Impact of inequalities in health care on the mortality risk of individuals with severe mental illnesses

Univ Fed Sao Paulo, UNIFESP, Dept Psiquiatria, Res Grp Mol & Behav Neurosci Bipolar Disorder, Sao Paulo, BrazilUniv Hlth Network, Mood Disorders Psychopharmacol Unit, Toronto, ON, CanadaBrain & Cognit Res Fdn, Toronto, ON, CanadaUniv Fed Sao Paulo, UNIFESP, Dept Psiquiatria, Res Grp Mol & Behav Neurosci Bipolar Disorder, Sao Paulo, BrazilWeb of Scienc

Lean economies and innovation in mental health systems

Poor access to mental health care is widely reported, although it differs according to sociopolitical and economic contexts. In emerging economies, including Brazil, Russia, India, China, and South Africa (BRICS), there has been increased public investment in recent years, but rapid economic growth in these countries has now slowed. Precarious global transitions affect both the burden of mental health problems and demand for services. Innovations prompted by these transitions, in both high-income and low-income countries, could help meet population needs during times of economic shock, whether scarcity or affluence

Effects of Risperidone on Cytokine Profile in Drug-Naive First-Episode Psychosis

Background: There is robust evidence that schizophrenia is characterized by immune-inflammatory abnormalities, including variations on cytokine levels. the results of previous studies, however, are heterogeneous due to several confounding factors, such as the effects of antipsychotic drugs. Therefore, research on drug-naive first-episode psychosis (FEP) patients is essential to elucidate the role of immune processes in that disorder.Methods: the aim of this study is to compare cytokine levels (IL-2, IL-10, IL-4, IL-6, IFN-gamma, TNF-alpha, and IL-17) in drug-naive FEP patients both before and after treatment with risperidone for 10 weeks, and to investigate possible associations between cytokine levels and clinical responses to treatment and presence of depressive symptoms. It this study, we included 55 drug-naive FEP patients who had repeated measurements of cytokine levels and 57 healthy controls.Results: We found that FEP patients had significantly higher IL-6, IL-10 and TNF-alpha levels than healthy controls. After risperidone treatment, these three cytokines and additionally IL-4 decreased significantly. No significant difference was found between the post-treatment cytokine levels in FEP patients and in healthy controls, suggesting that these alterations in cytokine profiles are a state marker of FEP. No significant association was found between risperidone-induced changes in cytokines and the clinical response to treatment or the presence of depression. There was a significant inverse association between the risperidone-induced changes in IL-10 and the negative symptoms.Conclusions: in conclusion, our results show a specific cytokine profile in FEP patients (monocytic and regulatory T-cell activation) and suggest immunoregulatory effects of risperidone treatment, characterized by suppressant effects on monocytic, Th2, and T-regulatory functions.Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Fundacao SafraFundacao ABADSJanssenEli LillyLundbeckNovartisRocheUniversidade Federal de São Paulo, Dept Psychiat, São Paulo, BrazilFac Ciencias Med Santa Casa São Paulo, Episode Psychosis Program 1, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Morphol & Genet, Div Genet, São Paulo, BrazilDeakin Univ, Dept Psychiat, Geelong, Vic 3217, AustraliaChulalongkorn Univ, Dept Psychiat, Bangkok, ThailandUniversidade Federal de São Paulo, Dept Psychiat, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Morphol & Genet, Div Genet, São Paulo, BrazilWeb of Scienc

The effect of overweight/obesity on cognitive function in euthymic individuals with bipolar disorder

