF)-α quantification. Preterm births were identified by medical record review. Controlling for relevant covariates, there were significant positive associations between average levels of both overall and acute perceived stressor severity and plasma IL-1β levels. Controlling for perceived stress at assessment and exposure to racial discrimination did not affect these results. Mediation models revealed that exposure to more chronic stressors was related to higher plasma IL-1β levels, as mediated by higher average levels of overall perceived stressor severity. Exposure to fewer acute stressors was related to higher plasma IL-1β levels, as mediated by higher average levels of acute perceived stressor severity. Finally, women who went on to give birth preterm had higher levels of plasma IL-6. These data thus highlight the potential importance of assessing and addressing lifetime stressor exposure among mothers before and during maternal-infant care.

Psychosocial Treatments for Bipolar Disorder in Children and Adolescents

Evidence suggests that adjunctive psychosocial intervention for the treatment of pediatric bipolar spectrum disorders (BPSDs) is effective, feasible, and highly accepted as both an acute and maintenance treatment for youth with BPSD diagnoses as well as a preventive treatment for high-risk youth who are either asymptomatic or exhibit subsyndromal mood symptoms. Here, we provide a comprehensive review of all known evidence-based interventions, including detailed descriptions of treatment targets and core components, results of clinical trials, and updated research on mediators and moderators of treatment efficacy. Treatments are presented systematically according to level of empirical support (i.e., well established, probably efficacious, possibly efficacious, experimental, or questionable); upcoming and ongoing trials are included when possible. In line with a staging approach, preventive interventions are presented separately. Recommendations for best practices based on age, stage, and additional evidence-based child and family factors shown to affect treatment outcomes are provided. Expected final online publication date for the Annual Review of Clinical Psychology, Volume 18 is May 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

Association Between Socio-Affective Symptoms and Glutathione and CD4 and CD8 Lymphocytes in College Students

Background: The prevalence of anxiety and depression in young students is associated with biosocial factors and scholastic stress. However, few studies have evaluated emotional-affective symptoms that are related to the immune system and antioxidant parameters in young individuals without diagnoses of affective disorders. Aim: This study aims to assess the relationship between emotional-affective symptoms and glutathione concentrations and CD4 and CD8 lymphocyte counts in college students. Methods: College students (n = 177) completed standardized psychometric instruments, including the Perceived Stress Scale, Hamilton Anxiety Scale, Beck Depression Inventory, Familiar Social and Friends Support Scale, and Rosenberg Scale. Blood samples were biochemically analyzed. Analyses of variance were conducted between four groups according to symptom severity. Results: A considerable prevalence of stress, anxiety, and depression symptoms was observed and negatively correlated with self-esteem and socio-familiar support. Perceived stress was sexually dimorphic. Although biochemical parameters were within reference ranges, glutathione, CD4, and CD8 tended to be lower in participants with anxiety and depression symptoms, which may be of predictive value. Conclusion: The relationship between antioxidant/immune parameters and socio-affective scores is latent in undiagnosed college students who might develop affective disorders. The findings suggest that during the initial development of affective disorders, stress management strategies should be implemented to help college students cope with the academic load and monitor negative changes in their physiological state.

Does cognitive behaviour therapy affect peripheral inflammation of depression? A protocol for the systematic review and meta-analysis

INTRODUCTION

Cognitive-behavioural therapy (CBT) is becoming the most commonly implemented and standard treatment for depression. Up to date, only a few numbers of studies have investigated the potential relationship between CBT and the change of inflammatory biomarkers in individuals of depression. And the results are inconsistent among studies. The current study aims to provide a comprehensive, systematic review of the association between CBT and changes of peripheral inflammation of individuals with depression, and clarify the alterations of inflammatory cytokines pre-CBT and post-CBT treatment by meta-analysis, anti-inflammatory.

