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Molina-Ruiz R, Nakagami Y, Mörkl S, Vargas M, Shalbafan M, Chang JPC, Rai Y, Seun-Fadipe CT, Erzin G, Kazhungil F, Vidal P, Brihastami S, Yıldızhan E, Maiti T, Fedotov I, Rojnic-Palavra I, Horinouchi T, Renganathan V, Pinto da Costa M. Training in neuropsychiatry: views of early career psychiatrists from across the world. BJPsych Bull 2024; 48:78-84. [PMID: 37395121 PMCID: PMC10985715 DOI: 10.1192/bjb.2023.32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 02/01/2023] [Accepted: 04/16/2023] [Indexed: 07/04/2023] Open
Abstract
BACKGROUND Training and practice in neuropsychiatry varies across the world. However, little is known about the experiences and opinions of early career psychiatrists (ECPs) across different countries regarding neuropsychiatry. AIMS AND METHOD To investigate neuropsychiatry training experiences, practices and opinions among ECPs across different countries. An online survey was distributed to ECPs in 35 countries across the world. RESULTS A total of 522 participants took part in this study. Responses show that neuropsychiatry is integrated to a variable extent in psychiatric training curricula across the world. Most respondents were not aware of the existence of neuropsychiatric training or of neuropsychiatric units. Most agreed that training in neuropsychiatry should be done during or after the psychiatry training period. Lack of interest among specialty societies, lack of time during training, and political and economic reasons are regarded as the main barriers. CLINICAL IMPLICATIONS These findings call for an improvement in the extent and in the quality of neuropsychiatry training across the world.
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Affiliation(s)
| | | | | | | | - Mohammadreza Shalbafan
- Iran University of Medical Sciences, Tehran, Iran
- Institute for Cognitive Sciences Studies, Tehran, Iran
| | | | - Yugesh Rai
- Essex Partnership University NHS Foundation Trust, Colchester, UK
| | | | - Gamze Erzin
- Diskapi Training and Research Hospital, Ankara, Turkey
| | | | - Pablo Vidal
- Hospitalario Universitario A Coruña, A Coruña, Spain
| | | | - Eren Yıldızhan
- Bakirkoy Mazhar Osman Research and Training Hospital for Psychiatry, Istanbul, Turkey
| | - Tanay Maiti
- South Yorkshire NHS Foundation Trust, Dewsbury, UK
| | | | | | - Toru Horinouchi
- Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | | | - Mariana Pinto da Costa
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto, Portugal
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Lackner S, Mahnert A, Moissl-Eichinger C, Madl T, Habisch H, Meier-Allard N, Kumpitsch C, Lahousen T, Kohlhammer-Dohr A, Mörkl S, Strobl H, Holasek S. Interindividual differences in aronia juice tolerability linked to gut microbiome and metabolome changes-secondary analysis of a randomized placebo-controlled parallel intervention trial. Microbiome 2024; 12:49. [PMID: 38461313 PMCID: PMC10924357 DOI: 10.1186/s40168-024-01774-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 02/05/2024] [Indexed: 03/11/2024]
Abstract
BACKGROUND Aronia melanocarpa is a berry rich in polyphenols known for health benefits. However, the bioavailability of polyphenols has been questioned, and the individual taste acceptance of the fruit with its specific flavor varies. We recently observed substantial differences in the tolerability of aronia juice among healthy females, with half of the individuals tolerating aronia juice without complaints. Given the importance of the gut microbiome in food digestion, we investigated in this secondary analysis of the randomized placebo-controlled parallel intervention study (ClinicalTrials.gov registration: NCT05432362) if aronia juice tolerability was associated with changes in intestinal microbiota and bacterial metabolites, seeking for potential mechanistic insights into the impact on aronia polyphenol tolerance and metabolic outcomes. RESULTS Forty females were enrolled for this 6-week trial, receiving either 100 ml natural aronia juice (verum, V) twice daily or a polyphenol-free placebo (P) with a similar nutritional profile, followed by a 6-week washout. Within V, individuals were categorized into those who tolerated the juice well (Vt) or reported complaints (Vc). The gut microbiome diversity, as analyzed by 16S rRNA gene-based next-generation sequencing, remained unaltered in Vc but changed significantly in Vt. A MICOM-based flux balance analysis revealed pronounced differences in the 40 most predictive metabolites post-intervention. In Vc carbon-dioxide, ammonium and nine O-glycans were predicted due to a shift in microbial composition, while in Vt six bile acids were the most likely microbiota-derived metabolites. NMR metabolomics of plasma confirmed increased lipoprotein subclasses (LDL, VLDL) post-intervention, reverting after wash out. Stool samples maintained a stable metabolic profile. CONCLUSION In linking aronia polyphenol tolerance to gut microbiota-derived metabolites, our study explores adaptive processes affecting lipoprotein profiles during high polyphenol ingestion in Vt and examines effects on mucosal gut health in response to intolerance to high polyphenol intake in Vc. Our results underpin the importance of individualized hormetic dosing for beneficial polyphenol effects, demonstrate dynamic gut microbiome responses to aronia juice, and emphasize personalized responses in polyphenol interventions.
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Affiliation(s)
- Sonja Lackner
- Division of Immunology, Otto Loewi Research Center for Vascular Biology, Immunology and Inflammation, Medical University of Graz, Stiftingtalstraße 6, 8010, Graz, Austria
| | - Alexander Mahnert
- Diagnostic and Research Institute of Hygiene, Microbiology and Environmental Medicine, Medical University of Graz, Neue Stiftingtalstraße 6, 8010, Graz, Austria
| | - Christine Moissl-Eichinger
- Diagnostic and Research Institute of Hygiene, Microbiology and Environmental Medicine, Medical University of Graz, Neue Stiftingtalstraße 6, 8010, Graz, Austria
- BioTechMed-Graz, Mozartgasse 12/II, 8010, Graz, Austria
| | - Tobias Madl
- Division of Medicinal Chemistry, Otto Loewi Research Center, Medical University of Graz, Neue Stiftingtalstraße 6, 8010, Graz, Austria
- BioTechMed-Graz, Mozartgasse 12/II, 8010, Graz, Austria
| | - Hansjörg Habisch
- Division of Medicinal Chemistry, Otto Loewi Research Center, Medical University of Graz, Neue Stiftingtalstraße 6, 8010, Graz, Austria
| | - Nathalie Meier-Allard
- Division of Immunology, Otto Loewi Research Center for Vascular Biology, Immunology and Inflammation, Medical University of Graz, Stiftingtalstraße 6, 8010, Graz, Austria
| | - Christina Kumpitsch
- Diagnostic and Research Institute of Hygiene, Microbiology and Environmental Medicine, Medical University of Graz, Neue Stiftingtalstraße 6, 8010, Graz, Austria
| | - Theresa Lahousen
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Auenbruggerplatz 31, 8036, Graz, Austria
| | - Alexandra Kohlhammer-Dohr
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Auenbruggerplatz 31, 8036, Graz, Austria
| | - Sabrina Mörkl
- Division of Medical Psychology, Psychosomatics and Psychotherapeutic Medicine, Auenbruggerplatz 3, 8036, Graz, Austria
| | - Herbert Strobl
- Division of Immunology, Otto Loewi Research Center for Vascular Biology, Immunology and Inflammation, Medical University of Graz, Stiftingtalstraße 6, 8010, Graz, Austria
| | - Sandra Holasek
- Division of Immunology, Otto Loewi Research Center for Vascular Biology, Immunology and Inflammation, Medical University of Graz, Stiftingtalstraße 6, 8010, Graz, Austria.
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3
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Ribera C, Sánchez-Ortí JV, Clarke G, Marx W, Mörkl S, Balanzá-Martínez V. Probiotic, prebiotic, synbiotic and fermented food supplementation in psychiatric disorders: A systematic review of clinical trials. Neurosci Biobehav Rev 2024; 158:105561. [PMID: 38280441 DOI: 10.1016/j.neubiorev.2024.105561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 01/03/2024] [Accepted: 01/20/2024] [Indexed: 01/29/2024]
Abstract
The use of probiotics, prebiotics, synbiotics or fermented foods can modulate the gut-brain axis and constitute a potentially therapeutic intervention in psychiatric disorders. This systematic review aims to identify current evidence regarding these interventions in the treatment of patients with DSM/ICD psychiatric diagnoses. Forty-seven articles from 42 studies met the inclusion criteria. Risk of bias was assessed in all included studies. Major depression was the most studied disorder (n = 19 studies). Studies frequently focused on schizophrenia (n = 11) and bipolar disorder (n = 5) and there were limited studies in anorexia nervosa (n = 4), ADHD (n = 3), Tourette (n = 1), insomnia (n = 1), PTSD (n = 1) and generalized anxiety disorder (n = 1). Except in MDD, current evidence does not clarify the role of probiotics and prebiotics in the treatment of mental illness. Several studies point to an improvement in the immune and inflammatory profile (e.g. CRP, IL6), which may be a relevant mechanism of action of the therapeutic response identified in these studies. Future research should consider lifestyle and dietary habits of patients as possible confounders that may influence inter-individual treatment response.
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Affiliation(s)
- Carlos Ribera
- Department of Psychiatry, Hospital Clínico Universitario de Valencia, Department of Psychiatry, Blasco Ibañez 17, floor 7B, 46010 Valencia, Spain.
| | - Joan Vicent Sánchez-Ortí
- Faculty of Psychology, University of Valencia, Valencia, Spain; INCLIVA - Health Research Institute, Valencia, Spain; TMAP - Evaluation Unit in Personal Autonomy, Dependency and Serious Mental Disorders, University of Valencia, Fundación INCLIVA, Av. Menéndez y Pelayo 4, 46010 Valencia, Spain.
| | - Gerard Clarke
- Department of Psychiatry and Neurobehavioural Science, University College Cork, Cork, Ireland; APC Microbiome Ireland, University College Cork, Dept of Psychiatry and Neurobehavioural Science, College Rd, 1.15 Biosciences Building, Cork, Ireland.
| | - Wolfgang Marx
- Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, Food & Mood Centre, School of Medicine, Barwon Health, 299 Ryrie street, Geelong, VIC 3220, Australia.
| | - Sabrina Mörkl
- Division of Medical Psychology, Psychosomatics and Psychotherapeutic Medicine, Medical University of Graz, Neue Stiftingtalstraße 6, 8010 Graz, Austria.
| | - Vicent Balanzá-Martínez
- INCLIVA - Health Research Institute, Valencia, Spain; TMAP - Evaluation Unit in Personal Autonomy, Dependency and Serious Mental Disorders, University of Valencia, Fundación INCLIVA, Av. Menéndez y Pelayo 4, 46010 Valencia, Spain; Teaching Unit of Psychiatry and Psychological Medicine, Department of Medicine, University of Valencia. Blasco Ibañez 15, 46010 Valencia, Spain.; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), ISCIII, Madrid, Spain; VALSME (Valencia Salut Mental i Estigma) Research Group, University of Valencia, Valencia, Spain.
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Wiener M, Bengesser SA, Wagner-Skacel J, Haidacher FNA, Lahousen-Luxenberger T, Wenninger J, Hasiba-Seebacher K, Fellendorf FT, Painold A, Kreuzer K, Butler M, Lackner S, Pilz R, Mörkl S. Impaired implicit learning in adults with anorexia nervosa. Int J Eat Disord 2024; 57:195-200. [PMID: 37870449 DOI: 10.1002/eat.24075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 10/03/2023] [Accepted: 10/03/2023] [Indexed: 10/24/2023]
Abstract
OBJECTIVE Cognitive alterations play an important role in the pathophysiology and treatment of anorexia nervosa (AN). Previous studies suggest that some implicit learning processes may be inhibited in AN. However, this has not yet been fully explored. The purpose of this study is to analyze implicit learning in patients with AN in comparison to healthy controls. METHODS In this pilot-study, a total of 21 patients diagnosed with AN and 21 matched controls were administered the weather prediction task (WPT), a probabilistic implicit category learning task that consists of two sub-variants. During the feedback (FB) version of the task, participants learn associations between tarot cards and weather outcomes via an operant learning model through which they receive immediate FB on their answers, whereas during the paired associate (PA) variant, participants are directly asked to memorize given associations. RESULTS AN patients showed selective impairment on the FB task where they scored significantly lower both in comparison to controls (p = .001) who completed the same task and when compared to their own performance on the PA variant (p = .006). Clinical measures showed no significant correlations with test scores. DISCUSSION Our results demonstrate implicit FB learning deficiencies in adult patients with AN. These impairments may have an impact on the effect of psychotherapeutic interventions and could partially explain the lack of treatment response in AN. Further studies are necessary to derive when and through which mechanisms these alterations originate, and to what extent they should be considered during treatment of the disorder. PUBLIC SIGNIFICANCE Cognitive impairments pose a challenge in the management of anorexia nervosa. Improved comprehension of cognitive alterations could lead to a greater understanding of the disease and adaptation of psychotherapeutic treatments. In this study, we found that implicit feedback learning in anorexia nervosa is impaired compared to healthy controls. This could indicate the necessity of treatment adaptations in the form of therapy tools without feedback and a larger focus on psychoeducation.
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Affiliation(s)
- Markus Wiener
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Susanne A Bengesser
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Jolana Wagner-Skacel
- Department of Medical Psychology, Psychosomatics and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Fiona N A Haidacher
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | | | - Julian Wenninger
- Department of Medical and Chemical Laboratory Diagnostics, LKH Hochsteiermark, Leoben, Austria
| | - Karin Hasiba-Seebacher
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Frederike T Fellendorf
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Annamaria Painold
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Kathrin Kreuzer
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Mary Butler
- Department of Psychiatry and Clinical Neuroscience, University College Cork, Cork, Ireland
| | - Sonja Lackner
- Division of Immunology, Otto Loewi Research Center, Medical University of Graz, Graz, Austria
| | - René Pilz
- Department of Medical Psychology, Psychosomatics and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Sabrina Mörkl
- Department of Medical Psychology, Psychosomatics and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
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Őri D, Szocsics P, Molnár T, Motlova LB, Kazakova O, Mörkl S, Wallies M, Abdulhakim M, Boivin S, Bruna K, Cabaços C, Carbone EA, Dashi E, Grech G, Greguras S, Ivanovic I, Guevara K, Kakar S, Kotsis K, Ingeholm Klinkby IM, Maslak J, Matheiken S, Mirkovic A, Nechepurenko N, Panayi A, Pereira AT, Pomarol-Clotet E, Raaj S, Prelog PR, Soler-Vidal J, Strumila R, Schuster F, Kisand H, Reim A, Ahmadova G, Vircik M, Kafali HY, Grinko N, Győrffy Z, Rózsa S. Attitudes of psychiatrists towards people with mental illness: a cross-sectional, multicentre study of stigma in 32 European countries. EClinicalMedicine 2023; 66:102342. [PMID: 38149261 PMCID: PMC10749877 DOI: 10.1016/j.eclinm.2023.102342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 11/09/2023] [Accepted: 11/15/2023] [Indexed: 12/28/2023] Open
Abstract
Background Mental health-related stigma occurs among the public and professionals alike. The lived experience of mental illness has been linked to less stigmatising attitudes. However, data on psychiatrists and the relationship between stigmatising attitudes and psychotherapeutic activity or case discussion groups remains scarce. Methods A cross-sectional multicentre study was performed in 32 European countries to investigate the lived experiences and attitudes of psychiatrists toward patients with mental illness as well as the relationship between stigma, psychosocial and professional factors. The self-reported, anonymous, internet-based Opening Minds Stigma Scale for Health Care Providers was used to measure the stigmatising attitudes. The survey was translated into the local language of each participating country. All participants were practising specialists and trainees in general adult or child and adolescent psychiatry. The study took place between 2nd October, 2019 and 9th July, 2021 and was preregistered at ClinicalTrial.gov (NCT04644978). Findings A total of 4245 psychiatrists completed the survey. The majority, 2797 (66%), had completed training in psychiatry, and 3320 (78%) worked in adult psychiatry. The final regression model showed that across European countries more favourable attitudes toward people with mental illness were statistically significantly associated with the lived experience of participants (including seeking help for their own mental health conditions (d = -0.92, 95% confidence interval (CI) = -1.68 to -0.15, p = 0.019), receiving medical treatment for a mental illness (d = -0.88, 95% CI = -1.71 to -0.04, p = 0.040), as well as having a friend or a family member similarly affected (d = -0.68, 95% CI = -1.14 to -0.22, p = 0.004)), being surrounded by colleagues who are less stigmatising (d = -0.98, 95% CI = -1.26 to -0.70, p < 0.001), providing psychotherapy to patients (d = -1.14, 95% CI = -1.63 to -0.65 p < 0.001), and being open to (d = -1.69, 95% CI = -2.53 to -0.85, p < 0.001) and actively participating in (d = -0.94, 95% CI = -1.45 to -0.42, p < 0.001) case discussion, supervision, or Balint groups. Interpretation Our study highlights the importance of psychotherapy training, supervision, case discussions and Balint groups in reducing the stigmatising attitudes of psychiatrists toward patients. As the findings represent cross-national predictors, Europe-wide policy interventions, national psychiatric education systems and the management of psychiatric institutions should take these findings into consideration. Funding National Youth Talent Award (Ministry of Human Resources, Hungary, (NTP-NFTÖ-20-B-0134). All authors received no funding for their contribution.