Background. - Persistent impairment in cognitive function has been described in euthymic individuals with bipolar disorder. Collective work indicates that obesity is associated with reduced cognitive function in otherwise healthy individuals. This sub-group post-hoc analysis preliminarily explores and examines the association between overweight/obesity and cognitive function in euthymic individuals with bipolar disorder. Methods. - Euthymic adults with DSM-IV-TR-defined bipolar I or II disorder were enrolled. Subjects included in this post-hoc analysis (n = 67) were divided into two groups (normal weight, body mass index [BMI] of 18.5-24.9 kg/m(2); overweight/obese, BMI >= 25.0 kg/m(2)). Demographic and clinical information were obtained at screening. At baseline, study participants completed a comprehensive cognitive battery to assess premorbid IQ, verbal learning and memory, attention and psychomotor processing speed, executive function, general intellectual abilities, recollection and habit memory, as well as self-perceptions of cognitive failures. Results. - BMI was negatively correlated with attention and psychomotor processing speed as measured by the Digit Symbol Substitution Test (P < 0.01). Overweight and obese bipolar individuals had a significantly lower score on the Verbal Fluency Test when compared to normal weight subjects (P < 0.05). For all other measures of cognitive function, non-significant trends suggesting a negative association with BMI were observed, with the exception of measures of executive function (i.e. Trail Making Test B) and recollection memory (i.e. process-dissociation task). Conclusion. - Notwithstanding the post-hoc methodology and relatively small sample size, the results of this study suggest a possible negative effect of overweight/obesity on cognitive function in euthymic individuals with bipolar disorder. Taken together, these data provide the impetus for more rigorous evaluation of the mediational role of overweight/obesity (and other medical co-morbidity) on cognitive function in psychiatric populations. (C) 2011 Elsevier Masson SAS. All rights reserved.Stanley Medical Research InstituteBristol-Myers-Squibb Canada Inc

Recognition and Treatment of Cognitive Dysfunction in Major Depressive Disorder

Major Depressive Disorder (MDD) is a prevalent, chronic, disabling, and multidimensional mental disorder. Cognitive dysfunction represents a core diagnostic and symptomatic criterion of MDD, and is a principal determinant of functional non-recovery. Cognitive impairment has been observed to persist despite remission of mood symptoms, suggesting dissociability of mood and cognitive symptoms in MDD. Recurrent impairments in several domains including, but not limited to, executive function, learning and memory, processing speed, and attention and concentration, are associated with poor psychosocial and occupational outcomes. Attempts to restore premorbid functioning in individuals with MDD requires regular screenings and assessment of objective and subjective measures of cognition by clinicians. Easily accessible and cost-effective tools such as the THINC-integrated tool (THINC-it) are suitable for use in a busy clinical environment and appear to be promising for routine usage in clinical settings. However, antidepressant treatments targeting specific cognitive domains in MDD have been insufficiently studied. While select antidepressants, e.g., vortioxetine, have been demonstrated to have direct and independent pro-cognitive effects in adults with MDD, research on additional agents remains nascent. A comprehensive clinical approach to cognitive impairments in MDD is required. The current narrative review aims to delineate the importance and relevance of cognitive dysfunction as a symptomatic target for prevention and treatment in the phenomenology of MDD

