Esquizofrenia: avanços no tratamento multidisciplinar

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Potential biomarkers of major depression diagnosis and chronicity

Background Molecular biomarkers are promising tools to be routinely used in clinical psychiatry. Among psychiatric diseases, major depression disorder (MDD) has gotten attention due to its growing prevalence and morbidity. Methods We tested some peripheral molecular parameters such as serum mature Brain-Derived Neurotrophic Factor (mBDNF), plasma C-Reactive Protein (CRP), serum cortisol (SC), and the salivary Cortisol Awakening Response (CAR), as well as the Pittsburgh sleep quality inventory (PSQI), as part of a multibiomarker panel for potential use in MDD diagnosis and evaluation of disease's chronicity using regression models, and ROC curve. Results For diagnosis model, two groups were analyzed: Patients in the first episode of major depression (MD: n = 30) and a healthy control (CG: n = 32). None of those diagnosis models tested had greater power than Hamilton Depression Rating Scale-6. For MDD chronicity, a group of patients with treatment-resistant major depression (TRD: n = 28) was tested across the MD group. The best chronicity model (p < 0.05) that discriminated between MD and TRD included four parameters, namely PSQI, CAR, SC, and mBDNF (AUC ROC = 0.99), with 96% of sensitivity and 93% of specificity. Conclusion These results indicate that changes in specific biomarkers (CAR, SC, mBDNF and PSQI) have potential on the evaluation of MDD chronicity, but not for its diagnosis. Therefore, these findings can contribute for further studies aiming the development of a stronger model to be commercially available and used in psychiatry clinical practice

Efeitos da pregabalina sobre alterações comportamentais induzidas pela cetamina em ratos

Objective: The aim of this study is to investigate the effects of pregabalin on the behavior of rats under the influence of ketamine, an NMDA receptor antagonist that mimics the symptoms of schizophrenia. Methods: Rats were injected with saline or 25 mg/kg ketamine intraperitoneally. After that, behavior modifications were investigated by the evaluation of stereotypy and hyperlocomotion, after treating rats with pregabalin (at doses of 30 mg/kg or 100 mg/kg) or placebo (saline solution). Results: The administration of pregabalin reduced ketamine-induced hyperlocomotion. However, neither doses of pregabalin had a significant effect on ketamine-induced stereotypy. Conclusion: This is the first study to investigate the effects of pregabalin using an animal model of psychosis. Furthermore, our results indicate that behavioral changes induced by ketamine in rats can be reversed with the use of pregabalin, suggesting its potential to treat psychotic symptoms.Objetivo: O presente estudo tem como objetivo investigar os efeitos da pregabalina sobre as alterações comportamentais em ratos induzidas pela cetamina, um antagonista do receptor glutamatérgico NMDA, utilizado em modelos animais de psicose. Métodos:\ud Ratos receberam injeção com solução salina ou cetamina, na dose de 25 mg/kg, com posterior avaliação das alterações comportamentais induzidas, através da avaliação da estereotipia e hiperlocomoção, depois destes ratos terem sido tratados com pregabalina (30 mg/kg ou 100 mg/kg) ou placebo. Resultados: A administração de pregabalina reduziu a hiperlocomoção nos ratos sob o efeito da cetamina. No entanto, nenhuma das doses de pregabalina teve efeito significativo sobre a estereotipia induzida pela cetamina. Conclusão:\ud Este é o primeiro estudo que investiga os efeitos da pregabalina em um modelo animal de psicose. Nossos resultados indicam que alterações comportamentais induzidas pela cetamina em ratos podem ser revertidas após uso da pregabalina, o que sugere um possível potencial desta no tratamento de sintomas psicóticos.CNPqINCTFMRP-USPUNES

Cortisol modulation by ayahuasca in patients with treatment resistant depression and healthy controls