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Affiliation(s)
- Dorottya Őri
- Institute of Behavioural Sciences, Semmelweis University, Budapest, Hungary
- Department of Mental Health, Heim Pál National Pediatric Institute, Budapest, Hungary
| | - Péter Szocsics
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
| | - Tamás Molnár
- Department of Psychiatry, Aladar Petz County Teaching Hospital, Győr, Hungary
| | - Lucie Bankovska Motlova
- Division of Medical Psychology, 3rd Faculty of Medicine, Charles University, Prague, The Czech Republic
| | - Olga Kazakova
- Inpatient Psychiatric Department #2, Psychiatric Clinic of Minsk City, Minsk, Belarus
| | - Sabrina Mörkl
- Division of Medical Psychology, Psychosomatics and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | | | | | - Sylvie Boivin
- Department of Child and Adolescent Psychiatry, EPSM du Finistère Sud, Quimper, France
| | - Krista Bruna
- Admission Ward, State Psychiatric Hospital Gintermuiza, Jelgava, Latvia
| | - Carolina Cabaços
- Psychiatry Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- Institute of Psychological Medicine, Faculty of Medicine, Coimbra University, Coimbra, Portugal
- Coimbra Institute for Biomedical Imaging and Translational Research, Coimbra, Portugal
| | - Elvira Anna Carbone
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Catanzaro, Italy
| | - Elona Dashi
- Department of Neuroscience, University Hospital Center “Mother Theresa”, Tirane, Albania
| | - Giovanni Grech
- Mental Health Services, Mount Carmel Hospital, Attard, Malta
| | - Stjepan Greguras
- Division of Child and Adolescent Psychiatry and Psychotherapy, Department of Psychiatry and Psychological Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Iva Ivanovic
- Department for Child Psychiatry, Institute for Children's Diseases, Clinical Centre of Montenegro, Podgorica, Montenegro
| | - Kaloyan Guevara
- Acute Detoxification Ward, State Psychiatric Hospital for Treatment of Drug Addiction and Alcoholism, Sofia, Bulgaria
| | - Selay Kakar
- Department of Psychiatry, Erasmus University Medical Center, Rotterdam, the Netherlands
| | | | | | | | | | - Ana Mirkovic
- Child Psychiatry Unit, University Children's Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Nikita Nechepurenko
- The Serbsky State Scientific Center for Social and Forensic Psychiatry, Moscow, Russian Federation
| | | | - Ana Telma Pereira
- Institute of Psychological Medicine, Faculty of Medicine, Coimbra University, Coimbra, Portugal
- Coimbra Institute for Biomedical Imaging and Translational Research, Coimbra, Portugal
| | - Edith Pomarol-Clotet
- FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain
- Centro de Investigacion Biomedica en Red de Salud Mental, Instituto de Salud Carlos III, Barcelona, Spain
| | - Shaeraine Raaj
- Department of General Adult Psychiatry, South Meath Mental Health Service, Co.Meath, Ireland
| | - Polona Rus Prelog
- Centre for Clinical Psychiatry, University Psychiatric Clinic Ljubljana, Ljubljana, Slovenia
| | - Joan Soler-Vidal
- FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain
- Centro de Investigacion Biomedica en Red de Salud Mental, Instituto de Salud Carlos III, Barcelona, Spain
- Hospital Benito Menni, Complex Assistencial Salut Mental, Sant Boi de Llobregat, Spain
| | - Robertas Strumila
- Department of Urgent and Post Urgent Psychiatry, CHU Montpellier, Montpellier, France
- Institute of Functional Genomics, University of Montpellier, CNRS, INSERM, Montpellier, France
- Psychiatric Clinic, Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania
| | - Florian Schuster
- Klinikum Rechts der Isar der Technischen Universität München: Klinik und Poliklinik für Psychiatrie und Psychotherapie, Technische Universität München, Munich, Germany
| | | | - Ann Reim
- University of Tartu, Tartu, Estonia
| | - Gumru Ahmadova
- Department of Psychiatry, United City Hospital N15, Baku, Azerbaijan
| | - Matus Vircik
- Acute Psychiatric Department 1, Psychiatric Hospital Michalovce, Michalovce, Slovak Republic
| | - Helin Yilmaz Kafali
- Department of Psychology, Fevziye School Fundatitions, Işık University, Istanbul, Turkey
| | - Natalia Grinko
- Department of Clinical Psychology, Ukrainian Catholic University, Lviv, Ukraine
| | - Zsuzsa Győrffy
- Institute of Behavioural Sciences, Semmelweis University, Budapest, Hungary
| | - Sándor Rózsa
- Department of Personality and Health Psychology, Károli Gáspár University of the Reformed Church, Budapest, Hungary
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6
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Pahsini K, Marinschek S, Reininghaus EZ, Dalkner N, Bengesser SA, Mörkl S, Russell M, Russell AN, Scheer PJ, Dunitz-Scheer M. The Association of Tube Weaning and Oral Skill Development in Infants With Tube Dependency: A Prospective Study. J Pediatr Gastroenterol Nutr 2023; 77:e54-e60. [PMID: 37307357 DOI: 10.1097/mpg.0000000000003856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE This study was the first of its kind by assessing oral skills development during and after applying the "Graz Model" of tube weaning. METHODS This prospective case series study included data of 67 (35 females, 32 males, treated from March 2018 to April 2019) tube dependent children, who participated in the effective "Graz Model" of tube weaning. Parents filled out the standardized Pediatric Assessment Scale for Severe Feeding Problems (PASSFP) prior to and immediately after completion of the program. Paired sample t tests were conducted to examine pre-to-post changes in the children's oral skills. RESULTS The study showed that oral skills increased significantly during tube weaning PASSFP score of 24.76 (standard deviation, SD = 12.38) prior to versus 47.97 (SD = 6.98) after completion of the program. Furthermore, significant changes in their sensory and tactile perception and in their general eating behavior were observed. Children also showed reduced oral aversion symptoms and food pocketing, could enjoy their meals, and increased their food repertoire. Mealtime duration could be decreased, and parents were less anxious about their infants' intake and less frustrated because of their children's eating behavior. CONCLUSION The results of this study demonstrated for the first time that tube dependent children can improve their oral skills significantly during and after their participation in the child-led approach of the "Graz model" of tube weaning.
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Affiliation(s)
- Karoline Pahsini
- From the Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Sabine Marinschek
- From the Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Eva Z Reininghaus
- From the Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Nina Dalkner
- From the Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Susanne A Bengesser
- From the Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Sabrina Mörkl
- From the Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Marion Russell
- the Department of Occupational Therapy, Creighton University, Omaha, NE
| | | | - Peter J Scheer
- the Department of Pediatric and Adolescent Medicine, Division of General Pediatrics, Medical University of Graz, Graz, Austria
| | - Marguerite Dunitz-Scheer
- the Department of Pediatric and Adolescent Medicine, Division of General Pediatrics, Medical University of Graz, Graz, Austria
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7
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Mairinger M, Maget A, Wagner-Skacel J, Mörkl S, Dalkner N, Hellinger T, Birner A, Fellendorf FT, Platzer M, Kreuzer K, Queissner R, Reininghaus B, Lenger M, Fabisch K, Fitz W, Kohlhammer-Dohr A, Krammer A, Holl AK, Painold A, Häussl A, Stross TM, Schmiedhofer F, Tmava-Berisha A, Pahsini K, Marinschek S, Wenninger J, Hamm C, Pilz R, Lehofer M, Amouzadeh-Ghadikolai O, Horvath A, Kainz G, Gallé B, Dinan TG, Butler MI, Reininghaus E, Bengesser S. Gut Microbiome Composition and Its Association with Sleep in Major Psychiatric Disorders. Neuropsychobiology 2023; 82:220-233. [PMID: 37321188 DOI: 10.1159/000530386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 03/14/2023] [Indexed: 06/17/2023]
Abstract
INTRODUCTION Sleep disturbances are highly prevalent across most major psychiatric disorders. Alterations in the hypothalamic-pituitary-adrenal axis, neuroimmune mechanisms, and circadian rhythm disturbances partially explain this connection. The gut microbiome is also suspected to play a role in sleep regulation, and recent studies suggest that certain probiotics, prebiotics, synbiotics, and fecal microbiome transplantation can improve sleep quality. METHODS We aimed to assess the relationship between gut-microbiota composition, psychiatric disorders, and sleep quality in this cross-sectional, cross-disorder study. We recruited 103 participants, 63 patients with psychiatric disorders (major depressive disorder [n = 31], bipolar disorder [n = 13], psychotic disorder [n = 19]) along with 40 healthy controls. Sleep quality was assessed with the Pittsburgh Sleep Quality Index (PSQI). The fecal microbiome was analyzed using 16S rRNA sequencing, and groups were compared based on alpha and beta diversity metrics, as well as differentially abundant species and genera. RESULTS A transdiagnostic decrease in alpha diversity and differences in beta diversity indices were observed in psychiatric patients, compared to controls. Correlation analysis of diversity metrics and PSQI score showed no significance in the patient and control groups. However, three species, Ellagibacter isourolithinifaciens, Senegalimassilia faecalis, and uncultured Blautia sp., and two genera, Senegalimassilia and uncultured Muribaculaceae genus, were differentially abundant in psychiatric patients with good sleep quality (PSQI >8), compared to poor-sleep quality patients (PSQI ≤8). CONCLUSION In conclusion, this study raises important questions about the interconnection of the gut microbiome and sleep disturbances.
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Affiliation(s)
- Marco Mairinger
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria,
| | - Alexander Maget
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Jolana Wagner-Skacel
- Department of Medical Psychology, Psychosomatics and Psychotherapy, Medical University of Graz, Graz, Austria
| | - Sabrina Mörkl
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Nina Dalkner
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Teresa Hellinger
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Armin Birner
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Frederike T Fellendorf
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Martina Platzer
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Kathrin Kreuzer
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Robert Queissner
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Bernd Reininghaus
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Melanie Lenger
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Karin Fabisch
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Werner Fitz
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | | | - Alexandra Krammer
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Anna Katharina Holl
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Annamaria Painold
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Alfred Häussl
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Tatjana Maria Stross
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Franziska Schmiedhofer
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Adelina Tmava-Berisha
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Karoline Pahsini
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Sabine Marinschek
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Julian Wenninger
- Department of Psychiatry, Psychiatric Hospital LKH Graz 2, Graz, Austria
| | - Carlo Hamm
- Department of Psychiatry, Psychiatric Hospital LKH Graz 2, Graz, Austria
| | - René Pilz
- Department of Psychiatry, Psychiatric Hospital LKH Graz 2, Graz, Austria
| | - Michael Lehofer
- Department of Psychiatry, Psychiatric Hospital LKH Graz 2, Graz, Austria
| | | | - Angela Horvath
- Center for Biomarker Research in Medicine, Graz, Austria
- Department of Gastroenterology and Hepatology, Medical University of Graz, Graz, Austria
| | - Gudrun Kainz
- Center for Medical Research, Medical University of Graz, Graz, Austria
| | - Birgit Gallé
- Center for Medical Research, Medical University of Graz, Graz, Austria
| | - Timothy G Dinan
- Department of Psychiatry and Neurobehavioral Science, University College Cork, Cork, Ireland
| | - Mary I Butler
- Department of Psychiatry and Neurobehavioral Science, University College Cork, Cork, Ireland
| | - Eva Reininghaus
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Susanne Bengesser
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
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Tatzber F, Wonisch W, Resch U, Strohmaier W, Lindschinger M, Mörkl S, Cvirn G. Thinking beyond Vaccination: Promising Add-On Strategies to Active Immunization and Vaccination in Pandemics-A Mini-Review. Viruses 2023; 15:1372. [PMID: 37376671 DOI: 10.3390/v15061372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 06/06/2023] [Accepted: 06/12/2023] [Indexed: 06/29/2023] Open
Abstract
There is little doubt that final victories over pandemics, such as COVID-19, are attributed to herd immunity, either through post-disease convalescence or active immunization of a high percentage of the world's population with vaccines, which demonstrate protection from infection and transmission and are available in large quantities at reasonable prices. However, it is assumable that humans with immune defects or immune suppression, e.g., as a consequence of allograft transplantation, cannot be immunized actively nor produce sufficient immune responses to prevent SARS-CoV-2 infections. These subjects desperately need other strategies, such as sophisticated protection measures and passive immunization. Hypertonic salt solutions attack vulnerable core areas of viruses; i.e., salt denatures surface proteins and thus prohibits virus penetration of somatic cells. It has to be ensured that somatic proteins are not affected by denaturation regarding this unspecific virus protection. Impregnating filtering facepieces with hypertonic salt solutions is a straightforward way to inactivate viruses and other potential pathogens. As a result of the contact of salt crystals on the filtering facepiece, these pathogens become denatured and inactivated almost quantitatively. Such a strategy could be easily applied to fight against the COVID-19 pandemic and other ones that may occur in the future. Another possible tool to fight the COVID-19 pandemic is passive immunization with antibodies against SARS-CoV-2, preferably from human origin. Such antibodies can be harvested from human patients' sera who have successfully survived their SARS-CoV-2 infection. The disadvantage of a rapid decrease in the immunoglobulin titer after the infection ends can be overcome by immortalizing antibody-producing B cells via fusion with, e.g., mouse myeloma cells. The resulting monoclonal antibodies are then of human origin and available in, at least theoretically, unlimited amounts. Finally, dry blood spots are a valuable tool for surveilling a population's immunity. The add-on strategies were selected as examples for immediate, medium and long-term assistance and therefore did not raise any claim to completeness.
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Affiliation(s)
- Franz Tatzber
- Omnignostica Ltd., 3421 Höflein an der Danube, Austria
| | | | - Ulrike Resch
- Department of Vascular Biology and Thrombosis Research, Medical University of Vienna, 1090 Vienna, Austria
| | | | - Meinrad Lindschinger
- Outpatient Clinic Laßnitzhöhe, Institute of Nutritional and Metabolic Diseases, 8301 Laßnitzhöhe, Austria
| | - Sabrina Mörkl
- Division of Medical Psychology, Psychosomatics and Psychotherapeutic Medicine, Medical University of Graz, 8036 Graz, Austria
| | - Gerhard Cvirn
- Otto Loewi Research Center, Division of Physiological Chemistry, Medical University of Graz, 8010 Graz, Austria
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Őri D, Szocsics P, Molnár T, Bankovska Motlova L, Kazakova O, Mörkl S, Wallies M, Abdulhakim M, Boivin S, Bruna K, Cabacos C, Carbone EA, Dashi E, Grech G, Greguras S, Ivanovic I, Guevara K, Kakar S, Kotsis K, Klinkby IMI, Maslak J, Matheiken S, Mirkovic A, Nechepurenko N, Panayi A, Pereira AT, Pomarol-Clotet E, Raaj S, Rus Prelog P, Soler-Vidal J, Strumila R, Schuster F, Kisand H, Hargi A, Ahmadova G, Vircik M, Yilmaz Kafali H, Grinko N, Győrffy Z, Rózsa S. Psychometric properties of the Opening Minds Stigma Scale for Health Care Providers in 32 European countries - A bifactor ESEM representation. Front Public Health 2023; 11:1168929. [PMID: 37361150 PMCID: PMC10285467 DOI: 10.3389/fpubh.2023.1168929] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 03/17/2023] [Indexed: 06/28/2023] Open
Abstract
Aims To measure the stigma of healthcare providers toward people suffering from mental illness, the Opening Minds Stigma Scale for Health Care Providers (OMS-HC) is a commonly applied instrument. However, this scale has not been thoroughly validated in many European countries, its psychometric properties are still unknown and data on practicing psychiatrists is lacking. Therefore, this multicenter study aimed to assess the psychometric characteristics of the 15-item OMS-HC in trainees and specialists in adult and child psychiatry in 32 countries across Europe. Materials and methods The OMS-HC was conducted as an anonymous online survey and sent via Email to European adult and child psychiatrists. Parallel analysis was used to estimate the number of OMS-HC dimensions. Separate for each country, the bifactor ESEM, a bifactor exploratory structural equation modeling approach, was applied to investigate the factor structure of the scale. Cross-cultural validation was done based on multigroup confirmatory factor analyses and reliability measures. Results A total of 4,245 practitioners were included, 2,826 (67%) female, 1,389 (33%) male. The majority (66%) of participants were specialists, with 78% working in adult psychiatry. When country data were analyzed separately, the bifactor model (higher-order factor solution with a general factor and three specific factors) showed the best model fit (for the total sample χ2/df = 9.760, RMSEA = 0.045 (0.042-0.049), CFI = 0.981; TLI = 0.960, WRMR = 1.200). The average proportion of variance explained by the general factor was high (ECV = 0.682). This suggests that the aspects of 'attitude,' 'disclosure and help-seeking,' and 'social distance' could be treated as a single dimension of stigma. Among the specific factors, the 'disclosure and help-seeking' factor explained a considerable unique proportion of variance in the observed scores. Conclusion This international study has led to cross-cultural analysis of the OMS-HC on a large sample of practicing psychiatrists. The bifactor structure displayed the best overall model fit in each country. Rather than using the subscales, we recommend the total score to quantify the overall stigmatizing attitudes. Further studies are required to strengthen our findings in countries where the proposed model was found to be weak.
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Affiliation(s)
- Dorottya Őri
- Institute of Behavioural Sciences, Semmelweis University, Budapest, Hungary
- Department of Mental Health, Heim Pál National Pediatric Institute, Budapest, Hungary
- Department of Psychology, Illinois Institute of Technology, Chicago, IL, United States
| | - Péter Szocsics
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
| | - Tamás Molnár
- Department of Psychiatry, Aladar Petz County Teaching Hospital, Győr, Hungary
| | - Lucie Bankovska Motlova
- Division of Medical Psychology, 3rd Faculty of Medicine, Charles University, Prague, Czechia
| | - Olga Kazakova
- Inpatient Psychiatric Department #2, Psychiatric Clinic of Minsk City, Minsk, Belarus
| | - Sabrina Mörkl
- Division of Medical Psychology, Psychosomatics and Psychotherapy, Medical University of Graz, Graz, Austria
| | | | | | - Sylvie Boivin
- Department of Child and Adolescent Psychiatry, EPSM du Finistère Sud, Quimper, France
| | - Krista Bruna
- Admission Ward, State Psychiatric Hospital Gintermuiza, Jelgava, Latvia
| | - Carolina Cabacos
- Psychiatry Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Elvira Anna Carbone
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Catanzaro, Italy
| | - Elona Dashi
- Department of Neuroscience, University Hospital Center “Mother Theresa”, Tirana, Albania
| | - Giovanni Grech
- Mental Health Services, Mount Carmel Hospital, Attard, Malta
| | - Stjepan Greguras
- Department of Psychiatry and Psychological Medicine, Division of Child and Adolescent Psychiatry and Psychotherapy, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Iva Ivanovic
- Department for Child Psychiatry, Clinical Centre of Montenegro, Institute for Children’s Diseases, Podgorica, Montenegro
| | - Kaloyan Guevara
- Acute Detoxification Ward, State Psychiatric Hospital for Treatment of Drug Addiction and Alcoholism, Sofia, Bulgaria
| | - Selay Kakar
- Department of Psychiatry, Erasmus University Medical Center, Rotterdam, Netherlands
| | | | | | | | | | - Ana Mirkovic
- Child Psychiatry Unit, University Children's Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Nikita Nechepurenko
- The Serbsky State Scientific Center for Social and Forensic Psychiatry, Moscow, Russia
| | | | - Ana Telma Pereira
- Institute of Psychological Medicine, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Coimbra Institute for Biomedical Imaging and Translational Research, Coimbra, Portugal
| | - Edith Pomarol-Clotet
- FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain
- Centro de Investigacion Biomedica en Red de Salud Mental, Instituto de Salud Carlos III, Barcelona, Spain
| | - Shaeraine Raaj
- Department of General Adult Psychiatry, South Meath Mental Health Service, Meath, Ireland
| | - Polona Rus Prelog
- Centre for Clinical Psychiatry, University Psychiatric Clinic Ljubljana, Ljubljana, Slovenia
| | - Joan Soler-Vidal
- FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain
- Centro de Investigacion Biomedica en Red de Salud Mental, Instituto de Salud Carlos III, Barcelona, Spain
- Hospital Benito Menni, Complex Assistencial Salut Mental, Sant Boi de Llobregat, Spain
| | - Robertas Strumila
- Department of Urgent and Post Urgent Psychiatry, CHU Montpellier, Montpellier, France
- Institute of Functional Genomics, University of Montpellier, CNRS, INSERM, Montpellier, France
- Psychiatric Clinic, Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania
| | - Florian Schuster
- Klinikum rechts der Isar der Technischen Universität München: Klinik und Poliklinik für Psychiatrie und Psychotherapie, Technische Universität München, Munich, Germany
| | | | | | - Gumru Ahmadova
- Department of Psychiatry, United City Hospital N15, Baku, Azerbaijan
| | - Matus Vircik
- Acute Psychiatric Department 1, Psychiatric Hospital Michalovce, Michalovce, Slovakia
| | - Helin Yilmaz Kafali
- Child and Adolescent Psychiatry, Sultanbeyli State Hospital, Istanbul, Türkiye
| | - Natalia Grinko
- Department of Clinical Psychology, Ukrainian Catholic University, Lviv, Ukraine
| | - Zsuzsa Győrffy
- Institute of Behavioural Sciences, Semmelweis University, Budapest, Hungary
| | - Sandor Rózsa
- Department of Personality and Health Psychology, Károli Gáspár University of the Reformed Church, Budapest, Hungary
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Mörkl S, Oberascher A, Tatschl JM, Lackner S, Bastiaanssen TF, Butler MI, Moser M, Frühwirth M, Mangge H, Cryan JF, Dinan TG, Holasek SJ. The microbe-heart-brain dialogue: Vagal activity is associated with gut-microbiome patterns in women. Journal of Affective Disorders Reports 2023. [DOI: 10.1016/j.jadr.2023.100553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
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11
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Lackner S, Mörkl S, Winkler A, Toplak H, Roller-Wirnsberger R, Holasek S. Implementation Of Nutrition Education In The Medical School Of Graz, Austria. Self-Perception Of Clinical Nutrition Knowledge Among Medical Students - Preliminary Result. Clin Nutr ESPEN 2023. [DOI: 10.1016/j.clnesp.2022.09.237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2023]
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Medved S, Žaja N, Gazdag G, Lengvenyte A, Mörkl S, Mucci F, Ristić I, Jerotić S, Regente JF, Ivanović I, Purišić A, Sasvary F, Sivasanker V, Ziblak A, Lookene M, Sienaert P, Szczegielniak A, Trančik P, Bećirović E, Koutsomitros T, Grech G, Tapoi C, Radmanović B, Ströhle A, Bajs Janović M, Sartorius N. Preliminary Assessment of Pre-Electroconvulsive Therapy Evaluation Practices in European Countries: The Need for Guidelines. J ECT 2022; 38:230-237. [PMID: 35462388 DOI: 10.1097/yct.0000000000000854] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Pre-electroconvulsive therapy (ECT) evaluation is an essential part of ECT preparation, a standard treatment in the psychiatric field. However, no routine pre-ECT evaluation has been published so far. This preliminary study aimed to explore different practices in pre-ECT evaluation across European countries. METHODS The data were collected as a snowball sample approach using an online survey from September 2019 to April 2020. The final analysis included data from 18 clinics placed in 16 European countries. RESULTS Regulations on the pre-ECT evaluation were found in 9 countries. All clinics reported doing complete blood count, serum electrolytes, and renal function analysis as a part of regular laboratory testing, alongside with a cardiovascular assessment. Ten clinics reported using psychiatric scales. Six clinics reported doing a cognitive assessment, of which all had regulations on the pre-ECT evaluation. Not one evaluation had the same sets of procedures and diagnostics. CONCLUSIONS The differences in assessment approaches mirror high variability of the pre-ECT evaluation practice across Europe. Cognitive assessment and objectification of psychiatric symptoms should be a regular part of the pre-ECT evaluation because of the monitoring of the most common adverse effect and observing the clinical response to ECT. Standardization of the pre-ECT evaluation and ECT in general would remove criticisms and opposition to the treatment, make it based on the best of our knowledge, and provide a method respectful of patients' best interests and rights.