CONTAGEM DE CÉLULAS SOMÁTICAS EM LEITE FORMAL DE PRODUTORES DE MARECHAL CÂNDIDO RONDON - PR

The objective of this work was to evaluate the effect of the productive profile of the producers and the seasonal period on the counting of somatic cells in formal milk from Marechal Cândido Rondon city producers, in Paraná State. The productive profiles had been established with the data of the milk daily production of 1580 producers registered in cadastre of FRIMESA dairy industry in 2004, as the following intervals: less than 50; 50 and 100; 100 and 250; 250 and 400; and bigger than 400 L.day-1. For the study of the influence of the productive profile, the following intervals of CCS had been used: less than 0,4x106; 0,4x106 and 0,75x106; 0,75x106 and 1,0x106; and bigger of 1,0x106 SC.ml-1. In regard to the study on the influence of the seasonal period, the values of CCS had been transformed in somatic cells scores for accomplishment of the statistical analyses. From the showed producers, 7.9% had not taken care of to the current regulation for the CCS, therefore they had presented flocks with milk above of 1,0x106 CS.ml-1. The increase of the productive profile, in liters of milk legalized per day, implied in the increase of the percentage of flocks with milk presenting counting above of 1,0x106 CS.ml-1. For the climatic conditions of the city, milk displayed greater counting of somatic cells in the summer. The majority of producers (65%) presented productive profile less than 100 liters of legalized milk for day.O objetivo deste trabalho foi avaliar as contagens de células somáticas (CCS) em leite cru segundo o período sazonal e o perfil produtivo de produtores da microrregião de Marechal CândidoRondon, PR. Foram utilizados os dados da produção diária de 1580 produtores no ano de 2004. Os perfis produtivos foram estabelecidos conforme os seguintes níveis: menos de 50; entre 50 e 100; entre 100 e 250; entre 250 e 400 e mais de 400 L.dia-1. Para as avaliações com as contagens celulares foram utilizados os resultados de 934 produtores que possuíam dadoscompletos de CCS dos 12 meses do ano, totalizando 11208 dados, os quais foram agrupados conforme os seguintes intervalos: menos que 0,4x106; de 0,4x106 a 0,75x106; de 0,75x106 a 1,0x106 e maiores de 1,0x106 CS.ml-1. Para a realização das análises estatísticas, os valores de CCS foram transformados em escore linear de células somáticas (ECS). Dos produtores amostrados, 7,9% não atenderam à regulamentaçãoatual para a CCS, pois apresentaram rebanhos com leite acima de 1,0x106 CS.ml-1. O aumento do perfil produtivo, em litros de leite formalizados por dia, implicou no aumento do percentual de rebanhos com contagens acima de 1,0x106 CS.ml-1. Para as condições climáticas do município, o leite apresentou CCS mais elevada no verão. Dos 1580 produtores avaliados, 65% apresentaram perfil produtivo menor que 100 litros de leite comercializados sob inspeção por dia

Interleukin-6 gene (IL-6): a possible role in brain morphology in the healthy adult brain

Background: Cytokines such as interleukin 6 (IL-6) have been implicated in dual functions in neuropsychiatric disorders. Little is known about the genetic predisposition to neurodegenerative and neuroproliferative properties of cytokine genes. In this study the potential dual role of several IL-6 polymorphisms in brain morphology is investigated. Methodology: In a large sample of healthy individuals (N = 303), associations between genetic variants of IL-6 (rs1800795; rs1800796, rs2069833, rs2069840) and brain volume (gray matter volume) were analyzed using voxel-based morphometry (VBM). Selection of single nucleotide polymorphisms (SNPs) followed a tagging SNP approach (e.g., Stampa algorigthm), yielding a capture 97.08% of the variation in the IL-6 gene using four tagging SNPs. Principal findings/results: In a whole-brain analysis, the polymorphism rs1800795 (−174 C/G) showed a strong main effect of genotype (43 CC vs. 150 CG vs. 100 GG; x = 24, y = −10, z = −15; F(2,286) = 8.54, puncorrected = 0.0002; pAlphaSim-corrected = 0.002; cluster size k = 577) within the right hippocampus head. Homozygous carriers of the G-allele had significantly larger hippocampus gray matter volumes compared to heterozygous subjects. None of the other investigated SNPs showed a significant association with grey matter volume in whole-brain analyses. Conclusions/significance: These findings suggest a possible neuroprotective role of the G-allele of the SNP rs1800795 on hippocampal volumes. Studies on the role of this SNP in psychiatric populations and especially in those with an affected hippocampus (e.g., by maltreatment, stress) are warranted.Bernhard T Baune, Carsten Konrad, Dominik Grotegerd, Thomas Suslow, Eva Birosova, Patricia Ohrmann, Jochen Bauer, Volker Arolt, Walter Heindel, Katharina Domschke, Sonja Schöning, Astrid V Rauch, Christina Uhlmann, Harald Kugel and Udo Dannlowsk