Major depression is a highly prevalent mood disorder, affecting about 350 million people, and around 30% of the patients are resistant to currently available antidepressant medications. Recent evidence from a randomized controlled trial (RCT) supports the rapid antidepressant effects of the psychedelic ayahuasca in treatment-resistant depression. The aim of this study was to explore the effect of ayahuasca on plasma cortisol and awakening salivary cortisol response, in the same group of treatment-resistant patients (MD) and in healthy volunteers (C). Subjects received a single dose of ayahuasca or placebo (dosing session), and both plasma and awakening salivary cortisol response were measured at baseline (before dosing session) and 48 h after the dosing session. Baseline assessment (D0) showed blunted awakening salivary cortisol response and hypocortisolemia in patients, with respect to healthy controls. Salivary cortisol was also measured during dosing session, and we observed higher increases for both C and MD that ingested ayahuasca than placebo. After 48 h from the dosing session with ayahuasca, patients' awakening salivary cortisol response is similar to the ones detected in controls. No significant changes in plasma cortisol levels were observed 48 h after the sessions. Therefore, these findings point to new evidence on the modulation of salivary cortisol levels as a result of an ayahuasca session, both in healthy and depressive volunteers. Considering that cortisol acts in regulation of distinct physiological pathways, emotional and cognitive processes, it is assumed to be critically involved to the etiology of depression and its regulation seems to be important for the treatment and remission of major depression, ayahuasca use as antidepressant should be further investigated. Moreover, this study highlights the importance of psychedelics in the treatment of human mental disorders

Moderators of ayahuasca’s biological antidepressant action

IntroductionThe understanding of biological responses to psychedelics with antidepressant potential is imperative. Here we report how a set of acute parameters, namely emotional (depressive symptoms), cognitive (psychedelic experience), and physiological (salivary cortisol), recorded during an ayahuasca dosing session, modulated serum brain-derived neurotrophic factor (BDNF), serum cortisol (SC), serum interleukin 6 (IL-6), plasma C-reactive protein (CRP), and salivary cortisol awakening response (CAR).MethodsResults were analyzed 2 days after the psychedelic intervention (ayahuasca) versus placebo in both patients with treatment-resistant depression and healthy volunteers. These measures were assessed as part of a randomized double-blinded, placebo-controlled trial (n = 72).ResultsResults revealed that larger reductions of depressive symptoms during the dosing session significantly moderated higher levels of SC in patients. Whereas lesser changes in salivary cortisol levels during the ayahuasca intervention were related to higher BDNF levels in patients with a larger clinical response in the reduction in depressive symptoms. No moderator was found for patient’s CAR, IL-6, and CRP responses to ayahuasca and for all biomarker responses to ayahuasca in healthy controls and in the placebo group.DiscussionIn summary, some specific emotional and physiological parameters during experimental ayahuasca session were revealed as critical moderators of the improvement of major depression biomarkers, mainly BDNF and SC two days after ayahuasca intake. These findings contribute to paving the way for future studies investigating the biological antidepressant response to psychedelic therapy

Rapid antidepressant effects of the psychedelic ayahuasca in treatment-resistant depression: a randomized placebo-controlled trial

Background Recent open-label trials show that psychedelics, such as ayahuasca, hold promise as fast-onset antidepressants in treatment-resistant depression. Methods To test the antidepressant effects of ayahuasca, we conducted a parallel-arm, double-blind randomized placebo-controlled trial in 29 patients with treatment-resistant depression. Patients received a single dose of either ayahuasca or placebo. We assessed changes in depression severity with the Montgomery-Åsberg Depression Rating Scale (MADRS) and the Hamilton Depression Rating scale at baseline, and at 1 (D1), 2 (D2), and 7 (D7) days after dosing. Results We observed significant antidepressant effects of ayahuasca when compared with placebo at all-time points. MADRS scores were significantly lower in the ayahuasca group compared with placebo at D1 and D2 (p = 0.04), and at D7 (p < 0.0001). Between-group effect sizes increased from D1 to D7 (D1: Cohen's d = 0.84; D2: Cohen's d = 0.84; D7: Cohen's d = 1.49). Response rates were high for both groups at D1 and D2, and significantly higher in the ayahuasca group at D7 (64% v. 27%; p = 0.04). Remission rate showed a trend toward significance at D7 (36% v. 7%, p = 0.054). Conclusions To our knowledge, this is the first controlled trial to test a psychedelic substance in treatment-resistant depression. Overall, this study brings new evidence supporting the safety and therapeutic value of ayahuasca, dosed within an appropriate setting, to help treat depression. This study is registered at http://clinicaltrials.gov (NCT02914769)

Effects of atypical antipsychotics clozapine and ziprasidone on brain amino acid and pregnenolone neuroactive steroid levels in rats