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Affiliation(s)
- Sara Medved
- From the Department of Psychiatry and Psychological Medicine, University Hospital Centre Zagreb
| | - Nikola Žaja
- University Psychiatric Hospital Vrapče, Zagreb, Croatia
| | - Gabor Gazdag
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
| | | | - Sabrina Mörkl
- Department for Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Federico Mucci
- Department of Mental Health, North-Western Tuscany Local Health Unit, Tuscany NHS, Cecina, Italy
| | | | - Stefan Jerotić
- Clinic for Psychiatry, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Johannes Frederik Regente
- Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin (Campus Charité Mitte), Berlin, Germany
| | - Iva Ivanović
- Department for Child Psychiatry, Clinical Centre of Montenegro, Institute for Children's Diseases
| | - Anela Purišić
- Department for Adult Psychiatry, Clinical Centre of Montenegro, Podgorica, Montenegro
| | - Ferdinand Sasvary
- Department of Psychiatry, Faculty of Medicine Comenius University and University Hospital Bratislava, Bratislava, Slovakia
| | - Vimal Sivasanker
- ECT Service, Hertfordshire Partnership University NHS Foundation Trust, Kingfisher Court, Radlett, United Kingdom
| | - Alper Ziblak
- Department of Psychiatry, Denizli State Hospital, Denizli, Turkey
| | - Margus Lookene
- Psychiatry Clinic, The North Estonia Medical Centre, Tallinn, Estonia
| | - Pascal Sienaert
- KU Leuven, Department of Neurosciences, Research Group Psychiatry, Neuropsychiatry, Academic Center for ECT and Neuromodulation (AcCENT), University Psychiatric Center KU Leuven (UPC KU Leuven), Kortenberg, Belgium
| | - Anna Szczegielniak
- Department of Psychoprophylaxis, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Pavel Trančik
- Psychiatric Hospital Bohnice, Prague, Czech Republic
| | - Elvir Bećirović
- Clinic of Psychiatry, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina
| | | | | | - Cristiana Tapoi
- Prof. Dr. Alexandru Obregia Clinical Psychiatry Hospital, Bucharest, Romania
| | - Branimir Radmanović
- Department of Psychiatry, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Andreas Ströhle
- Clinic for Psychiatry, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Maja Bajs Janović
- From the Department of Psychiatry and Psychological Medicine, University Hospital Centre Zagreb
| | - Norman Sartorius
- Association for the Improvement of Mental Health Programmes, Geneva, Switzerland
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Mörkl S, Oberascher A, Tatschl JM, Lackner S, Bastiaanssen TFS, Butler MI, Moser M, Frühwirth M, Mangge H, Cryan JF, Dinan TG, Holasek SJ. Cardiac vagal activity is associated with gut-microbiome patterns in women-An exploratory pilot study. Dialogues Clin Neurosci 2022; 24:1-9. [PMID: 36246995 PMCID: PMC9559470 DOI: 10.1080/19585969.2022.2128697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Introduction A functional reciprocity between the gut microbiome and vagal nerve activity has been suggested, however, human studies addressing this phenomenon are limited. Methods Twenty-four-hour cardiac vagal activity (CVA) was assessed from 73 female participants (aged 24.5 ± 4.3 years). Additionally, stool samples were subjected to 16SrRNA gene analysis (V1–V2). Quantitative Insights Into Microbial Ecology (QIIME) was used to analyse microbiome data. Additionally, inflammatory parameters (such as CRP and IL-6) were derived from serum samples. Results Daytime CVA correlated significantly with gut microbiota diversity (rsp = 0.254, p = 0.030), CRP (rsp = −0.348, p = 0.003), and IL-6 (rsp = −0.320, p = 0.006). When the group was divided at the median of 24 h CVA (Mdn = 1.322), the following features were more abundant in the high CVA group: Clostridia (Linear discriminant analysis effect size (LDA) = 4.195, p = 0.029), Clostridiales (LDA = 4.195, p = 0.029), Lachnospira (LDA = 3.489, p = 0.004), Ruminococcaceae (LDA = 4.073, p = 0.010), Faecalibacterium (LDA = 3.982, p = 0.042), Lactobacillales (LDA = 3.317, p = 0.029), Bacilli (LDA = 3.294, p = 0.0350), Streptococcaceae (LDA = 3.353, p = 0.006), Streptococcus (LDA = 3.332, p = 0.011). Based on Dirichlet multinomial mixtures two enterotypes could be detected, which differed significantly in CVA, age, BMI, CRP, IL-6, and diversity. Conclusions As an indicator of gut-brain communication, gut microbiome analysis could be extended by measurements of CVA to enhance our understanding of signalling via microbiota-gut-brain-axis and its alterations through psychobiotics.
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Affiliation(s)
- Sabrina Mörkl
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria,CONTACT Sabrina Mörkl Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Auenbruggerplatz 31/1, Graz, 8036, Austria
| | - Andreas Oberascher
- Department of Psychiatry, Psychotherapy and Psychosomatics, Paracelsus Medical University of Salzburg, Salzburg, Austria,Division of Physiology, Otto Loewi Research Center (for Vascular Biology, Immunology and Inflammation), Medical University of Graz, Graz, Austria
| | | | - Sonja Lackner
- Division of Immunology and Pathophysiology, Otto Loewi Research Center (for Vascular Biology, Immunology and Inflammation), Medical University of Graz, Graz, Austria
| | | | - Mary I. Butler
- APC Microbiome Ireland, University College Cork, Cork, Ireland,Department of Psychiatry and Clinical Neuroscience, University College Cork, Cork, Ireland
| | - Maximilian Moser
- Division of Physiology, Otto Loewi Research Center (for Vascular Biology, Immunology and Inflammation), Medical University of Graz, Graz, Austria,Human Research Institute of Health Technology and Prevention Research, Weiz, Austria
| | - Matthias Frühwirth
- Human Research Institute of Health Technology and Prevention Research, Weiz, Austria
| | - Harald Mangge
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
| | - John F. Cryan
- APC Microbiome Ireland, University College Cork, Cork, Ireland
| | - Timothy G. Dinan
- APC Microbiome Ireland, University College Cork, Cork, Ireland,Department of Psychiatry and Clinical Neuroscience, University College Cork, Cork, Ireland
| | - Sandra J. Holasek
- Division of Immunology and Pathophysiology, Otto Loewi Research Center (for Vascular Biology, Immunology and Inflammation), Medical University of Graz, Graz, Austria
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Ori D, Szocsics P, Molnar T, Rozsa S, Wallies M, Kazakova O, Bankovska-Motlova L, Boivin S, Raaj S, Overgaard Ingeholm Klinkby I, Cabacos C, Pereira A, Matheiken S, Kakar S, Greguras S, Maslak J, Nechepurenko N, Kotsis K, Yilmaz Kafali H, Mirkovic A, Rus Prelog P, Bruna K, Guevara K, Strumila R, Mörkl S, Abdulhakim M, Carbone E, Panayi A, Ivanović I, Dashi E, Grech G, Vircik M, Schuster F, Soler-Vidal J, Pomarol-Clotet E, Ahmadova G, Hargi A, Kisand H, Grinko N, Gyorffy Z. Cross-cultural analysis of the stigmatising attitudes of psychiatrists across Europe and measurement invariance of the Opening Minds Stigma Scale for healthcare providers. Eur Psychiatry 2022. [PMCID: PMC9565287 DOI: 10.1192/j.eurpsy.2022.539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Since the literature investigating the stigmatising attitudes of psychiatrists is scarce, this is the first study which examines the phenomena across Europe. The Opening Minds Stigma Scale for Health Care Providers (OMS-HC) is a widely used questionnaire to measure stigma in healthcare providers towards people with mental illness, although it has not been validated in many European countries. Objectives A cross-sectional, observational, multi-centre study was conducted in 32 European countries to investigate the attitudes towards patients among specialists and trainees in general adult and child psychiatry. In order to be able to compare stigma scores across cultures, we aimed to calculate measurement invariance. Methods An internet-based, anonymous survey was distributed in the participating countries, which was completed by n=4245 psychiatrists. The factor structure of the scale was investigated by using separate confirmatory factor analyses for each country. The cross-cultural validation was based on multigroup confirmatory factor analyses. Results When country data were analysed separately, the three dimensions of the OMS-HC were confirmed, and the bifactor model showed the best model fit. However, in some countries, a few items were found to be weak. The attitudes towards patients seemed favourable since stigma scores were less than half of the reachable maximum. Results allowed comparison to be made between stigma scores in different countries and subgroups. Conclusions This international cooperation has led to the cross-cultural validation of the OMS-HC on a large sample of practicing psychiatrists. The results will be useful in the evaluation of future anti-stigma interventions and will contribute to the knowledge of stigma. Disclosure No significant relationships.
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Wagner-Skacel J, Haidacher F, Wiener M, Pahsini K, Marinschek S, Lahousen T, Wonisch W, Bengesser S, Butler MI, Lackner S, Meinitzer A, Enko D, Mörkl S. Oxidative Status in Adult Anorexia Nervosa Patients and Healthy Controls—Results from a Cross-Sectional Pilot Study. Antioxidants (Basel) 2022; 11:antiox11050842. [PMID: 35624706 PMCID: PMC9137881 DOI: 10.3390/antiox11050842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 04/21/2022] [Accepted: 04/22/2022] [Indexed: 11/17/2022] Open
Abstract
Oxidative stress describes an imbalance of reactive oxygen species (ROS) and antioxidative defence systems. Recently, the consequences of oxidative stress have become a central field of research and have been linked to the genesis of multiple psychiatric diseases. Some oxidative stress parameters have not been investigated before in anorexia nervosa (AN) patients, including the gut microbiota-derived metabolite trimethylamine N-oxide (TMAO) and polyphenols (PPm). In this cross-sectional pilot study, we evaluated these markers together with total peroxides (TOC), antioxidative capacity (TAC), endogenous peroxidase activity (EPA) and antibodies against oxidized LDL (oLAb) in serum samples of 20 patients with AN compared to 20 healthy controls. The antioxidative capacity was significantly decreased in AN patients, with a mean TAC of 1.57 mmol/L (SD: ±0.62); t (34) = −2.181, p = 0.036) compared to HC (mean = 1.91 mmol/L (SD: ±0.56), while the other investigated parameters were not significantly different between the two groups. In AN patients, TAC correlated with EPA (rsp = −0.630, p = 0.009). This study suggests that there is an antioxidative deficiency in AN patients. In this respect, there is a demand for interventional studies to determine whether antioxidants can be used as add-on therapy in the treatment of AN.
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Affiliation(s)
- Jolana Wagner-Skacel
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, 8036 Graz, Austria; (J.W.-S.); (F.H.); (M.W.); (K.P.); (S.M.); (T.L.); (S.B.)
- Department of Medical Psychology and Psychotherapy, Medical University of Graz, 8036 Graz, Austria
| | - Fiona Haidacher
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, 8036 Graz, Austria; (J.W.-S.); (F.H.); (M.W.); (K.P.); (S.M.); (T.L.); (S.B.)
| | - Markus Wiener
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, 8036 Graz, Austria; (J.W.-S.); (F.H.); (M.W.); (K.P.); (S.M.); (T.L.); (S.B.)
| | - Karoline Pahsini
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, 8036 Graz, Austria; (J.W.-S.); (F.H.); (M.W.); (K.P.); (S.M.); (T.L.); (S.B.)
| | - Sabine Marinschek
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, 8036 Graz, Austria; (J.W.-S.); (F.H.); (M.W.); (K.P.); (S.M.); (T.L.); (S.B.)
| | - Theresa Lahousen
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, 8036 Graz, Austria; (J.W.-S.); (F.H.); (M.W.); (K.P.); (S.M.); (T.L.); (S.B.)
| | - Willibald Wonisch
- Division of Physiological Chemistry, Medical University of Graz, 8036 Graz, Austria;
| | - Susanne Bengesser
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, 8036 Graz, Austria; (J.W.-S.); (F.H.); (M.W.); (K.P.); (S.M.); (T.L.); (S.B.)
| | - Mary I. Butler
- Department of Psychiatry and Neurobehavioral Science, University College Cork, T12 YT20 Cork, Ireland;
| | - Sonja Lackner
- Division of Immunology and Pathophysiology, Otto Loewi Research Center, Medical University of Graz, 8036 Graz, Austria;
| | - Andreas Meinitzer
- Division of Medical and Clinical Laboratory Diagnostics, Medical University Graz, 8036 Graz, Austria; (A.M.); (D.E.)
| | - Dietmar Enko
- Division of Medical and Clinical Laboratory Diagnostics, Medical University Graz, 8036 Graz, Austria; (A.M.); (D.E.)
| | - Sabrina Mörkl
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, 8036 Graz, Austria; (J.W.-S.); (F.H.); (M.W.); (K.P.); (S.M.); (T.L.); (S.B.)
- Department of Psychiatry and Neurobehavioral Science, University College Cork, T12 YT20 Cork, Ireland;
- Correspondence: ; Tel.: +43-316-385-81743
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Stadler JT, Lackner S, Mörkl S, Meier-Allard N, Scharnagl H, Rani A, Mangge H, Zelzer S, Holasek SJ, Marsche G. Anorexia Nervosa Is Associated with a Shift to Pro-Atherogenic Low-Density Lipoprotein Subclasses. Biomedicines 2022; 10:biomedicines10040895. [PMID: 35453644 PMCID: PMC9030549 DOI: 10.3390/biomedicines10040895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 04/08/2022] [Accepted: 04/11/2022] [Indexed: 02/06/2023] Open
Abstract
Anorexia nervosa (AN) is a severe eating disorder affecting primarily female adolescents and younger adults. The energy deprivation associated with AN has been shown to alter lipoprotein metabolism, which may affect cardiovascular risk. However, the mechanisms leading to alterations in the composition, structure, and function of lipoproteins in AN patients are not well-understood yet. Here, we investigated the lipid abnormalities associated with AN, particularly changes in the distribution, composition, metabolism, and function of lipoprotein subclasses. In this exploratory study, we analyzed serum samples of 18 women diagnosed with AN (BMI < 17.5 kg/m2) and 24 normal-weight women (BMI from 18.5−24.9 kg/m2). Using the Quantimetrix Lipoprint® system, we determined low-density lipoprotein (LDL) subclass distribution, including quantitative measurements of very low-density lipoprotein (VLDL), intermediate density lipoprotein (IDL) and high-density lipoprotein (HDL) subclass distribution. We quantified the most abundant apolipoproteins of HDL and assessed lecithin-cholesterol acyltransferase (LCAT) and cholesteryl-ester transfer protein (CETP) activities. In addition, anti-oxidative capacity of apoB-depleted serum and functional metrics of HDL, including cholesterol efflux capacity and paraoxonase activity were assessed. The atherogenic lipoprotein subclasses VLDL and small LDL particles were increased in AN. Levels of VLDL correlated significantly with CETP activity (rs = 0.432, p = 0.005). AN was accompanied by changes in the content of HDL-associated apolipoproteins involved in triglyceride catabolism, such as apolipoprotein C-II (+24%) and apoA-II (−27%), whereas HDL-associated cholesterol, phospholipids, and triglycerides were not altered. Moreover, AN did not affect HDL subclass distribution, cholesterol efflux capacity, and paraoxonase activity. We observed a shift to more atherogenic lipoprotein subclasses in AN patients, whereas HDL functionality and subclass distribution were not altered. This finding underpins potential detrimental effects of AN on lipid metabolism and the cardiovascular system by increasing atherosclerotic risk factors.
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Affiliation(s)
- Julia T. Stadler
- Division of Pharmacology, Otto Loewi Research Center for Vascular Biology, Immunology and Inflammation, Medical University of Graz, Universitätsplatz 4, 8010 Graz, Austria; (J.T.S.); (A.R.)
| | - Sonja Lackner
- Division of Immunology, Otto Loewi Research Center, Medical University of Graz, Heinrichstraße 31a, 8010 Graz, Austria; (S.L.); (N.M.-A.)
| | - Sabrina Mörkl
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Auenbruggerplatz 31, 8036 Graz, Austria;
| | - Nathalie Meier-Allard
- Division of Immunology, Otto Loewi Research Center, Medical University of Graz, Heinrichstraße 31a, 8010 Graz, Austria; (S.L.); (N.M.-A.)
| | - Hubert Scharnagl
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria; (H.S.); (H.M.); (S.Z.)
| | - Alankrita Rani
- Division of Pharmacology, Otto Loewi Research Center for Vascular Biology, Immunology and Inflammation, Medical University of Graz, Universitätsplatz 4, 8010 Graz, Austria; (J.T.S.); (A.R.)
| | - Harald Mangge
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria; (H.S.); (H.M.); (S.Z.)
| | - Sieglinde Zelzer
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria; (H.S.); (H.M.); (S.Z.)
| | - Sandra J. Holasek
- Division of Immunology, Otto Loewi Research Center, Medical University of Graz, Heinrichstraße 31a, 8010 Graz, Austria; (S.L.); (N.M.-A.)
- Correspondence: (S.J.H.); (G.M.); Tel.: +43-316-385-74128 (G.M.)
| | - Gunther Marsche
- Division of Pharmacology, Otto Loewi Research Center for Vascular Biology, Immunology and Inflammation, Medical University of Graz, Universitätsplatz 4, 8010 Graz, Austria; (J.T.S.); (A.R.)
- Correspondence: (S.J.H.); (G.M.); Tel.: +43-316-385-74128 (G.M.)