METHODS AND ANALYSIS

This study will be conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A systematic search of predetermined terms will be conducted with electronic databases of CENTRAL, MEDLINE, EMBASE and PsycINFO from inception to July 2021. Database searches will be supplemented by expert contact, reference and citation checking, and grey literature. Primary outcomes of interest will be validated measures for levels of inflammatory cytokines pre-CBT and post- CBT treatment in individuals with depression. Hedges' g will be used to represent the effect size.

SYSTEMATIC REVIEW REGISTRATION

The protocol of current meta-analysis has been registered at the Open Science Framework (https://doi.org/10.17605/osf.io/tr9yh).

ETHICS AND DISSEMINATION

Formal ethical approval is not required by the National Ethical Review Board in China as primary data will not be collected. The results alterations of peripheral inflammatory cytokines pre-CBT and post-CBT treatment in individuals with depression will be disseminated through a peer-reviewed publication and inform the most up-to-date evidence of the roles of CBT treatment for depression.

Inflammation, anxiety, and stress in bipolar disorder and borderline personality disorder: A narrative review

Bipolar disorder (BD) and borderline personality disorder (BPD) are serious and prevalent psychiatric diseases that share common phenomenological characteristics: symptoms (such as anxiety, affective lability or emotion dysregulation), neuroimaging features, risk factors and comorbidities. While several studies have focused on the link between stress and peripheral inflammation in other affective disorders such as anxiety or depression, fewer have explored this relationship in BD and BPD. This review reports on evidence showing an interplay between immune dysregulation, anxiety and stress, and how an altered acute neuroendocrine stress response may exist in these disorders. Moreover, we highlight limitations and confounding factors of these existing studies and discuss multidirectional hypotheses that either suggest inflammation or stress and anxiety as the primum movens in BD and BPD pathophysiology, or inflammation as a consequence of the pathophysiology of these diseases. Untangling these associations and implementing a transdiagnostic approach will have diagnostic, therapeutic and prognostic implications for BD and BPD patients.

What Does Immunology Have to Do With Normal Brain Development and the Pathophysiology Underlying Tourette Syndrome and Related Neuropsychiatric Disorders?

Objective: The goal of this article is to review the past decade's literature and provide a critical commentary on the involvement of immunological mechanisms in normal brain development, as well as its role in the pathophysiology of Tourette syndrome, other Chronic tic disorders (CTD), and related neuropsychiatric disorders including Obsessive-compulsive disorder (OCD) and Attention deficit hyperactivity disorder (ADHD). Methods: We conducted a literature search using the Medline/PubMed and EMBASE electronic databases to locate relevant articles and abstracts published between 2009 and 2020, using a comprehensive list of search terms related to immune mechanisms and the diseases of interest, including both clinical and animal model studies. Results: The cellular and molecular processes that constitute our "immune system" are crucial to normal brain development and the formation and maintenance of neural circuits. It is also increasingly evident that innate and adaptive systemic immune pathways, as well as neuroinflammatory mechanisms, play an important role in the pathobiology of at least a subset of individuals with Tourette syndrome and related neuropsychiatric disorders In the conceptual framework of the holobiont theory, emerging evidence points also to the importance of the "microbiota-gut-brain axis" in the pathobiology of these neurodevelopmental disorders. Conclusions: Neural development is an enormously complex and dynamic process. Immunological pathways are implicated in several early neurodevelopmental processes including the formation and refinement of neural circuits. Hyper-reactivity of systemic immune pathways and neuroinflammation may contribute to the natural fluctuations of the core behavioral features of CTD, OCD, and ADHD. There is still limited knowledge of the efficacy of direct and indirect (i.e., through environmental modifications) immune-modulatory interventions in the treatment of these disorders. Future research also needs to focus on the key molecular pathways through which dysbiosis of different tissue microbiota influence neuroimmune interactions in these disorders, and how microbiota modification could modify their natural history. It is also possible that valid biomarkers will emerge that will guide a more personalized approach to the treatment of these disorders.