Seguindo como um dos transtornos mais desafiadores, apesar dos avanços dos estudos que tentam elucidar sua fisiopatologia, a esquizofrenia continua sendo objeto de estudo de pesquisa na busca de novas opções de tratamento. Explicações que vão além da teoria dopaminérgica da esquizofrenia têm estimulado pesquisas, em particular as relacionadas a neurotransmissão glutamatérgica (com foco nos receptores N-metil-D-Aspartato - NMDA), receptor influenciado por diversas substâncias além do glutamato, como por exemplo, os aminoácidos D-serina e glicina, assim como os esteroides neuroativos, como a pregnenolona. Com a existência de estudos clínicos já sugerindo efeitos positivos da D-serina e da pregnenolona, como tratamento adjuvante aos antipsicóticos, tem-se acumulado interesse pelo estudo do papel desta na fisiopatologia da esquizofrenia. Ao mesmo tempo, pergunta-se se os antipsicóticos não influenciariam de alguma maneira a neurotransmissão gabaérgica e glutamatérgica, através de alteração nos níveis da pregnenolona e/ou de aminoácidos neuroativos, como a D-serina. Assim, este estudo objetivou a avaliação dos efeitos dos antipsicóticos atípicos clozapina e ziprasidona sobre os níveis cerebrais de aminoácidos neuroativos, como a D-serina, assim como da pregnenolona. Os testes foram feitos em cérebros de ratos após o tratamento com as medicações ou o placebo, após uso agudo (1, 3 e 24 horas) e subagudo (7 e 21 dias). Com grupos de 4 a 5 ratos, as medições dos aminoácidos e dos esteroides nos cérebros foram feitas através de cromatografia líquida de alta performance (CLAP) para os aminoácidos e de cromatografia gasosa/espectroscopia de massa para os esteroides neuroativos. Os dados foram analisados com software SPSS 17, através dos testes ANOVA e pós teste Student Newman Keuls. Como resultados, não observamos alterações dos níveis dos aminoácidos após o uso das medicações quando comparadas ao placebo. Já em relação a pregnenolona, esta se mostrou aumentada após o uso dos antipsicóticos, mas este aumento não manteve sua significância após análises pós teste. Apesar de estudos já terem demonstrado diferenças nos níveis de aminoácidos após uso de antipsicóticos, em regiões cerebrais de ratos, nosso estudo não evidenciou tal influência nas concentrações globais deaminoácidos nos cérebros estudados, assim como não demonstrou mudanças nos níveis de pregnenolona após o uso agudo e subagudo dos antipsicóticos. Considerando dados prévios, que apontavam para alterações de esteroides neuroativos após uso de psicotrópicos, inclusive com estudos demonstrando previamente efeitos da clozapina nos níveis de pregnenolona, nosso estudo obteve dados discordantes, que podem ser explicados pelo desenho de uso agudo das medicações. As observações feitas no presente estudo trazem novos dados em relação ao que já existia na literatura, quanto ao potencial de alterações dos níveis cerebrais de aminoácidos e esteroides neuroativos. Assim, esperamos contribuir de alguma forma, para um melhor entendimento do mecanismo de ação das medicações antipsicóticas, apesar de ressaltar a necessidade de estudos mais amplos que avaliem as alterações nos níveis das moléculas aqui estudadas, mas que considerem mensurações em regiões específicas cerebrais.It is considered one of the most challenging disorders, despite advances in studies that attempt to elucidate its pathophysiology, schizophrenia continues to be the subject of research in the search for new treatment options. Explanations that go beyond the dopaminergic theory of schizophrenia, have stimulated research, in particular, those related to glutamatergic neurotransmission (focusing on N-methyl-D-Aspartate - NMDA receptors), a receptor influenced by several substances besides glutamate, , amino acids D-serine and glycine, as well as neuroactive steroids, such as pregnenolone. With the existence of clinical studies already suggesting positive effects of D-serine and pregnenolone, as an adjunctive treatment to antipsychotics, interest has been accumulated in the study of its role in the pathophysiology of schizophrenia. At the same time, it is questioned whether antipsychotics would not, in some way, influence gabaergic and glutamatergic neurotransmission, through changes in the levels of pregnenolone and / or neuroactive amino acids, such as D-serine. Thus, this study aimed to evaluate the effects of atypical antipsychotics clozapine and ziprasidone on brain levels of neuroactive amino acids, such as D-serine, as well as pregnenolone. Tests were performed on rat brains after treatment with the medications or placebo, after acute (1, 3 and 24 hours) and subacute (7 and 21 days) use. With groups of 4 to 5 mice, measurements of amino acids and pregnenolone in the brains were made by high performance liquid chromatography (CLAP) for amino acids and gas chromatography / mass spectroscopy for pregnenolone. Data were analyzed using SPSS 17 software, using ANOVA and Student Newman Keuls post hoc test. As a result, we did not observe changes in amino acid levels after the use of the medications when compared to placebo. Regarding pregnenolone, it was shown to be increased after the use of antipsychotics, but this increase did not maintain its significance after post-test analysis. Although studies have shown differences in amino acid levels after antipsychotic use in rat brain regions, our study failed to demonstrate such an influence on overall amino acid concentrations in the brains studied, as well as to demonstrate changes in pregnenolone levels after use acute and subacute antipsychotics. Considering previous data, which pointed to neuroactive steroid alterations after the use of psychotropic drugs, including studies showingpreviously effects of clozapine on pregnenolone levels, our study obtained discordant data, which can be explained by the design of acute use of medications. The observations made in the present study bring new data in relation to what already existed in the literature, regarding the potential of alterations of the cerebral levels of aminoacids and neuroactive steroids. Thus, we hope to contribute in some way to a better understanding of the mechanism of action of antipsychotic medications, although it emphasizes the need for broader studies that assess changes in the levels of the molecules studied here, but that consider measures in specific regions of the brain