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Bengesser SA, Hohenberger H, Tropper B, Dalkner N, Birner A, Fellendorf FT, Platzer M, Rieger A, Maget A, Hamm C, Queissner R, Pilz R, Bauer K, Lenger M, Mörkl S, Wagner-Skacel J, Kapfhammer HP, Meier-Allard N, Stracke A, Holasek SJ, Murphy L, Reininghaus EZ. Gene expression analysis of MAOA and the clock gene ARNTL in individuals with bipolar disorder compared to healthy controls. World J Biol Psychiatry 2022; 23:287-294. [PMID: 34468263 DOI: 10.1080/15622975.2021.1973816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 07/30/2021] [Accepted: 08/24/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Circadian rhythms are associated with bipolar disorder (BD). This cross-sectional study aimed at investigating ARNTL and MAOA gene expression differences (1) between individuals with BD and controls, (2) between affective episodes, and (3) the relationship between ARNTL and MAOA expression. METHODS ARNTL and MAOA gene expression in peripheral mononuclear blood cells were analysed from fasting blood samples (BD n = 81, controls n = 54) with quantitative real-time PCR operating on TaqMan® assays (normalised to 18S RNA expression). ANCOVAs corrected for age, sex, body mass index, and medication was used to evaluate expression differences and correlation analyses for the relation between ARNTL and MAOA expression. RESULTS ARNTL gene expression differed between affective episodes (F(2,78) = 3.198, p = 0.047, Partial Eta2= 0.083), but not between BD and controls (n.s.). ARNTL and MAOA expression correlated positively in BD (r = 0.704, p < 0.001) and in controls (r = 0.932, p < 0.001). MAOA expression differed neither between BD and controls nor between affective episodes (n.s.). DISCUSSION Clock gene expression changes were observed in different affective states of BD. More precisely, ARNTL gene expression was significantly higher in euthymia than in depression. ARNTL and MAOA gene expression correlated significantly in BD and in controls, which emphasises the strong concatenation between circadian rhythms and neurotransmitter breakdown.
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Affiliation(s)
- S A Bengesser
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - H Hohenberger
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - B Tropper
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - N Dalkner
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - A Birner
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - F T Fellendorf
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - M Platzer
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - A Rieger
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - A Maget
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - C Hamm
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - R Queissner
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - R Pilz
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - K Bauer
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - M Lenger
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - S Mörkl
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - J Wagner-Skacel
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - H P Kapfhammer
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - N Meier-Allard
- Otto Loewi Research Center, Chair of Pathophysiology and Immunology, Medical University of Graz, Graz, Austria
| | - A Stracke
- Otto Loewi Research Center, Chair of Pathophysiology and Immunology, Medical University of Graz, Graz, Austria
| | - S J Holasek
- Otto Loewi Research Center, Chair of Pathophysiology and Immunology, Medical University of Graz, Graz, Austria
| | - L Murphy
- CAMH Pharmacogenetic Research Clinic, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
| | - E Z Reininghaus
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
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18
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Maget A, Dalkner N, Hamm C, Bengesser SA, Fellendorf FT, Platzer M, Queissner R, Birner A, Lenger M, Mörkl S, Kohlhammer-Dohr A, Rieger A, Seidl M, Mendel L, Färber T, Wetzlmair L, Schwalsberger K, Amberger-Otti DV, Schöggl H, Lahousen T, Leitner-Afschar B, Unterweger R, Zelzer S, Mangge H, Reininghaus EZ. Sex differences in zonulin in affective disorders and associations with current mood symptoms. J Affect Disord 2021; 294:441-446. [PMID: 34320451 DOI: 10.1016/j.jad.2021.07.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 07/09/2021] [Accepted: 07/12/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The bidirectional connection between the brain and the gut within psychiatric entities has gained increasing scientific attention over the last years. As a regulator of intestinal permeability, zonulin acts as a key player on the interface of this interplay. Like several psychiatric disorders, intestinal permeability was associated with inflammation in previous findings. METHODS In this study we explored differences in zonulin serum levels in currently depressed (n = 55) versus currently euthymic (n = 37) individuals with an affective disorder. Further, we explored sex differences and possible influences on zonulin and affective symptoms like medication, age, body mass index, and smoking status. RESULTS Serum zonulin was significantly higher in females than in men independent from affective status (z = -2.412, p = .016). More specifically, females in the euthymic subgroup had higher zonulin levels than euthymic men (z = -2.114, p = .035). There was no difference in zonulin serum levels in individuals taking or not taking a specific psychopharmacotherapy. We found no correlation between zonulin serum levels and depression severity. DISCUSSION Increased serum zonulin levels as a proxy for increased intestinal permeability in women may indicate a state of elevated susceptibility for depression-inducing stimuli.
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Affiliation(s)
- A Maget
- Departement for Psychiatry and Psychotherapeutic Medicine, Medical University Graz, Graz, Austria
| | - N Dalkner
- Departement for Psychiatry and Psychotherapeutic Medicine, Medical University Graz, Graz, Austria
| | - C Hamm
- Departement for Psychiatry and Psychotherapeutic Medicine, Medical University Graz, Graz, Austria
| | - S A Bengesser
- Departement for Psychiatry and Psychotherapeutic Medicine, Medical University Graz, Graz, Austria
| | - F T Fellendorf
- Departement for Psychiatry and Psychotherapeutic Medicine, Medical University Graz, Graz, Austria.
| | - M Platzer
- Departement for Psychiatry and Psychotherapeutic Medicine, Medical University Graz, Graz, Austria
| | - R Queissner
- Departement for Psychiatry and Psychotherapeutic Medicine, Medical University Graz, Graz, Austria
| | - A Birner
- Departement for Psychiatry and Psychotherapeutic Medicine, Medical University Graz, Graz, Austria
| | - M Lenger
- Departement for Psychiatry and Psychotherapeutic Medicine, Medical University Graz, Graz, Austria
| | - S Mörkl
- Departement for Psychiatry and Psychotherapeutic Medicine, Medical University Graz, Graz, Austria
| | - A Kohlhammer-Dohr
- Departement for Psychiatry and Psychotherapeutic Medicine, Medical University Graz, Graz, Austria
| | - A Rieger
- Departement for Psychiatry and Psychotherapeutic Medicine, Medical University Graz, Graz, Austria
| | - M Seidl
- Departement for Psychiatry and Psychotherapeutic Medicine, Medical University Graz, Graz, Austria
| | - L Mendel
- Departement for Psychiatry and Psychotherapeutic Medicine, Medical University Graz, Graz, Austria
| | - T Färber
- Departement for Psychiatry and Psychotherapeutic Medicine, Medical University Graz, Graz, Austria
| | - L Wetzlmair
- Departement for Psychiatry and Psychotherapeutic Medicine, Medical University Graz, Graz, Austria
| | - K Schwalsberger
- Departement for Psychiatry and Psychotherapeutic Medicine, Medical University Graz, Graz, Austria
| | - D V Amberger-Otti
- Departement for Psychiatry and Psychotherapeutic Medicine, Medical University Graz, Graz, Austria
| | - H Schöggl
- Departement for Psychiatry and Psychotherapeutic Medicine, Medical University Graz, Graz, Austria
| | - T Lahousen
- Departement for Psychiatry and Psychotherapeutic Medicine, Medical University Graz, Graz, Austria
| | - B Leitner-Afschar
- Departement for Psychiatry and Psychotherapeutic Medicine, Medical University Graz, Graz, Austria
| | - R Unterweger
- Departement for Psychiatry and Psychotherapeutic Medicine, Medical University Graz, Graz, Austria
| | - S Zelzer
- Institute of Medical and Chemical Laboratory Diagnostics, Medical University Graz, Graz, Austria
| | - H Mangge
- Institute of Medical and Chemical Laboratory Diagnostics, Medical University Graz, Graz, Austria
| | - E Z Reininghaus
- Departement for Psychiatry and Psychotherapeutic Medicine, Medical University Graz, Graz, Austria
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Wagner-Skacel J, Mörkl S, Dalkner N, Fellendorf F, Fitz W, Brix B, Neshev R, Wedenig S, Mächler P, Dorr A, Picha R, Rudlof ME, Bartel TO, Tatschl JM, Gostner JM, Bengesser SA, Reininghaus EZ, Jenewein J, Goswami N. The Impact of Cardiovascular Rehabilitation on Psychophysiological Stress, Personality and Tryptophan Metabolism: A Randomized Pilot Feasibility Study. Antioxidants (Basel) 2021; 10:antiox10091425. [PMID: 34573057 PMCID: PMC8467958 DOI: 10.3390/antiox10091425] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 08/10/2021] [Accepted: 08/16/2021] [Indexed: 01/17/2023] Open
Abstract
Multicomponent cardiac rehabilitation (CR) is a secondary prevention strategy for cardiac patients to tackle stress and psychosocial wellbeing. However, there is a lack of data on its psychoneuroimmunological effects and of biomarkers to determine individual risk and to develop treatment strategies. We conducted a pilot randomized controlled trial (RCT) to investigate the feasibility of deriving psychophysiological stress markers in patients with cardiovascular diseases. Thirty individuals with cardiovascular disease (mean age 58.8 years; 23.3% female) were enrolled and randomized into three treatment groups: standard rehabilitation, yoga, or transcendental meditation (TM). Depression, anxiety, sleep, stress perception, personality functioning, hair cortisol, serum tryptophan, kynurenine and neopterin concentrations were estimated at baseline and after a four-week intervention. Hair cortisol levels decreased significantly after rehabilitation in all groups (F = 15.98, p < 0.001). In addition, personality functioning improved in all patients over time. Participants with impairments in personality functioning showed a positive correlation with baseline neopterin that did not remain significant after Bonferroni correction. Concentrations of serum tryptophan and its metabolite kynurenine did not change significantly. This pilot RCT provides preliminary evidence of multicomponent CR leading to stabilization of hair cortisol levels and improved psychophysiological wellbeing and personality functioning. Impairments in personality functioning were correlated with neopterin levels, which may impact the symptomatology and outcome.
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Affiliation(s)
- Jolana Wagner-Skacel
- Department of Medical Psychology and Psychotherapy, Medical University Graz, 8036 Graz, Austria; (J.W.-S.); (J.J.)
| | - Sabrina Mörkl
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, 8036 Graz, Austria; (N.D.); (F.F.); (W.F.); (S.W.); (S.A.B.); (E.Z.R.)
- Correspondence: ; Tel.: +43-316-3858-1743
| | - Nina Dalkner
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, 8036 Graz, Austria; (N.D.); (F.F.); (W.F.); (S.W.); (S.A.B.); (E.Z.R.)
| | - Frederike Fellendorf
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, 8036 Graz, Austria; (N.D.); (F.F.); (W.F.); (S.W.); (S.A.B.); (E.Z.R.)
| | - Werner Fitz
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, 8036 Graz, Austria; (N.D.); (F.F.); (W.F.); (S.W.); (S.A.B.); (E.Z.R.)
| | - Bianca Brix
- Department of Physiology, Otto Loewi Research Center for Vascular Biology, Immunology and Inflammation, 8010 Graz, Austria; (B.B.); (R.N.); (M.E.R.); (T.O.B.); (N.G.)
| | - Ruslan Neshev
- Department of Physiology, Otto Loewi Research Center for Vascular Biology, Immunology and Inflammation, 8010 Graz, Austria; (B.B.); (R.N.); (M.E.R.); (T.O.B.); (N.G.)
| | - Sarah Wedenig
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, 8036 Graz, Austria; (N.D.); (F.F.); (W.F.); (S.W.); (S.A.B.); (E.Z.R.)
| | - Petra Mächler
- Rehabilitation Center for Cardiovascular Disease, 8061 St. Radegund, Austria; (P.M.); (A.D.); (R.P.)
| | - Andreas Dorr
- Rehabilitation Center for Cardiovascular Disease, 8061 St. Radegund, Austria; (P.M.); (A.D.); (R.P.)
| | - Rainer Picha
- Rehabilitation Center for Cardiovascular Disease, 8061 St. Radegund, Austria; (P.M.); (A.D.); (R.P.)
| | - Maximilian E. Rudlof
- Department of Physiology, Otto Loewi Research Center for Vascular Biology, Immunology and Inflammation, 8010 Graz, Austria; (B.B.); (R.N.); (M.E.R.); (T.O.B.); (N.G.)
| | - Till O. Bartel
- Department of Physiology, Otto Loewi Research Center for Vascular Biology, Immunology and Inflammation, 8010 Graz, Austria; (B.B.); (R.N.); (M.E.R.); (T.O.B.); (N.G.)
| | - Josef M. Tatschl
- Health Psychology Unit, Institute of Psychology, Karl-Franzens University of Graz, 8010 Graz, Austria;
| | - Johanna M. Gostner
- Biochemical Immunotoxicology Group, Institute of Medical Biochemistry, Medical University Innsbruck, 6020 Innsbruck, Austria;
| | - Susanne A. Bengesser
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, 8036 Graz, Austria; (N.D.); (F.F.); (W.F.); (S.W.); (S.A.B.); (E.Z.R.)
| | - Eva Z. Reininghaus
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, 8036 Graz, Austria; (N.D.); (F.F.); (W.F.); (S.W.); (S.A.B.); (E.Z.R.)
| | - Josef Jenewein
- Department of Medical Psychology and Psychotherapy, Medical University Graz, 8036 Graz, Austria; (J.W.-S.); (J.J.)
| | - Nandu Goswami
- Department of Physiology, Otto Loewi Research Center for Vascular Biology, Immunology and Inflammation, 8010 Graz, Austria; (B.B.); (R.N.); (M.E.R.); (T.O.B.); (N.G.)
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Ori D, Szocsics P, Molnar T, Guevara K, Bankovska-Motlova L, Ivanovic I, Carbone E, Kotsis K, Dashi E, Ahmadova G, Panayi A, Kafali HY, Klinkby I, Bruna K, Vircik M, Wallies M, Kisand H, Hargi A, Mirkovic A, Prelog PR, Cabaços C, Pereira A, Boivin S, Angyal V, Grinko N, Grech G, Schuster F, Valdivielso M, Raaj S, Maslak J, Mörkl S, Strumila R, Nechepurenko N, Kazakova O, Kakar S, Abdulhakim M, Matheiken S, Oanca V, Salopek I, Kalpak G, Gyorffy Z. European study on the attitude of psychiatrists towards their patients. Eur Psychiatry 2021. [PMCID: PMC9470455 DOI: 10.1192/j.eurpsy.2021.340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Many people think that people with mental disorders might be dangerous or unpredictable. These patients face various sources of disadvantages and experience discrimination in job interviews, in education, and housing. Mental health-related stigma occurs not only within the public community, it is a growing issue among professionals as well. Our study is the first that investigates the stigmatising attitude of psychiatrists across Europe. Objectives We designed a cross-sectional, observational, multi-centre, international study of 33 European countries to investigate the attitude towards patients among medical specialists and trainees in the field of general adult and child and adolescent psychiatry. Methods An internet-based, anonymous survey will measure the stigmatising attitude by using the local version of the Opening Minds Stigma Scale for Health Care Providers. Data gathering started in July this year and will continue until December 2020. Results This study will be the first to describe the stigmatising attitude of psychiatric practitioners across Europe from their perspectives. Conclusions The study will contribute to knowledge of gaps in stigmatising attitude towards people with mental health problems and will provide with new directions in anti-stigma interventions. Disclosure No significant relationships.
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Stadler JT, Lackner S, Mörkl S, Trakaki A, Scharnagl H, Borenich A, Wonisch W, Mangge H, Zelzer S, Meier-Allard N, Holasek SJ, Marsche G. Obesity Affects HDL Metabolism, Composition and Subclass Distribution. Biomedicines 2021; 9:biomedicines9030242. [PMID: 33673728 PMCID: PMC7997277 DOI: 10.3390/biomedicines9030242] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 02/19/2021] [Accepted: 02/23/2021] [Indexed: 12/22/2022] Open
Abstract
Background: Obesity increases the risk of coronary heart disease, partly due to its strong association with atherogenic dyslipidemia, characterized by high triglycerides and low high-density lipoprotein (HDL) cholesterol levels. Functional impairment of HDL may contribute to the increased cardiovascular mortality, but the effect of obesity on composition, structure, and function of HDL is not well understood. Design and Methods: We determined HDL composition, HDL subclass distribution, parameters of HDL function, and activities of most important enzymes involved in lipoprotein remodeling, including lecithin–cholesterol acyltransferase (LCAT) and cholesteryl ester transfer protein (CETP) in relatively young normal weight (n = 26), overweight (n = 22), and obese (n = 20) women. Results: Obesity (body mass index (BMI) ≥ 30) was associated with noticeable changes in LCAT and CETP activities and altered HDL composition, such as decreased apolipoprotein A-I, cholesterol, and phospholipid content, while pro-inflammatory HDL serum amyloid a content was increased. We observed a marked shift towards smaller HDL subclasses in obesity linked to lower anti-oxidative capacity of serum. LCAT activity, HDL subclass distribution, and HDL-cholesterol were associated with soluble leptin receptor, adiponectin, and liver enzyme activities. Of note, most of these alterations were only seen in obese women but not in overweight women. Conclusions: Obesity markedly affects HDL metabolism, composition, and subclass distribution linked to changes in liver and adipose tissue. HDL dysfunction may contribute to increased cardiovascular risk in obesity.
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Affiliation(s)
- Julia T. Stadler
- Division of Pharmacology, Otto Loewi Research Center, Medical University of Graz, Universitätsplatz 4, 8010 Graz, Austria; (J.T.S.); (A.T.)
| | - Sonja Lackner
- Division of Immunology and Pathophysiology, Otto Loewi Research Center, Medical University of Graz, Heinrichstraße 31a, 8010 Graz, Austria; (S.L.); (N.M.-A.)
| | - Sabrina Mörkl
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Auenbruggerplatz 31, 8036 Graz, Austria;
| | - Athina Trakaki
- Division of Pharmacology, Otto Loewi Research Center, Medical University of Graz, Universitätsplatz 4, 8010 Graz, Austria; (J.T.S.); (A.T.)
| | - Hubert Scharnagl
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria; (H.S.); (H.M.); (S.Z.)
| | - Andrea Borenich
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Auenbruggerplatz 2, 8036 Graz, Austria;
| | - Willibald Wonisch
- Division of Physiological Chemistry, Otto Loewi Research Center, Medical University of Graz, Neue Stiftingtalstraße 6, 8010 Graz, Austria;
| | - Harald Mangge
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria; (H.S.); (H.M.); (S.Z.)
| | - Sieglinde Zelzer
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria; (H.S.); (H.M.); (S.Z.)
| | - Nathalie Meier-Allard
- Division of Immunology and Pathophysiology, Otto Loewi Research Center, Medical University of Graz, Heinrichstraße 31a, 8010 Graz, Austria; (S.L.); (N.M.-A.)
| | - Sandra J. Holasek
- Division of Immunology and Pathophysiology, Otto Loewi Research Center, Medical University of Graz, Heinrichstraße 31a, 8010 Graz, Austria; (S.L.); (N.M.-A.)
- Correspondence: (S.J.H.); (G.M.); Tel.: +43-316-385-741-28 (G.M.)
| | - Gunther Marsche
- Division of Pharmacology, Otto Loewi Research Center, Medical University of Graz, Universitätsplatz 4, 8010 Graz, Austria; (J.T.S.); (A.T.)
- BioTechMed Graz, Mozartgasse 12/II, 8010 Graz, Austria
- Correspondence: (S.J.H.); (G.M.); Tel.: +43-316-385-741-28 (G.M.)
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22
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Lackner S, Meier-Allard N, Mörkl S, Müller W, Fürhapter-Rieger A, Mangge H, Zelzer S, Holasek S. Hypercarotenemia in Anorexia Nervosa Patients May Influence Weight Balance: Results of a Clinical Cross-Sectional Cohort Study. Front Psychiatry 2021; 12:758300. [PMID: 34992554 PMCID: PMC8725815 DOI: 10.3389/fpsyt.2021.758300] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 11/29/2021] [Indexed: 12/16/2022] Open
Abstract
Introduction: Anorexia nervosa (AN) can co-occur with hypercarotenemia, a clinical condition characterized by elevated β-carotene in plasma and skin tissue. Carotenoids have known anti-obesogenic effects in adipocyte biology. Thus, carotenoids may potentially play a retarding role in weight gain during the recovery of AN patients. This study evaluated the plasma carotenoid profile and subcutaneous adipose tissue (SAT) in a cohort of AN patients and normal weight (NW) controls. Methods: Plasma concentrations of α-carotene, β-carotene, β-cryptoxanthin, and lycopene were determined by HPLC analysis. SAT thicknesses were measured by a highly accurate and reliable ultrasound technique. Information on dietary intakes were collected by repeated 24-h recalls. Results: Sixty-two females (AN: n = 18, NW: n = 44) were included. The concentrations of β-cryptoxanthin (p = 0.045) and lycopene (p = 0.004) were significantly lower in AN patients. β-carotene levels were higher in AN patients (n.s.) and α-carotene did not differ significantly. SAT thickness was significantly lower in AN patients compared to controls (p < 0.001). β-carotene was significantly negative (r s = -0.471) and lycopene significantly positive (r s = 0.366) correlated with SAT. The correlation of β-carotene and SAT was even higher in the AN group alone (r s = -0.742). Also, β- cryptoxanthin and the sum of provitamin A carotenoids were correlated to SAT (r s = -0.647 and r s = -0.746, respectively) in AN patients. Fruits and vegetable intake did not differ significantly between AN and NW but adjusted for SAT, AN patients consumed relatively higher amounts (p = 0.006). Conclusion: Higher plasma β-carotene concentrations were associated with reduced SAT levels, most probably due to a reduced ability of the remaining adipose tissue to store carotenoids. Thus, the antiobesity effects of carotenoids might impact the treatment success of undernutrition and AN. A systemic carotenoid overload may contribute to changes in adipogenesis and metabolic capacities for energy storage. Therefore, high plasma β-carotene may be a marker of delay in weight recovery in AN patients. Interventional studies should consider including carotenoid-status in AN treatment.
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Affiliation(s)
- Sonja Lackner
- Division of Immunology and Pathophysiology, Otto Loewi Research Center, Medical University of Graz, Graz, Austria
| | - Nathalie Meier-Allard
- Division of Immunology and Pathophysiology, Otto Loewi Research Center, Medical University of Graz, Graz, Austria
| | - Sabrina Mörkl
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Wolfram Müller
- Division of Biophysics, Gottfried Schatz Research Center, Medical University of Graz, Graz, Austria
| | - Alfred Fürhapter-Rieger
- Division of Biophysics, Gottfried Schatz Research Center, Medical University of Graz, Graz, Austria
| | - Harald Mangge
- Clinical Institute for Medical and Chemical Laboratory Diagnosis, Medical University of Graz, Graz, Austria
| | - Sieglinde Zelzer
- Clinical Institute for Medical and Chemical Laboratory Diagnosis, Medical University of Graz, Graz, Austria
| | - Sandra Holasek
- Division of Immunology and Pathophysiology, Otto Loewi Research Center, Medical University of Graz, Graz, Austria
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Wagner-Skacel J, Dalkner N, Bengesser S, Ratzenhofer M, Fink N, Kahn J, Pilz R, Mörkl S, Lenger M, Fazekas C, Matzer F, Butler M, Reininghaus EZ, Müller H, Kniepeiss D. COVID-19 Pandemic Stress-Induced Somatization in Transplant Waiting List Patients. Front Psychiatry 2021; 12:671383. [PMID: 34295270 PMCID: PMC8291906 DOI: 10.3389/fpsyt.2021.671383] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 05/31/2021] [Indexed: 01/08/2023] Open
Abstract
Background: The coronavirus disease 2019 (COVID-19) pandemic has resulted in widespread socioeconomic restrictions including quarantine, social distancing and self-isolation. This is the first study investigating the psychological impact of the pandemic on patients waiting for liver or kidney transplantation, a particularly vulnerable group. Methods: Twenty-seven patients on the transplantation waiting list and 43 healthy controls took part in an online survey including the Beck Depression Inventory (BDI-2), the Brief Symptom Inventory-18 (BSI-18), the Pittsburgh Sleep Quality Index (PSQI), the Alcohol Use Identification Test (AUDIT-C), the 12-item Operationalized Psychodynamic Diagnosis Structure Questionnaire (OPD-SQS) and a questionnaire to determine cognitions and beliefs, attitude and fear related to COVID-19. Results: BSI-18 Somatization was increased in waiting list patients compared to controls. Correlation analyses indicated a relationship between Somatization and the fear of contracting the coronavirus in the patient group; however this association was weak. In patients and controls, other psychologicial symptoms (depression, anxiety) correlated highly with emotional distress due to social distancing. There were no differences between patients and controls in depression scores and sleep disturbances. Alcohol consumption and personality structure were not related to COVID-19 fears. Conclusion: In times of the first lockdown during the COVID-19 pandemic, patients on the transplantation waiting list have high somatization symptoms associated with COVID-19 fears. As vulnerable group, they need psychological counseling to improve mental well-being during times of crisis.
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Affiliation(s)
- Jolana Wagner-Skacel
- Department of Medical Psychology and Psychotherapy, Medical University of Graz, Graz, Austria
| | - Nina Dalkner
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Susanne Bengesser
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Michaela Ratzenhofer
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Nadja Fink
- General, Visceral and Transplant Surgery, Medical University of Graz, Graz, Austria
| | - Judith Kahn
- General, Visceral and Transplant Surgery, Medical University of Graz, Graz, Austria.,Transplant Center Graz, Graz, Austria
| | - Rene Pilz
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Sabrina Mörkl
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Melanie Lenger
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Christian Fazekas
- Department of Medical Psychology and Psychotherapy, Medical University of Graz, Graz, Austria
| | - Franziska Matzer
- Department of Medical Psychology and Psychotherapy, Medical University of Graz, Graz, Austria
| | - Mary Butler
- Department of Psychiatry, University College Cork, Cork, Ireland
| | - Eva Z Reininghaus
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Helmut Müller
- General, Visceral and Transplant Surgery, Medical University of Graz, Graz, Austria.,Transplant Center Graz, Graz, Austria
| | - Daniela Kniepeiss
- General, Visceral and Transplant Surgery, Medical University of Graz, Graz, Austria.,Transplant Center Graz, Graz, Austria
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Wagner-Skacel J, Horvath A, Grande P, Wenninger J, Matzer F, Fazekas C, Mörkl S, Meinitzer A, Stadlbauer V. Association of fibroblast growth factor 21 with alcohol consumption and alcohol liver cirrhosis. Neuropsychiatr 2020; 35:140-146. [PMID: 33330965 PMCID: PMC8429377 DOI: 10.1007/s40211-020-00380-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 11/07/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Fibroblast growth factor 21 (FGF21) is produced in the liver and binds to different complex receptor/coreceptor systems. Besides many other processes, FGF21 regulates the intake of simple sugars and alcohol. Increased levels of FGF21 decrease harmful alcohol intake in mice. To increase our understanding on the relationship between FGF21 and alcohol intake in humans, we aimed to measure FGF21 levels in patients with alcoholic liver cirrhosis (ALC) in comparison to patients with nonalcoholic liver cirrhosis (NALC) and healthy persons based on their present alcohol consumption. METHODS Alcohol intake was verified by urinary ethyl glucuronide (uETG) levels, eating and drinking behaviour by a Food Frequency Questionnaire and FGF 21 plasma levels were determined by ELISA in 96 persons (ALC n = 41; NALC n = 34; healthy n = 21). RESULTS Both ALC and NALC patients with elevated ETG levels (≥0.5 μg/ml; indicating alcohol consumption in the last 12-72 h) showed significantly higher FGF21 plasma levels in comparison to patients with negative ETG levels. Eating behaviour did not have an impact on FGF21 plasma levels. CONCLUSIONS Increased FGF21 levels in patients with recent alcohol consumption (verified by ETG) confirmed the first part of the liver-brain endocrine axis: alcohol consumption was associated with increased FGF21 levels. We could not confirm that elevated FGF21 levels were associated with reduced alcohol intake as a result. That points towards a pathology in this pathway, which might be caused by a malfunction of β‑Klotho or FGF receptors according to other studies and chronic alcohol dependency. Further research is required to clarify these pathologies, which may open new pharmacological treatment for patients with alcohol use disorder and alcohol dependence.
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Affiliation(s)
- Jolana Wagner-Skacel
- Department of Medical Psychology and Psychotherapy, Medical University of Graz (MUG), Auenbruggerplatz 3, 8036, Graz, Austria.
| | - Angela Horvath
- Division of Gastroenterology and Hepatology, Medical University of Graz (MUG), Graz, Austria
| | - Philipp Grande
- Division of Gastroenterology and Hepatology, Medical University of Graz (MUG), Graz, Austria
| | - Julian Wenninger
- Department of Child and Adolescent Psychiatry, LKH Graz II, Graz, Austria
| | - Franziska Matzer
- Department of Medical Psychology and Psychotherapy, Medical University of Graz (MUG), Auenbruggerplatz 3, 8036, Graz, Austria
| | - Christian Fazekas
- Department of Medical Psychology and Psychotherapy, Medical University of Graz (MUG), Auenbruggerplatz 3, 8036, Graz, Austria
| | - Sabrina Mörkl
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz (MUG), Graz, Austria
| | - Andreas Meinitzer
- Department of Clinical and Chemical Laboratory Diagnostics, Medical University of Graz (MUG), Graz, Austria
| | - Vanessa Stadlbauer
- Division of Gastroenterology and Hepatology, Medical University of Graz (MUG), Graz, Austria
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25
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Faber PL, Milz P, Reininghaus EZ, Mörkl S, Holl AK, Kapfhammer HP, Pascual-Marqui RD, Kochi K, Achermann P, Painold A. Fundamentally altered global- and microstate EEG characteristics in Huntington's disease. Clin Neurophysiol 2020; 132:13-22. [PMID: 33249251 DOI: 10.1016/j.clinph.2020.10.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 08/25/2020] [Accepted: 10/14/2020] [Indexed: 01/14/2023]
Abstract
OBJECTIVE Huntington's disease (HD) is characterized by psychiatric, cognitive, and motor disturbances. The study aimed to determine electroencephalography (EEG) global state and microstate changes in HD and their relationship with cognitive and behavioral impairments. METHODS EEGs from 20 unmedicated HD patients and 20 controls were compared using global state properties (connectivity and dimensionality) and microstate properties (EEG microstate analysis). For four microstate classes (A, B, C, D), three parameters were computed: duration, occurrence, coverage. Global- and microstate properties were compared between groups and correlated with cognitive test scores for patients. RESULTS Global state analysis showed reduced connectivity in HD and an increasing dimensionality with increasing HD severity. Microstate analysis revealed parameter increases for classes A and B (coverage), decreases for C (occurrence) and D (coverage and occurrence). Disease severity and poorer test performances correlated with parameter increases for class A (coverage and occurrence), decreases for C (coverage and duration) and a dimensionality increase. CONCLUSIONS Global state changes may reflect higher functional dissociation between brain areas and the complex microstate changes possibly the widespread neuronal death and corresponding functional deficits in brain regions associated with HD symptomatology. SIGNIFICANCE Combining global- and microstate analyses can be useful for a better understanding of progressive brain deterioration in HD.
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Affiliation(s)
- Pascal L Faber
- The KEY Institute for Brain-Mind Research, Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry, Zurich, Switzerland
| | - Patricia Milz
- The KEY Institute for Brain-Mind Research, Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry, Zurich, Switzerland
| | - Eva Z Reininghaus
- Department of Psychiatry and Psychotherapy, Medical University of Graz, Graz, Austria
| | - Sabrina Mörkl
- Department of Psychiatry and Psychotherapy, Medical University of Graz, Graz, Austria
| | - Anna K Holl
- Department of Psychiatry and Psychotherapy, Medical University of Graz, Graz, Austria
| | - Hans-Peter Kapfhammer
- Department of Psychiatry and Psychotherapy, Medical University of Graz, Graz, Austria
| | - Roberto D Pascual-Marqui
- The KEY Institute for Brain-Mind Research, Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry, Zurich, Switzerland
| | - Kieko Kochi
- The KEY Institute for Brain-Mind Research, Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry, Zurich, Switzerland
| | - Peter Achermann
- The KEY Institute for Brain-Mind Research, Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry, Zurich, Switzerland
| | - Annamaria Painold
- Department of Psychiatry and Psychotherapy, Medical University of Graz, Graz, Austria.
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Reininghaus EZ, Wetzlmair LC, Fellendorf FT, Platzer M, Queissner R, Birner A, Pilz R, Hamm C, Maget A, Rieger A, Prettenhofer A, Wurm W, Mörkl S, Dalkner N. Probiotic Treatment in Individuals with Euthymic Bipolar Disorder: A Pilot-Study on Clinical Changes and Compliance. Neuropsychobiology 2020; 79:71-79. [PMID: 30343291 DOI: 10.1159/000493867] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 09/17/2018] [Indexed: 11/19/2022]
Abstract
The importance of the microbiome for psychological well-being has gained rising interest in the last decade. A strategy to examine the role of the microbiome in different diseases is the intake of supplements that modulate the gut microbiome. Despite promising results in animal studies, research in humans is sparse to date and especially in individuals with psychiatric disorders almost missing. The current report of the ProbioBIP-one pilot study aims at describing general effects of the intake of the probiotic OMNi-BiOTiC Stress repair® on psychological parameters as well as gastrointestinal symptoms and general compliance in a cohort of euthymic individuals with bipolar disorder (BD), receiving daily probiotic treatment over a time period of 3 months. Twenty-seven individuals with BD took part in the present study (mean age = 50.7 years, SD = 12.2; females 40.7%). In sum, there was a high compliance rate with 81.5% of the study participants completing all 3 study visits and 85% of planned probiotic ingestions taken. Gastrointestinal problems were prevalent in more than half of the patients at the time of inclusion (t1). Expectedly, in the whole cohort, a high proportion of study participants experienced changes concerning digestion during probiotic treatment, around one third reported positive changes (reduced flatulence and easier and more frequent bowel movements) after 1 month (t2) and further after 3 months (t3). In contrast, a smaller part of study participants reported gastrointestinal discomfort after 1 and after 3 months (mainly flatulence and obstipation). We found a significantly reduced cognitive reactivity to sad mood between t2 and t3 indicating that participants under probiotic supplementation perceived themselves to be less distracted by ruminative thoughts. Further changes in psychiatric symptoms were small due to the euthymic state and already low scoring at the time of inclusion. Nevertheless, we found a significant symptom reduction in the rating scales measuring manic symptoms. From a clinical point of view, probiotic supplementation might provide a well-tolerated tool to positively influence gastrointestinal quality of life as well as mental and somatic health, cognition and immune response and potentially have effects on psychiatric symptoms.
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Affiliation(s)
- Eva Z Reininghaus
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Lisa-Christin Wetzlmair
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria,
| | - Frederike T Fellendorf
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Martina Platzer
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Robert Queissner
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Armin Birner
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Ren Pilz
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Carlo Hamm
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Alexander Maget
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Alexandra Rieger
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Antonia Prettenhofer
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Walter Wurm
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Sabrina Mörkl
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Nina Dalkner
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
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Mörkl S, Butler MI, Holl A, Cryan JF, Dinan TG. Correction to: Probiotics and the Microbiota-Gut-Brain Axis: Focus on Psychiatry. Curr Nutr Rep 2020; 9:183. [DOI: 10.1007/s13668-020-00319-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Abstract
PURPOSE OF REVIEW Probiotics are living bacteria, which when ingested in adequate amounts, confer health benefits. Gut microbes are suggested to play a role in many psychiatric disorders and could be a potential therapeutic target. Between the gut and the brain, there is a bi-directional communication pathway called the microbiota-gut-brain axis. The purpose of this review is to examine data from recent interventional studies focusing on probiotics and the gut-brain axis for the treatment of depression, anxiety and schizophrenia. RECENT FINDINGS Probiotics are likely to improve depression but not schizophrenia. Regarding anxiety, there is only one trial which showed an effect of a multispecies probiotic. However, determinants like the duration of treatment, dosage and interactions have not been thoroughly investigated and deserve more scientific attention. Microbiome-based therapies such as probiotics could be cautiously recommended for depression to enhance beneficial bacteria in the gut and to improve mood through the gut-brain axis.
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Affiliation(s)
- Sabrina Mörkl
- APC Microbiome Ireland, University College Cork, Cork, Ireland.
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria.
| | - Mary I Butler
- APC Microbiome Ireland, University College Cork, Cork, Ireland
- Department of Psychiatry and Neurobehavioural Science, University College Cork, Cork, Ireland
| | - Anna Holl
- APC Microbiome Ireland, University College Cork, Cork, Ireland
| | - John F Cryan
- APC Microbiome Ireland, University College Cork, Cork, Ireland
- Department of Anatomy and Neuroscience, University College Cork, Cork, Ireland
| | - Timothy G Dinan
- APC Microbiome Ireland, University College Cork, Cork, Ireland
- Department of Psychiatry and Neurobehavioural Science, University College Cork, Cork, Ireland
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29
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Reiter A, Bengesser SA, Hauschild AC, Birkl-Töglhofer AM, Fellendorf FT, Platzer M, Färber T, Seidl M, Mendel LM, Unterweger R, Lenger M, Mörkl S, Dalkner N, Birner A, Queissner R, Hamm C, Maget A, Pilz R, Kohlhammer-Dohr A, Wagner-Skacel J, Kreuzer K, Schöggl H, Amberger-Otti D, Lahousen T, Leitner-Afschar B, Haybäck J, Kapfhammer HP, Reininghaus E. Interleukin-6 Gene Expression Changes after a 4-Week Intake of a Multispecies Probiotic in Major Depressive Disorder-Preliminary Results of the PROVIT Study. Nutrients 2020; 12:E2575. [PMID: 32858844 PMCID: PMC7551871 DOI: 10.3390/nu12092575] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 08/20/2020] [Accepted: 08/21/2020] [Indexed: 12/13/2022] Open
Abstract
Major depressive disorder (MDD) is a prevalent disease, in which one third of sufferers do not respond to antidepressants. Probiotics have the potential to be well-tolerated and cost-efficient treatment options. However, the molecular pathways of their effects are not fully elucidated yet. Based on previous literature, we assume that probiotics can positively influence inflammatory mechanisms. We aimed at analyzing the effects of probiotics on gene expression of inflammation genes as part of the randomized, placebo-controlled, multispecies probiotics PROVIT study in Graz, Austria. Fasting blood of 61 inpatients with MDD was collected before and after four weeks of probiotic intake or placebo. We analyzed the effects on gene expression of tumor necrosis factor (TNF), nuclear factor kappa B subunit 1 (NFKB1) and interleukin-6 (IL-6). In IL-6 we found no significant main effects for group (F(1,44) = 1.33, p = ns) nor time (F(1,44) = 0.00, p = ns), but interaction was significant (F(1,44) = 5.67, p < 0.05). The intervention group showed decreasing IL-6 gene expression levels while the placebo group showed increasing gene expression levels of IL-6. Probiotics could be a useful additional treatment in MDD, due to their anti-inflammatory effects. Results of the current study are promising, but further studies are required to investigate the beneficial effects of probiotic interventions in depressed individuals.
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Affiliation(s)
- Alexandra Reiter
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Auenbruggerplatz 31, 8036 Graz, Austria; (A.R.); (F.T.F.); (M.P.); (M.S.); (L.-M.M.); (R.U.); (M.L.); (S.M.); (N.D.); (A.B.); (R.Q.); (C.H.); (A.M.); (R.P.); (A.K.-D.); (J.W.-S.); (K.K.); (H.S.); (D.A.-O.); (T.L.); (B.L.-A.); (H.-P.K.); (E.R.)
| | - Susanne A. Bengesser
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Auenbruggerplatz 31, 8036 Graz, Austria; (A.R.); (F.T.F.); (M.P.); (M.S.); (L.-M.M.); (R.U.); (M.L.); (S.M.); (N.D.); (A.B.); (R.Q.); (C.H.); (A.M.); (R.P.); (A.K.-D.); (J.W.-S.); (K.K.); (H.S.); (D.A.-O.); (T.L.); (B.L.-A.); (H.-P.K.); (E.R.)
| | - Anne-Christin Hauschild
- Department of Mathematics & Computer Science, University of Marburg, 35043 Marburg, Germany;
| | - Anna-Maria Birkl-Töglhofer
- Institute for Pathology, Neuropathology and Molecular Pathology, Medical University of Innsbruck, 6020 Innsbruck, Austria; (A.-M.B.-T.); (J.H.)
| | - Frederike T. Fellendorf
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Auenbruggerplatz 31, 8036 Graz, Austria; (A.R.); (F.T.F.); (M.P.); (M.S.); (L.-M.M.); (R.U.); (M.L.); (S.M.); (N.D.); (A.B.); (R.Q.); (C.H.); (A.M.); (R.P.); (A.K.-D.); (J.W.-S.); (K.K.); (H.S.); (D.A.-O.); (T.L.); (B.L.-A.); (H.-P.K.); (E.R.)
| | - Martina Platzer
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Auenbruggerplatz 31, 8036 Graz, Austria; (A.R.); (F.T.F.); (M.P.); (M.S.); (L.-M.M.); (R.U.); (M.L.); (S.M.); (N.D.); (A.B.); (R.Q.); (C.H.); (A.M.); (R.P.); (A.K.-D.); (J.W.-S.); (K.K.); (H.S.); (D.A.-O.); (T.L.); (B.L.-A.); (H.-P.K.); (E.R.)
| | - Tanja Färber
- Institute of Psychology, University of Bamberg, 96047 Bamberg, Germany;
| | - Matthias Seidl
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Auenbruggerplatz 31, 8036 Graz, Austria; (A.R.); (F.T.F.); (M.P.); (M.S.); (L.-M.M.); (R.U.); (M.L.); (S.M.); (N.D.); (A.B.); (R.Q.); (C.H.); (A.M.); (R.P.); (A.K.-D.); (J.W.-S.); (K.K.); (H.S.); (D.A.-O.); (T.L.); (B.L.-A.); (H.-P.K.); (E.R.)
| | - Lilli-Marie Mendel
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Auenbruggerplatz 31, 8036 Graz, Austria; (A.R.); (F.T.F.); (M.P.); (M.S.); (L.-M.M.); (R.U.); (M.L.); (S.M.); (N.D.); (A.B.); (R.Q.); (C.H.); (A.M.); (R.P.); (A.K.-D.); (J.W.-S.); (K.K.); (H.S.); (D.A.-O.); (T.L.); (B.L.-A.); (H.-P.K.); (E.R.)
| | - Renate Unterweger
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Auenbruggerplatz 31, 8036 Graz, Austria; (A.R.); (F.T.F.); (M.P.); (M.S.); (L.-M.M.); (R.U.); (M.L.); (S.M.); (N.D.); (A.B.); (R.Q.); (C.H.); (A.M.); (R.P.); (A.K.-D.); (J.W.-S.); (K.K.); (H.S.); (D.A.-O.); (T.L.); (B.L.-A.); (H.-P.K.); (E.R.)
| | - Melanie Lenger
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Auenbruggerplatz 31, 8036 Graz, Austria; (A.R.); (F.T.F.); (M.P.); (M.S.); (L.-M.M.); (R.U.); (M.L.); (S.M.); (N.D.); (A.B.); (R.Q.); (C.H.); (A.M.); (R.P.); (A.K.-D.); (J.W.-S.); (K.K.); (H.S.); (D.A.-O.); (T.L.); (B.L.-A.); (H.-P.K.); (E.R.)
| | - Sabrina Mörkl
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Auenbruggerplatz 31, 8036 Graz, Austria; (A.R.); (F.T.F.); (M.P.); (M.S.); (L.-M.M.); (R.U.); (M.L.); (S.M.); (N.D.); (A.B.); (R.Q.); (C.H.); (A.M.); (R.P.); (A.K.-D.); (J.W.-S.); (K.K.); (H.S.); (D.A.-O.); (T.L.); (B.L.-A.); (H.-P.K.); (E.R.)
| | - Nina Dalkner
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Auenbruggerplatz 31, 8036 Graz, Austria; (A.R.); (F.T.F.); (M.P.); (M.S.); (L.-M.M.); (R.U.); (M.L.); (S.M.); (N.D.); (A.B.); (R.Q.); (C.H.); (A.M.); (R.P.); (A.K.-D.); (J.W.-S.); (K.K.); (H.S.); (D.A.-O.); (T.L.); (B.L.-A.); (H.-P.K.); (E.R.)
| | - Armin Birner
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Auenbruggerplatz 31, 8036 Graz, Austria; (A.R.); (F.T.F.); (M.P.); (M.S.); (L.-M.M.); (R.U.); (M.L.); (S.M.); (N.D.); (A.B.); (R.Q.); (C.H.); (A.M.); (R.P.); (A.K.-D.); (J.W.-S.); (K.K.); (H.S.); (D.A.-O.); (T.L.); (B.L.-A.); (H.-P.K.); (E.R.)
| | - Robert Queissner
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Auenbruggerplatz 31, 8036 Graz, Austria; (A.R.); (F.T.F.); (M.P.); (M.S.); (L.-M.M.); (R.U.); (M.L.); (S.M.); (N.D.); (A.B.); (R.Q.); (C.H.); (A.M.); (R.P.); (A.K.-D.); (J.W.-S.); (K.K.); (H.S.); (D.A.-O.); (T.L.); (B.L.-A.); (H.-P.K.); (E.R.)
| | - Carlo Hamm
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Auenbruggerplatz 31, 8036 Graz, Austria; (A.R.); (F.T.F.); (M.P.); (M.S.); (L.-M.M.); (R.U.); (M.L.); (S.M.); (N.D.); (A.B.); (R.Q.); (C.H.); (A.M.); (R.P.); (A.K.-D.); (J.W.-S.); (K.K.); (H.S.); (D.A.-O.); (T.L.); (B.L.-A.); (H.-P.K.); (E.R.)
| | - Alexander Maget
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Auenbruggerplatz 31, 8036 Graz, Austria; (A.R.); (F.T.F.); (M.P.); (M.S.); (L.-M.M.); (R.U.); (M.L.); (S.M.); (N.D.); (A.B.); (R.Q.); (C.H.); (A.M.); (R.P.); (A.K.-D.); (J.W.-S.); (K.K.); (H.S.); (D.A.-O.); (T.L.); (B.L.-A.); (H.-P.K.); (E.R.)
| | - Rene Pilz
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Auenbruggerplatz 31, 8036 Graz, Austria; (A.R.); (F.T.F.); (M.P.); (M.S.); (L.-M.M.); (R.U.); (M.L.); (S.M.); (N.D.); (A.B.); (R.Q.); (C.H.); (A.M.); (R.P.); (A.K.-D.); (J.W.-S.); (K.K.); (H.S.); (D.A.-O.); (T.L.); (B.L.-A.); (H.-P.K.); (E.R.)
| | - Alexandra Kohlhammer-Dohr
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Auenbruggerplatz 31, 8036 Graz, Austria; (A.R.); (F.T.F.); (M.P.); (M.S.); (L.-M.M.); (R.U.); (M.L.); (S.M.); (N.D.); (A.B.); (R.Q.); (C.H.); (A.M.); (R.P.); (A.K.-D.); (J.W.-S.); (K.K.); (H.S.); (D.A.-O.); (T.L.); (B.L.-A.); (H.-P.K.); (E.R.)
| | - Jolana Wagner-Skacel
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Auenbruggerplatz 31, 8036 Graz, Austria; (A.R.); (F.T.F.); (M.P.); (M.S.); (L.-M.M.); (R.U.); (M.L.); (S.M.); (N.D.); (A.B.); (R.Q.); (C.H.); (A.M.); (R.P.); (A.K.-D.); (J.W.-S.); (K.K.); (H.S.); (D.A.-O.); (T.L.); (B.L.-A.); (H.-P.K.); (E.R.)
| | - Kathrin Kreuzer
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Auenbruggerplatz 31, 8036 Graz, Austria; (A.R.); (F.T.F.); (M.P.); (M.S.); (L.-M.M.); (R.U.); (M.L.); (S.M.); (N.D.); (A.B.); (R.Q.); (C.H.); (A.M.); (R.P.); (A.K.-D.); (J.W.-S.); (K.K.); (H.S.); (D.A.-O.); (T.L.); (B.L.-A.); (H.-P.K.); (E.R.)
| | - Helmut Schöggl
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Auenbruggerplatz 31, 8036 Graz, Austria; (A.R.); (F.T.F.); (M.P.); (M.S.); (L.-M.M.); (R.U.); (M.L.); (S.M.); (N.D.); (A.B.); (R.Q.); (C.H.); (A.M.); (R.P.); (A.K.-D.); (J.W.-S.); (K.K.); (H.S.); (D.A.-O.); (T.L.); (B.L.-A.); (H.-P.K.); (E.R.)
| | - Daniela Amberger-Otti
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Auenbruggerplatz 31, 8036 Graz, Austria; (A.R.); (F.T.F.); (M.P.); (M.S.); (L.-M.M.); (R.U.); (M.L.); (S.M.); (N.D.); (A.B.); (R.Q.); (C.H.); (A.M.); (R.P.); (A.K.-D.); (J.W.-S.); (K.K.); (H.S.); (D.A.-O.); (T.L.); (B.L.-A.); (H.-P.K.); (E.R.)
| | - Theresa Lahousen
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Auenbruggerplatz 31, 8036 Graz, Austria; (A.R.); (F.T.F.); (M.P.); (M.S.); (L.-M.M.); (R.U.); (M.L.); (S.M.); (N.D.); (A.B.); (R.Q.); (C.H.); (A.M.); (R.P.); (A.K.-D.); (J.W.-S.); (K.K.); (H.S.); (D.A.-O.); (T.L.); (B.L.-A.); (H.-P.K.); (E.R.)
| | - Birgitta Leitner-Afschar
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Auenbruggerplatz 31, 8036 Graz, Austria; (A.R.); (F.T.F.); (M.P.); (M.S.); (L.-M.M.); (R.U.); (M.L.); (S.M.); (N.D.); (A.B.); (R.Q.); (C.H.); (A.M.); (R.P.); (A.K.-D.); (J.W.-S.); (K.K.); (H.S.); (D.A.-O.); (T.L.); (B.L.-A.); (H.-P.K.); (E.R.)
| | - Johannes Haybäck
- Institute for Pathology, Neuropathology and Molecular Pathology, Medical University of Innsbruck, 6020 Innsbruck, Austria; (A.-M.B.-T.); (J.H.)
| | - Hans-Peter Kapfhammer
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Auenbruggerplatz 31, 8036 Graz, Austria; (A.R.); (F.T.F.); (M.P.); (M.S.); (L.-M.M.); (R.U.); (M.L.); (S.M.); (N.D.); (A.B.); (R.Q.); (C.H.); (A.M.); (R.P.); (A.K.-D.); (J.W.-S.); (K.K.); (H.S.); (D.A.-O.); (T.L.); (B.L.-A.); (H.-P.K.); (E.R.)
| | - Eva Reininghaus
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Auenbruggerplatz 31, 8036 Graz, Austria; (A.R.); (F.T.F.); (M.P.); (M.S.); (L.-M.M.); (R.U.); (M.L.); (S.M.); (N.D.); (A.B.); (R.Q.); (C.H.); (A.M.); (R.P.); (A.K.-D.); (J.W.-S.); (K.K.); (H.S.); (D.A.-O.); (T.L.); (B.L.-A.); (H.-P.K.); (E.R.)
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Wagner-Skacel J, Bengesser S, Dalkner N, Mörkl S, Painold A, Hamm C, Pilz R, Rieger A, Kapfhammer HP, Hiebler-Ragger M, Jauk E, Butler MI, Reininghaus EZ. Personality Structure and Attachment in Bipolar Disorder. Front Psychiatry 2020; 11:410. [PMID: 32477186 PMCID: PMC7233168 DOI: 10.3389/fpsyt.2020.00410] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 04/22/2020] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND An impairment of self and interpersonal functioning has an impact on coping strategies, regulation of affect and stress. Little is known so far about the impairment of personality functioning in patients with bipolar disorder (BD). The aim of this study is to assess the effects of personality structure and attachment in BD patients on the symptom burden. METHODS Forty-six patients with the diagnosis of BD were assessed by the 12-item Operationalized Psychodynamic Diagnosis Structure Questionnaire (OPD-SQS), the short version of Experience in Close Relationship-revised (ECR-R-D), and the Brief Symptom Inventory-18 (BSI 18) to determine the level of personality functioning, attachment patterns, and symptom load. RESULTS We observed positive correlations between personality difficulties, insecure attachment, and symptom load in patients with BD. A low level of structural integration and an insecure attachment style in patients with BD were accompanied by a significantly higher symptom load (r = 0.66, p ≤ 0.01). Interestingly, there were no significant differences in the structural integration (T(1.44) = -0.93, p = 0.357) and in the attachment style attachment related avoidance: (T(1,44) = 1.50, p = 0.140); attachment related anxiety (T(1,44) = -0.781, p = 0.439) of study participants with BD when compared to the normative value of the general population. LIMITATIONS Our limitations are the small sample size of our group and the lack of a control group. CONCLUSION In general, our results suggest that there is a link between personality structure and affective dynamics including depressive, anxiety, and somatization symptoms in BD. These findings underline the increasing importance of assessing personality structure and attachment for diagnosis and treatment planning of BD.
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Affiliation(s)
- Jolana Wagner-Skacel
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz (MUG), Graz, Austria
- Department of Medical Psychology and Psychotherapy, MUG, Graz, Austria
| | - Susanne Bengesser
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz (MUG), Graz, Austria
| | - Nina Dalkner
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz (MUG), Graz, Austria
| | - Sabrina Mörkl
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz (MUG), Graz, Austria
| | - Annamaria Painold
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz (MUG), Graz, Austria
| | - Carlo Hamm
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz (MUG), Graz, Austria
| | - René Pilz
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz (MUG), Graz, Austria
| | - Alexandra Rieger
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz (MUG), Graz, Austria
| | - Hans-Peter Kapfhammer
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz (MUG), Graz, Austria
| | - Michaela Hiebler-Ragger
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz (MUG), Graz, Austria
- Gruener Kreis Society, Center for Integrative Addiction Research, Johnsdorf, Austria
| | - Emanuel Jauk
- Institute of Psychology, University of Graz, Graz, Austria
- Clinical Psychology and Behavioral Neuroscience, Technische Universität Dresden, Dresden, Germany
| | - Mary I. Butler
- Department for Psychiatry and Neurobehavioral Science, University College Cork, Cork, Ireland
| | - Eva Z. Reininghaus
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz (MUG), Graz, Austria
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Painold A, Faber PL, Reininghaus EZ, Mörkl S, Holl AK, Achermann P, Saletu B, Saletu-Zyhlarz G, Anderer P, Dalkner N, Birner A, Bengesser S, Kapfhammer HP, Milz P. Reduced Brain Electric Activity and Functional Connectivity in Bipolar Euthymia: An sLORETA Source Localization Study. Clin EEG Neurosci 2020; 51:155-166. [PMID: 31845595 DOI: 10.1177/1550059419893472] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Bipolar disorder (BD) is a chronic illness with a relapsing and remitting time course. Relapses are manic or depressive in nature and intermitted by euthymic states. During euthymic states, patients lack the criteria for a manic or depressive diagnosis, but still suffer from impaired cognitive functioning as indicated by difficulties in executive and language-related processing. The present study investigated whether these deficits are reflected by altered intracortical activity in or functional connectivity between brain regions involved in these processes such as the prefrontal and the temporal cortices. Vigilance-controlled resting state EEG of 13 euthymic BD patients and 13 healthy age- and sex-matched controls was analyzed. Head-surface EEG was recomputed into intracortical current density values in 8 frequency bands using standardized low-resolution electromagnetic tomography. Intracortical current densities were averaged in 19 evenly distributed regions of interest (ROIs). Lagged coherences were computed between each pair of ROIs. Source activity and coherence measures between patients and controls were compared (paired t tests). Reductions in temporal cortex activity and in large-scale functional connectivity in patients compared to controls were observed. Activity reductions affected all 8 EEG frequency bands. Functional connectivity reductions affected the delta, theta, alpha-2, beta-2, and gamma band and involved but were not limited to prefrontal and temporal ROIs. The findings show reduced activation of the temporal cortex and reduced coordination between many brain regions in BD euthymia. These activation and connectivity changes may disturb the continuous frontotemporal information flow required for executive and language-related processing, which is impaired in euthymic BD patients.
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Affiliation(s)
- Annamaria Painold
- Department of Psychiatry and Psychotherapy, Medical University of Graz, Graz, Austria
| | - Pascal L Faber
- Department of Psychiatry, Psychotherapy and Psychosomatics, The KEY Institute for Brain-Mind Research, University Hospital of Psychiatry, Zurich, Switzerland
| | - Eva Z Reininghaus
- Department of Psychiatry and Psychotherapy, Medical University of Graz, Graz, Austria
| | - Sabrina Mörkl
- Department of Psychiatry and Psychotherapy, Medical University of Graz, Graz, Austria
| | - Anna K Holl
- Department of Psychiatry and Psychotherapy, Medical University of Graz, Graz, Austria
| | - Peter Achermann
- Department of Psychiatry, Psychotherapy and Psychosomatics, The KEY Institute for Brain-Mind Research, University Hospital of Psychiatry, Zurich, Switzerland
| | - Bernd Saletu
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Gerda Saletu-Zyhlarz
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Peter Anderer
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Nina Dalkner
- Department of Psychiatry and Psychotherapy, Medical University of Graz, Graz, Austria
| | - Armin Birner
- Department of Psychiatry and Psychotherapy, Medical University of Graz, Graz, Austria
| | - Susanne Bengesser
- Department of Psychiatry and Psychotherapy, Medical University of Graz, Graz, Austria
| | - Hans-Peter Kapfhammer
- Department of Psychiatry and Psychotherapy, Medical University of Graz, Graz, Austria
| | - Patricia Milz
- Department of Psychiatry, Psychotherapy and Psychosomatics, The KEY Institute for Brain-Mind Research, University Hospital of Psychiatry, Zurich, Switzerland
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Teasdale S, Mörkl S, Müller-Stierlin AS. Nutritional psychiatry in the treatment of psychotic disorders: Current hypotheses and research challenges. Brain Behav Immun Health 2020; 5:100070. [PMID: 34589852 PMCID: PMC8474162 DOI: 10.1016/j.bbih.2020.100070] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 04/10/2020] [Accepted: 04/16/2020] [Indexed: 02/07/2023] Open
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Mörkl S, Seltenreich D, Letmaier M, Bengesser S, Wurm W, Grohmann R, Bleich S, Toto S, Stübner S, Butler MI, Kasper S. Extrapyramidal reactions following treatment with antidepressants: Results of the AMSP multinational drug surveillance programme. World J Biol Psychiatry 2020; 21:308-316. [PMID: 31347932 DOI: 10.1080/15622975.2019.1648871] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Objectives: Extrapyramidal symptoms (EPS) are a common adverse effect of antipsychotics. However, there are case reports describing EPS following treatment with antidepressants. It is not fully understood how antidepressants cause EPS, but a serotonergic input to dopaminergic pathways is a probable mechanism of action.Methods: Data from a multicenter drug-surveillance programme (AMSP, 'drug safety in psychiatry') which systemically documents severe drug reactions during psychiatric inpatient admissions, were reviewed to assess for EPS associated with antidepressant treatment. We identified 15 such cases, which were studied to detect similarities and to characterise risk factors.Results: We report on 15 patients with EPS following antidepressant-therapy between 1994 and 2016. EPS frequently occurred with selective serotonin reuptake inhibitor (SSRI) treatment alone (7/15 cases) or concomitant SSRI treatment (6/15 cases). EPS were most frequent with escitalopram-treatment (5 cases). The most common EPS was atypical dyskinesia (6/15 cases) followed by akathisia (4/15 cases). The mean age of onset for EPS was 54.93 years (SD 17.9). EPS occurred at any dosage and equally often in men and women.Conclusions: Our results highlight the possibility of EPS as an important, although uncommon, adverse effect of antidepressants. Clinicians should beware of this adverse effect and monitor early warning signs carefully.
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Affiliation(s)
- Sabrina Mörkl
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Daniel Seltenreich
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Martin Letmaier
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Susanne Bengesser
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Walter Wurm
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Renate Grohmann
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany
| | - Stefan Bleich
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Sermin Toto
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Susanne Stübner
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany
| | - Mary I Butler
- Department of Psychiatry and Neurobehavioral Science, University College Cork, Cork, Ireland
| | - Siegfried Kasper
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
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Butler MI, Mörkl S, Sandhu KV, Cryan JF, Dinan TG. The Gut Microbiome and Mental Health: What Should We Tell Our Patients?: Le microbiote Intestinal et la Santé Mentale : que Devrions-Nous dire à nos Patients? Can J Psychiatry 2019; 64:747-760. [PMID: 31530002 PMCID: PMC6882070 DOI: 10.1177/0706743719874168] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The gut microbiome as a potential therapeutic target for mental illness is a hot topic in psychiatry. Trillions of bacteria reside in the human gut and have been shown to play a crucial role in gut-brain communication through an influence on neural, immune, and endocrine pathways. Patients with various psychiatric disorders including depression, bipolar disorder, schizophrenia, and autism spectrum disorder have been shown to have significant differences in the composition of their gut microbiome. Enhancing beneficial bacteria in the gut, for example, through the use of probiotics, prebiotics, or dietary change, has the potential to improve mood and reduce anxiety in both healthy people and patient groups. Much attention is being given to this subject in the general media, and patients are becoming increasingly interested in the potential to treat mental illness with microbiome-based therapies. It is imperative that those working with people with mental illness are aware of the rationale and current evidence base for such treatment strategies. In this review, we provide an overview of the gut microbiome, what it is, and what it does in relation to gut-brain communication and psychological function. We describe the fundamental principles and basic techniques used in microbiome-gut-brain axis research in an accessible way for a clinician audience. We summarize the current evidence in relation to microbiome-based strategies for various psychiatric disorders and provide some practical advice that can be given to patients seeking to try a probiotic for mental health benefit.
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Affiliation(s)
- Mary I Butler
- Department of Psychiatry and APC Microbiome Institute, University College Cork, Ireland
| | - Sabrina Mörkl
- Department of Psychiatry and APC Microbiome Institute, University College Cork, Ireland.,Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Austria
| | - Kiran V Sandhu
- Department of Anatomy and Neuroscience and APC Microbiome Institute, University College Cork, Ireland
| | - John F Cryan
- Department of Anatomy and Neuroscience and APC Microbiome Institute, University College Cork, Ireland
| | - Timothy G Dinan
- Department of Psychiatry and APC Microbiome Institute, University College Cork, Ireland
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Bengesser SA, Mörkl S, Painold A, Dalkner N, Birner A, Fellendorf FT, Platzer M, Queissner R, Hamm C, Maget A, Pilz R, Rieger A, Wagner-Skacel J, Reininghaus B, Kapfhammer HP, Petek E, Kashofer K, Halwachs B, Holzer P, Waha A, Reininghaus EZ. Epigenetics of the molecular clock and bacterial diversity in bipolar disorder. Psychoneuroendocrinology 2019; 101:160-166. [PMID: 30465968 DOI: 10.1016/j.psyneuen.2018.11.009] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 11/04/2018] [Accepted: 11/06/2018] [Indexed: 12/31/2022]
Abstract
Objectives The gut microbiome harbors substantially more genetic material than our body cells and has an impact on a huge variety of physiological mechanisms including the production of neurotransmitters and the interaction with brain functions through the gut-brain-axis. Products of microbiota can affect methylation according to preclinical studies. The current investigation aimed at analyzing the correlation between gut microbiome diversity and the methylation of the clock gene ARNTL in individuals with Bipolar Disorder (BD). Methods Genomic DNA was isolated from fasting blood of study participants with BD (n = 32). The methylation analysis of the ARNTL CG site cg05733463 was performed by bisulfite treatment of genomic DNA with the Epitect kit, PCR and pyrosequencing. Additionally, DNA was extracted from stool samples and subjected to 16S rRNA sequencing. QIIME was used to analyze microbiome data. Results Methylation status of the ARNTL CpG position cg05733463 correlated significantly with bacterial diversity (Simpson index: r= -0.389, p = 0.0238) and evenness (Simpson evenness index: r= -0.358, p = 0.044). Furthermore, bacterial diversity differed significantly between euthymia and depression (F(1,30) = 4.695, p = 0.039). Discussion The results of our pilot study show that bacterial diversity differs between euthymia and depression. Interestingly, gut microbiome diversity and evenness correlate negatively with methylation of ARNTL, which is known to regulate monoamine oxidase A transcription. We propose that alterations in overall diversity of the gut microbiome represent an internal environmental factor that has an epigenetic impact on the clock gene ARNTL which is thought to be involved in BD pathogenesis.
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Affiliation(s)
- S A Bengesser
- Medical University of Graz (MUG), Department of Psychiatry and Psychotherapeutic Medicine, Austria
| | - S Mörkl
- Medical University of Graz (MUG), Department of Psychiatry and Psychotherapeutic Medicine, Austria.
| | - A Painold
- Medical University of Graz (MUG), Department of Psychiatry and Psychotherapeutic Medicine, Austria
| | - N Dalkner
- Medical University of Graz (MUG), Department of Psychiatry and Psychotherapeutic Medicine, Austria
| | - A Birner
- Medical University of Graz (MUG), Department of Psychiatry and Psychotherapeutic Medicine, Austria
| | - F T Fellendorf
- Medical University of Graz (MUG), Department of Psychiatry and Psychotherapeutic Medicine, Austria
| | - M Platzer
- Medical University of Graz (MUG), Department of Psychiatry and Psychotherapeutic Medicine, Austria
| | - R Queissner
- Medical University of Graz (MUG), Department of Psychiatry and Psychotherapeutic Medicine, Austria
| | - C Hamm
- Medical University of Graz (MUG), Department of Psychiatry and Psychotherapeutic Medicine, Austria
| | - A Maget
- Medical University of Graz (MUG), Department of Psychiatry and Psychotherapeutic Medicine, Austria
| | - R Pilz
- Medical University of Graz (MUG), Department of Psychiatry and Psychotherapeutic Medicine, Austria
| | - A Rieger
- Medical University of Graz (MUG), Department of Psychiatry and Psychotherapeutic Medicine, Austria
| | - J Wagner-Skacel
- Medical University of Graz (MUG), Department of Psychiatry and Psychotherapeutic Medicine, Austria
| | - B Reininghaus
- Medical University of Graz (MUG), Department of Psychiatry and Psychotherapeutic Medicine, Austria
| | - H P Kapfhammer
- Medical University of Graz (MUG), Department of Psychiatry and Psychotherapeutic Medicine, Austria
| | - E Petek
- MUG, Diagnostic & Research Institute of Human Genetics, Austria
| | | | | | - P Holzer
- MUG, Otto Loewi Research Centre, Austria
| | - A Waha
- University of Bonn, Institute of Neuropathology, Germany
| | - E Z Reininghaus
- Medical University of Graz (MUG), Department of Psychiatry and Psychotherapeutic Medicine, Austria
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Painold A, Mörkl S, Kashofer K, Halwachs B, Dalkner N, Bengesser S, Birner A, Fellendorf F, Platzer M, Queissner R, Schütze G, Schwarz MJ, Moll N, Holzer P, Holl AK, Kapfhammer H, Gorkiewicz G, Reininghaus EZ. A step ahead: Exploring the gut microbiota in inpatients with bipolar disorder during a depressive episode. Bipolar Disord 2019; 21:40-49. [PMID: 30051546 PMCID: PMC6585963 DOI: 10.1111/bdi.12682] [Citation(s) in RCA: 118] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVES There is evidence that the gut microbiota plays a major role in the pathogenesis of diseases of the central nervous system through the gut-brain axis. The aim of the present study was to analyze gut microbiota composition in bipolar disorder (BD) and its relation to inflammation, serum lipids, oxidative stress, tryptophan (TRP)/kynurenine (KYN) levels, anthropometric measurements and parameters of metabolic syndrome. Further, microbial community differences of individuals with BD compared with healthy controls (HC) were explored. METHODS In this cross-sectional study, we performed 16S rRNA gene sequencing of stool samples from 32 BD individuals and 10 HC. Laboratory parameters included inflammatory markers, serum lipids, KYN, oxidative stress and anthropometric measures. Microbial community analysis and correlation to clinical parameters was performed with QIIME, differential abundance analysis of taxa encompassed linear discriminant analysis effect size (LEfSe). RESULTS We found a negative correlation between microbial alpha-diversity and illness duration in BD (R = -0.408, P = 0.021). Furthermore, we identified bacterial clades associated with inflammatory status, serum lipids, TRP, depressive symptoms, oxidative stress, anthropometrics and metabolic syndrome in individuals with BD. LEfSe identified the phylum Actinobacteria (LDA= 4.82, P = 0.007) and the class Coriobacteria (LDA= 4.75, P = 0.010) as significantly more abundant in BD when compared with HC, and Ruminococcaceae (LDA= 4.59, P = 0.018) and Faecalibacterium (LDA= 4.09, P = 0.039) as more abundant in HC when compared with BD. CONCLUSIONS The present findings suggest that causes and/or consequences of BD may also lie outside the brain. Exploratory research of the gut microbiota in affective disorders like BD may identify previously unknown underlying causes, and offer new research and therapeutic approaches to mood disorders.
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Affiliation(s)
- Annamaria Painold
- Department of Psychiatry and Psychotherapeutic MedicineMedical University of GrazGrazAustria
| | - Sabrina Mörkl
- Department of Psychiatry and Psychotherapeutic MedicineMedical University of GrazGrazAustria
| | - Karl Kashofer
- Institute of PathologyMedical University of GrazGrazAustria
| | | | - Nina Dalkner
- Department of Psychiatry and Psychotherapeutic MedicineMedical University of GrazGrazAustria
| | - Susanne Bengesser
- Department of Psychiatry and Psychotherapeutic MedicineMedical University of GrazGrazAustria
| | - Armin Birner
- Department of Psychiatry and Psychotherapeutic MedicineMedical University of GrazGrazAustria
| | - Frederike Fellendorf
- Department of Psychiatry and Psychotherapeutic MedicineMedical University of GrazGrazAustria
| | - Martina Platzer
- Department of Psychiatry and Psychotherapeutic MedicineMedical University of GrazGrazAustria
| | - Robert Queissner
- Department of Psychiatry and Psychotherapeutic MedicineMedical University of GrazGrazAustria
| | - Gregor Schütze
- Institute of Laboratory MedicineMedical Center of Munich University (LMU)MunichGermany
| | - Markus J. Schwarz
- Institute of Laboratory MedicineMedical Center of Munich University (LMU)MunichGermany
| | - Natalie Moll
- Institute of Laboratory MedicineMedical Center of Munich University (LMU)MunichGermany
| | - Peter Holzer
- Institute of Experimental and Clinical PharmacologyMedical University of GrazGrazAustria
| | - Anna K. Holl
- Department of Psychiatry and Psychotherapeutic MedicineMedical University of GrazGrazAustria
| | - Hans‐Peter Kapfhammer
- Department of Psychiatry and Psychotherapeutic MedicineMedical University of GrazGrazAustria
| | | | - Eva Z. Reininghaus
- Department of Psychiatry and Psychotherapeutic MedicineMedical University of GrazGrazAustria
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Lackner S, Mörkl S, Müller W, Fürhapter-Rieger A, Oberascher A, Lehofer M, Bieberger C, Wonisch W, Amouzadeh-Ghadikolai O, Moser M, Mangge H, Zelzer S, Holasek SJ. Novel approaches for the assessment of relative body weight and body fat in diagnosis and treatment of anorexia nervosa: A cross-sectional study. Clin Nutr 2019; 38:2913-2921. [PMID: 30670293 DOI: 10.1016/j.clnu.2018.12.031] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 10/26/2018] [Accepted: 12/21/2018] [Indexed: 12/23/2022]
Abstract
BACKGROUND & AIMS Anorexia nervosa (AN) is a severe psychosomatic disease that seriously affects nutritional status. Therapeutic approaches primarily aim for rapid weight restoration by high caloric diets and activity restriction. This often promotes abdominal body fat gain, which potentially negatively influences the patient's compliance and increases the risk of relapse. This study focused on the evaluation of body weight and subcutaneous adipose tissue (SAT) in AN patients by novel approaches. METHODS The SAT of AN patients (n = 18, body mass index (BMI) 15.3 ± 1.3 kg/m2) was determined by a highly accurate and reliable ultrasound method. The sum of SAT thicknesses of eight sites (DINCL) was calculated. Individual metabolic profiles were analyzed. The mass index (MI), which considers body proportions, was used in addition to BMI. Additional to the standard laboratory diagnostics, dermal carotenoids measured by resonance Raman spectroscopy, leptin, and oxidative stress indicators were determined. RESULTS The mean MI was 15.7 ± 1.4 kg/m2. The DINCL considerably differed between individuals with the same BMI. Half of the patients (Group 1) had low DINCL: 1.3-28.4 mm, and Group 2 showed values up to 58.2 mm (corresponding to approximately 6 kg SAT mass). The two group means differed by more than 300% (P < 0.001). Accordingly, leptin levels significantly differed (P < 0.001). Mean SAT thicknesses were significantly higher in Group 2 at all eight sites. The groups also significantly differed in two oxidative stress parameters: total antioxidative capacity, malondialdehyde-modified low density lipoprotein immunoglobulin M (MDA-LDL IgM), and in the carotenoid level. CONCLUSION Half of the patients had sufficiently high fat mass, despite very low BMI. Consequently, their muscle (and other organ) masses must have been extremely low. Diagnostic criteria and treatment protocols for AN should consider each patient's body composition. In addition to dietary treatments, muscle training at low energy turnover rates may be essential for avoiding unnecessary body fat gain, better treatment results, and long-term recovery.
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Affiliation(s)
- Sonja Lackner
- Department of Immunology and Pathophysiology, Medical University of Graz, Otto Loewi Research Center, Heinrichstraße, Graz, Austria
| | - Sabrina Mörkl
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Auenbruggerplatz, Graz, Austria
| | - Wolfram Müller
- Department of Biophysics, Medical University of Graz, Gottfried Schatz Research Center, Neue Stiftingtalstraße, Graz, Austria.
| | - Alfred Fürhapter-Rieger
- Department of Biophysics, Medical University of Graz, Gottfried Schatz Research Center, Neue Stiftingtalstraße, Graz, Austria
| | - Andreas Oberascher
- Department of Immunology and Pathophysiology, Medical University of Graz, Otto Loewi Research Center, Heinrichstraße, Graz, Austria
| | - Michael Lehofer
- State Hospital Graz South-West, Location South, Wagner Jauregg Platz, Graz, Austria
| | - Claudia Bieberger
- State Hospital Graz South-West, Location South, Wagner Jauregg Platz, Graz, Austria
| | - Willibald Wonisch
- Department of Physiological Chemistry, Medical University of Graz, Otto Loewi Research Center, Neue Stiftingtalstraße, Graz, Austria
| | | | - Maximilian Moser
- Department of Physiology, Medical University of Graz, Otto Loewi Research Center, Neue Stiftingtalstraße, Graz, Austria; Human Research Institute, Franz-Pichler-Straße, Weiz, Austria
| | - Harald Mangge
- Clinical Institute for Medical and Chemical Laboratory Diagnosis, Medical University of Graz, Auenbruggerplatz, Graz, Austria
| | - Sieglinde Zelzer
- Clinical Institute for Medical and Chemical Laboratory Diagnosis, Medical University of Graz, Auenbruggerplatz, Graz, Austria
| | - Sandra Johanna Holasek
- Department of Immunology and Pathophysiology, Medical University of Graz, Otto Loewi Research Center, Heinrichstraße, Graz, Austria
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Mörkl S, Meinitzer A, Dschietzig TB, Mangge H, Lackner S, Holasek SJ. Response to Letter to the Editor to Gut microbiota, dietary intakes and intestinal permeability reflected by serum zonulin in women. Eur J Nutr 2018; 57:3001-3002. [PMID: 30291420 DOI: 10.1007/s00394-018-1836-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Sabrina Mörkl
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Andreas Meinitzer
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
| | - Thomas Bernd Dschietzig
- Clinic for Cardiology and Angiology/Immundiagnostik AG, Charitè, University of Medicine Berlin, Campus Mitte, Stubenwald-Allee 8a, 64625, Bensheim, Germany
| | - Harald Mangge
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
| | - Sonja Lackner
- Division of Immunology and Pathophysiology, Otto Loewi Research Center (for Vascular Biology, Immunology and Inflammation), Medical University of Graz, Graz, Austria.
| | - Sandra Johanna Holasek
- Division of Immunology and Pathophysiology, Otto Loewi Research Center (for Vascular Biology, Immunology and Inflammation), Medical University of Graz, Graz, Austria
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Mörkl S, Wagner-Skacel J, Lahousen T, Lackner S, Holasek SJ, Bengesser SA, Painold A, Holl AK, Reininghaus E. The Role of Nutrition and the Gut-Brain Axis in Psychiatry: A Review of the Literature. Neuropsychobiology 2018; 79:1-9. [PMID: 30223263 DOI: 10.1159/000492834] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Accepted: 08/11/2018] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Individuals suffering from psychiatric disorders experience high levels of illness burden and a significantly reduced quality of life. Despite targeted psychopharmacological strategies and complementary psychotherapeutic procedures only moderate effects are obtained, and the risk of relapse is high in many patients. Worldwide, psychiatric diseases such as depression are continuously increasing, challenging the personal life of the affected as well as their families, but also whole societies by increasing disability, early retirement and hospitalization. According to current scientific knowledge psychiatric disorders are caused by a multifactorial pathogenesis, including genetics, inflammation and neurotransmitter imbalance; furthermore, also lifestyle-associated factors gain rising importance. In line with this, there is growing evidence that the gut microbiota and nutrition have an impact on the onset and course of psychiatric disorders. AIM This narrative review highlights the important role of nutrition in psychiatric care and underlines the significance of nutritional advice in the multifactorial, biopsychosocial treatment of patients. It focuses on current dietary interventions such as the Mediterranean diet, dietary supplements and modifications of the gut microbiota with pre-, pro- and postbiotics. RESULTS Recent studies support the connection between the quality of diet, gut microbiota and mental health through regulation of metabolic functions, anti-inflammatory and antiapoptotic properties and the support of neurogenesis. Dietary coaching to improve mental health seems to be an additional, cost-effective, practical, nonpharmacological intervention for individuals with psychiatric disorders. CONCLUSION The use of nutritional interventions in psychiatry equips therapists with a promising tool for both the prevention and treatment of psychiatric disorders. Besides pharmacological therapy, psychotherapy and physical activity, nutritional interventions are an important pillar in the multifactorial, biopsychosocial treatment of psychiatric disease and could be used as a potential therapeutic target.
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Affiliation(s)
- Sabrina Mörkl
- Department for Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Jolana Wagner-Skacel
- Department for Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Theresa Lahousen
- Department for Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Sonja Lackner
- Unit of Immunology and Pathophysiology, Otto Loewi Research Center (for Vascular Biology, Immunology and Inflammation), Medical University of Graz, Graz, Austria
| | - Sandra Johanna Holasek
- Unit of Immunology and Pathophysiology, Otto Loewi Research Center (for Vascular Biology, Immunology and Inflammation), Medical University of Graz, Graz, Austria
| | - Susanne Astrid Bengesser
- Department for Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Annamaria Painold
- Department for Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Anna Katharina Holl
- Department for Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Eva Reininghaus
- Department for Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
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Mörkl S, Lackner S, Meinitzer A, Gorkiewicz G, Kashofer K, Painold A, Holl A, Holasek S. [Pilot study: Gut microbiome and intestinal barrier in anorexia nervosa]. Fortschr Neurol Psychiatr 2018; 87:39-45. [PMID: 30049020 DOI: 10.1055/s-0043-123826] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Recent research has shown changes of the intestinal flora in anorexia nervosa (AN) patients. Alpha diversity (AD) represents the number of different bacterial species in the gut. Reduced AD and a leaky gut (zonulin) lead to inflammation and changes in nutrient absorption. METHODS AD was calculated from stool samples of 18 AN patients and 20 normal weight controls (NC) after 16S ribosomal RNA sequencing. Furthermore, Zonulin as an indicator of gut barrier function and inflammation parameters were investigated. RESULTS AN patients had significantly lower AD compared to NC (number of observed species p=0.042, Chao1 Diversity Index p=0.043). Zonulin was not significantly altered in AN patients compared to NC. There were no significant correlations of serum parameters and AD. DISCUSSION Regardless of gut permeability, AN patients showed significantly decreased AD compared to NC. Decreased AD can have an additional negative impact on calorie intake in AN. These results contribute to a better understanding of the illness and the development of new therapeutic options.
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Mörkl S, Lackner S, Müller W, Gorkiewicz G, Kashofer K, Oberascher A, Painold A, Holl A, Holzer P, Meinitzer A, Mangge H, Holasek S. Gut microbiota and body composition in anorexia nervosa inpatients in comparison to athletes, overweight, obese, and normal weight controls. Int J Eat Disord 2017; 50:1421-1431. [PMID: 29131365 DOI: 10.1002/eat.22801] [Citation(s) in RCA: 100] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 10/03/2017] [Accepted: 10/24/2017] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Anorexia nervosa (AN) is a heterogeneous eating disorder associated with alterations of body structure and the gut microbiome. We aimed to investigate the gut microbiota composition of a large female cohort including different BMI groups and activity levels along with body composition parameters. METHOD 106 female participants were included in this cross-sectional study: AN patients (n = 18), athletes (n = 20), normal weight (n = 26), overweight (n = 22), and obese women (n = 20). DNA was extracted from stool samples and subjected to 16S rRNA gene analysis. The software Quantitative Insights Into Microbial Ecology (QIIME) was used to analyze data. Additionally, we performed anthropometric assessments, ultrasound measurements of subcutaneous adipose tissue thickness, bioimpedance analysis, administered depression inventories, and ascertained laboratory parameters and dietary intakes. RESULTS Alpha diversity was particularly lower in AN patients and obese participants compared to other groups, while athletes showed highest alpha diversity. Several categories significantly associated with community structure were identified: body fat parameters, serum lipids, CRP, depression scales and smoking. Comparative analysis revealed Coriobacteriaceae as the only enriched phylotype in AN compared to other entities (LDA score >3.5). DISCUSSION This study provides further evidence of intestinal dysbiosis in AN and sheds light on characteristics of the gut microbiome in different BMI and physical activity groups. These insights point to new modulation possibilities of the gut microbiota which could improve the standard therapy of AN.
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Affiliation(s)
- Sabrina Mörkl
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Sonja Lackner
- Institute of Pathophysiology and Immunology, Medical University of Graz, Graz, Austria
| | - Wolfram Müller
- Institute of Biophysics, Medical University of Graz, Graz, Austria
| | | | - Karl Kashofer
- Institute of Pathology, Medical University of Graz, Graz, Austria
| | - Andreas Oberascher
- Institute of Pathophysiology and Immunology, Medical University of Graz, Graz, Austria
| | - Annamaria Painold
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Anna Holl
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Peter Holzer
- Institute of Experimental and Clinical Pharmacology, Medical University of Graz, Graz, Austria
| | - Andreas Meinitzer
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
| | - Harald Mangge
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
| | - Sandra Holasek
- Institute of Pathophysiology and Immunology, Medical University of Graz, Graz, Austria
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Mörkl S, Tmava A, Blesl C, Schmiedhofer F, Wurm WE, Holl A, Painold A. [The power plants of the cell: Treatment of psychiatric symptoms in patients with mitochondriopathy]. Fortschr Neurol Psychiatr 2017; 85:474-478. [PMID: 28841746 DOI: 10.1055/s-0043-113824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Introduction Mitochondriopathies are pathologies of cell organelles, which are essential for the formation of adenosine triphosphate (ATP), which is responsible for cellular energy stock. When mitochondrial mutations occur, symptoms arise frequently in those organs that rely on a continuous energy supply, such as the nervous system. Although psychiatric illness is increasingly prevalent in patients with mitochondrial disease, less attention has been paid to its psychiatric presentations. Case Report We describe a case of a 21-year-old woman who presented in our outpatient department with panic attacks and depression. The patient experienced major side effects after low-dose sertraline therapy. Conclusion Mitochondriopathies belong to the class of rare illnesses in psychiatry; nevertheless, they require adaptations of psychopharmacological therapy. Psychotropic drugs are potential respiratory chain inhibitors and could lead to distinct side effects.
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Mörkl S, Lackner S, Gorkiewicz G, Kashofer K, Blesl C, Tmava A, Oberascher A, Holasek S. Interplay of Gut Microbiota, Body Mass Index and Depression Scores in Anorexia Nervosa: Preliminary Data. Eur Psychiatry 2017. [DOI: 10.1016/j.eurpsy.2017.01.287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
IntroductionAnorexia nervosa (AN) is a lethal psychiatric disease with only narrow treatment possibilities. Recent study results point out, that gut microbiota might be a contributing factor in the development and persistence of AN through effects on the gut-brain-axis.MethodsWe used 16SRNA sequencing to characterize the composition and diversity of the gut microbiota of 18 AN patients, 19 normal weight controls and 19 athletes matched by age using stool samples. The QIIME-pipeline was used to assess the sequencing result. All participants completed an activity-questionnaire (IPAQ) and inventories to measure depression (BDI, HAMD).ResultsKruskal-Wallis test identified significant differences in alpha-diversity (Chao-1-estimator [P = 0.013], number of observed species [P = 0.027]) between groups. Spearman-Correlation revealed a significant correlation of number of observed species (r = 0.366, P = 0.006) Chao-1-estimator (r = 0.352, P = 0.008) and BMI (Fig. 1). Furthermore, a higher BMI was related to lower depression scores (r = 0.351, P < 0.001). Although there was a tendency of a negative correlation of BDI-scores and alpha-diversity (r = –0.180, P = 0.059), correlations with depression scores and IPAQ-scores did not reach significance level (Fig. 1).ConclusionsOur preliminary data demonstrate correlations of alpha-diversity and BMI. Further studies are needed to provide further insights in AN gut microbiota and its influence factors.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Störchle P, Müller W, Sengeis M, Ahammer H, Fürhapter-Rieger A, Bachl N, Lackner S, Mörkl S, Holasek S. Standardized Ultrasound Measurement of Subcutaneous Fat Patterning: High Reliability and Accuracy in Groups Ranging from Lean to Obese. Ultrasound Med Biol 2017; 43:427-438. [PMID: 27866704 DOI: 10.1016/j.ultrasmedbio.2016.09.014] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 09/08/2016] [Accepted: 09/09/2016] [Indexed: 06/06/2023]
Abstract
A recently standardized ultrasound technique for measuring subcutaneous adipose tissue (SAT) was applied to normal-weight, overweight and obese persons. Eight measurement sites were used: upper abdomen, lower abdomen, erector spinae, distal triceps, brachioradialis, lateral thigh, front thigh and medial calf. Fat compression was avoided. Fat patterning in 38 participants (body mass index: 18.6-40.3 kgm-2; SAT thickness sums from eight sites: 12-245 mm) was evaluated using a software specifically designed for semi-automatic multiple thickness measurements in SAT (sound speed: 1450 m/s) that also quantifies embedded fibrous structures. With respect to ultrasound intra-observer results, the correlation coefficient ρ = 0.999 (p < 0.01), standard error of the estimate = 1.1 mm and 95% of measurements were within ±2.2 mm. For the normal-weight subgroup, the median measurement deviation was 0.43 mm (1.1% of mean thickness), and for the obese/overweight subgroup it was 0.89 mm (0.5%). The eight sites used here are suggested to represent inter-individual differences in SAT patterning. High measurement accuracy and reliability can be obtained in all groups, from lean to overweight and obese, provided that measurers are trained appropriately.
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Affiliation(s)
- Paul Störchle
- Institute of Biophysics, Medical University of Graz, Graz, Austria
| | - Wolfram Müller
- Institute of Biophysics, Medical University of Graz, Graz, Austria.
| | - Marietta Sengeis
- Institute of Biophysics, Medical University of Graz, Graz, Austria
| | - Helmut Ahammer
- Institute of Biophysics, Medical University of Graz, Graz, Austria
| | | | - Norbert Bachl
- Centre of Sports Science, Department of Sports and Physiological Performance, University of Vienna, Vienna, Austria
| | - Sonja Lackner
- Institute of Pathophysiology and Immunology, Medical University of Graz, Graz, Austria
| | - Sabrina Mörkl
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Sandra Holasek
- Institute of Pathophysiology and Immunology, Medical University of Graz, Graz, Austria
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Mörkl S, Müller NJ, Blesl C, Wilkinson L, Tmava A, Wurm W, Holl AK, Painold A. Problem solving, impulse control and planning in patients with early- and late-stage Huntington's disease. Eur Arch Psychiatry Clin Neurosci 2016; 266:663-71. [PMID: 27372072 PMCID: PMC5037143 DOI: 10.1007/s00406-016-0707-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 06/11/2016] [Indexed: 12/14/2022]
Abstract
Sub-domains of executive functions, including problems with planning, accuracy, impulsivity, and inhibition, are core features of Huntington's disease. It is known that the decline of cognitive function in Huntington's disease is related to the anatomical progression of pathology in the basal ganglia. However, it remains to be determined whether the severity of executive dysfunction depends on the stage of the disease. To examine the severity of sub-domains of executive dysfunction in early- and late-stage Huntington's disease, we studied performance in the Tower of London task of two groups of Huntington's disease patients (Group 1: early, n = 23, and Group 2: late stage, n = 29), as well as a third group of age, education, and IQ matched healthy controls (n = 34). During the task, we measured the total number of problems solved, total planning time, and total number of breaks taken. One aspect of executive function indexed by the number of solved problems seems to progress in the course of the disease. Late-stage Huntington's disease patients scored significantly worse than early-stage patients and controls, and early-stage patients scored significantly worse than controls on this measure of accuracy. In contrast, late- and early-stage HD patients did not differ in terms of planning time and number of breaks. Early- and late-stage HD pathology has a different impact on executive sub-domains. While accuracy differs between early- and late-stage HD patients, other domains like planning time and number of breaks do not. Striatal degeneration, which is a characteristic feature of the disease, might not affect all aspects of executive function in HD.
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Affiliation(s)
- Sabrina Mörkl
- Department of Psychiatry, Medical University of Graz, Auenbruggerplatz 31/1, 8036, Graz, Austria
| | - Nicole J Müller
- Department of Psychiatry, Medical University of Graz, Auenbruggerplatz 31/1, 8036, Graz, Austria
| | - Claudia Blesl
- Department of Psychiatry, Medical University of Graz, Auenbruggerplatz 31/1, 8036, Graz, Austria.
| | - Leonora Wilkinson
- Behavioral Neurology Unit, National Institute of Neurological Disorders and Stroke, National Institutes of Health, 10 Center Dr., MSC 1440, Bethesda, MD, 20892-1440, USA
| | - Adelina Tmava
- Department of Psychiatry, Medical University of Graz, Auenbruggerplatz 31/1, 8036, Graz, Austria
| | - Walter Wurm
- Department of Psychiatry, Medical University of Graz, Auenbruggerplatz 31/1, 8036, Graz, Austria
| | - Anna K Holl
- Department of Psychiatry, Medical University of Graz, Auenbruggerplatz 31/1, 8036, Graz, Austria
| | - Annamaria Painold
- Department of Psychiatry, Medical University of Graz, Auenbruggerplatz 31/1, 8036, Graz, Austria
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Abstract
INTRODUCTION Mocarz is a Legal high that consists of dried parts of plants mixed with synthetic cannabinoids. There is currently limited information on its acute toxicity. CASE REPORT We describe a 35-year-old patient with no previous medical and psychiatric history who was admitted to the psychiatric clinic after developing agitation and paranoid psychotic symptoms following the use of Mocarz purchased over the internet. CONCLUSION Legal highs are a challenge in psychiatric acute care, because they provoke unpredictable mental states endangering self and others.
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Affiliation(s)
- S Mörkl
- Universitätsklinik für Psychiatrie, LKH Universitätsklinikum Graz
| | - C Blesl
- Universitätsklinik für Psychiatrie, LKH Universitätsklinikum Graz
| | - W E Wurm
- Klinik für Psychiatrie, Medizinische Universität Graz
| | - A Tmava
- Universitätsklinik für Psychiatrie, LKH Universitätsklinikum Graz
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Mörkl S, Blesl C, Tmava A, Wurm W, Holl A, Painold A. Inconsistent decline of executive functions in patients with early and late Huntington's disease. Eur Psychiatry 2016. [DOI: 10.1016/j.eurpsy.2016.01.1332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BackgroundHuntington's disease (HD) is characterized by executive dysfunctions like problems with planning, accuracy, inhibition and impulsivity. During the course of the disease executive function worsens with ongoing pathological changes in the basal ganglia. However, it is not clear whether cognitive dysfunction develops gradually or not during the course of the disease.MethodsWe assessed the development of executive dysfunction in 23 patients with early HD and 29 patients with late HD on the Tower of London (ToL) for the number of solved problems, planning time and number of breaks.ResultsHD patients showed a linear decrease of accuracy (as assessed by number of solved problems) during the course of the disease. Controls scored significantly higher than early stage HD patients and early stage HD patients scored significantly higher than late stage HD patients. In planning time and number of breaks a non-linear decrease was found.ConclusionExecutive dysfunctions in HD are not alone connected to degenerative changes in the striatum as they do not develop gradually and linear during the course of the disease. Obviously, executive function could not be seen as a single component, but as a combination of different abilities, which show a non-linear and non-parallel decline.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Mörkl S, Blesl C, Jahanshahi M, Painold A, Holl A. Impaired probabilistic classification learning with feedback in patients with major depression. Neurobiol Learn Mem 2016; 127:48-55. [DOI: 10.1016/j.nlm.2015.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Revised: 11/30/2015] [Accepted: 12/06/2015] [Indexed: 10/22/2022]
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Holl AK, Grohmann R, Letmaier M, Painold A, Mörkl S, Toto S, Kasper S. Pharmacotherapy of anxiety disorders in German-speaking countries: current status and changes between 1994 and 2011. Eur Arch Psychiatry Clin Neurosci 2015; 265:199-208. [PMID: 25138236 DOI: 10.1007/s00406-014-0523-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Accepted: 08/09/2014] [Indexed: 11/26/2022]
Abstract
Over the past years, international treatment guidelines have been established for the treatment of anxiety disorders. Nevertheless, little is known as to whether the actual inpatient treatment follows these guidelines. The main goal of this study was to answer the question whether patients with anxiety disorder are treated according to treatment guidelines. A total of 2,573 psychiatric inpatients with the diagnosis of anxiety disorder (920 men, 1,653 women) were identified on the basis of the data of the international drug safety programme in psychiatry AMSP. Of these patients, 25.3% presented with phobia, 26.6% with panic disorder, 18.7% with generalized anxiety disorder (GAD), and 29.4% with other diagnoses of anxiety. In all of the patients, 12.7% did not receive any psychotropic medication and 22.9% were not treated with antidepressants. Only 59.3% of patients with GAD, 73.9% of patients with panic disorder, and 52.1% of patients with phobia were treated according to diagnostic guidelines. The majority (60.3%) of all patients received one or two psychotropic drugs, and only 3.7% received five or more psychotropic drugs. In two groups of patients (one group with phobia and one with panic disorder), the annual prescription rate of antidepressants significantly increased over time. The prescription rate for anticonvulsants in patients with GAD increased from 0% in 1997 to 41.7% in 2011, and for antipsychotics, from 40.7% in 1997 to 47.2% in 2011. In particular, patients with GAD were commonly treated with antipsychotics.
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Affiliation(s)
- Anna K Holl
- Department of Psychiatry, Graz Medical University, Auenbruggerplatz 31, 8036, Graz, Austria
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Mörkl S, Bengesser SA, Schöggl H, Bayer D, Kapfhammer HP. [Tizanidine withdrawal symptoms in stress cardiomyopathy]. Fortschr Neurol Psychiatr 2015; 83:170-3. [PMID: 25794323 DOI: 10.1055/s-0034-1399167] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION An acute discontinuation of tizanidine, an alpha-2-agonistic muscle relaxant, is associated with reflex tachycardia, hypertension, tremor, hypertonicity and anxiety. CASE REPORT We describe a 53-year-old patient with broken-heart syndrome, who developed serious tizanidine withdrawal symptoms after high-dosed long-term treatment within the framework of stress cardiomyopathy. CONCLUSION Central muscle relaxants like tizanidine might have an impact on the development of delirium. Tizanidine withdrawal should be considered in patients who manifest signs and symptoms of withdrawal from medications. The drug should be gradually reduced in dosage under observation by a psychiatrist. When prescribing tizanidine, the possible pharmacological side effects and interactions should be taken into careful account.
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Affiliation(s)
- S Mörkl
- Universitätsklinik für Psychiatrie, Medizinische Universität Graz, Austria
| | - S A Bengesser
- Universitätsklinik für Psychiatrie, Medizinische Universität Graz, Austria
| | - H Schöggl
- Universitätsklinik für Psychiatrie, Medizinische Universität Graz, Austria
| | - D Bayer
- Universitätsklinik für Psychiatrie, Medizinische Universität Graz, Austria
| | - H P Kapfhammer
- Universitätsklinik für Psychiatrie, Medizinische Universität Graz, Austria
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