Effects of atypical antipsychotics clozapine and ziprasidone on brain amino acid and pregnenolone neuroactive steroid levels in rats

Seguindo como um dos transtornos mais desafiadores, apesar dos avanços dos estudos que tentam elucidar sua fisiopatologia, a esquizofrenia continua sendo objeto de estudo de pesquisa na busca de novas opções de tratamento. Explicações que vão além da teoria dopaminérgica da esquizofrenia têm estimulado pesquisas, em particular as relacionadas a neurotransmissão glutamatérgica (com foco nos receptores N-metil-D-Aspartato - NMDA), receptor influenciado por diversas substâncias além do glutamato, como por exemplo, os aminoácidos D-serina e glicina, assim como os esteroides neuroativos, como a pregnenolona. Com a existência de estudos clínicos já sugerindo efeitos positivos da D-serina e da pregnenolona, como tratamento adjuvante aos antipsicóticos, tem-se acumulado interesse pelo estudo do papel desta na fisiopatologia da esquizofrenia. Ao mesmo tempo, pergunta-se se os antipsicóticos não influenciariam de alguma maneira a neurotransmissão gabaérgica e glutamatérgica, através de alteração nos níveis da pregnenolona e/ou de aminoácidos neuroativos, como a D-serina. Assim, este estudo objetivou a avaliação dos efeitos dos antipsicóticos atípicos clozapina e ziprasidona sobre os níveis cerebrais de aminoácidos neuroativos, como a D-serina, assim como da pregnenolona. Os testes foram feitos em cérebros de ratos após o tratamento com as medicações ou o placebo, após uso agudo (1, 3 e 24 horas) e subagudo (7 e 21 dias). Com grupos de 4 a 5 ratos, as medições dos aminoácidos e dos esteroides nos cérebros foram feitas através de cromatografia líquida de alta performance (CLAP) para os aminoácidos e de cromatografia gasosa/espectroscopia de massa para os esteroides neuroativos. Os dados foram analisados com software SPSS 17, através dos testes ANOVA e pós teste Student Newman Keuls. Como resultados, não observamos alterações dos níveis dos aminoácidos após o uso das medicações quando comparadas ao placebo. Já em relação a pregnenolona, esta se mostrou aumentada após o uso dos antipsicóticos, mas este aumento não manteve sua significância após análises pós teste. Apesar de estudos já terem demonstrado diferenças nos níveis de aminoácidos após uso de antipsicóticos, em regiões cerebrais de ratos, nosso estudo não evidenciou tal influência nas concentrações globais deaminoácidos nos cérebros estudados, assim como não demonstrou mudanças nos níveis de pregnenolona após o uso agudo e subagudo dos antipsicóticos. Considerando dados prévios, que apontavam para alterações de esteroides neuroativos após uso de psicotrópicos, inclusive com estudos demonstrando previamente efeitos da clozapina nos níveis de pregnenolona, nosso estudo obteve dados discordantes, que podem ser explicados pelo desenho de uso agudo das medicações. As observações feitas no presente estudo trazem novos dados em relação ao que já existia na literatura, quanto ao potencial de alterações dos níveis cerebrais de aminoácidos e esteroides neuroativos. Assim, esperamos contribuir de alguma forma, para um melhor entendimento do mecanismo de ação das medicações antipsicóticas, apesar de ressaltar a necessidade de estudos mais amplos que avaliem as alterações nos níveis das moléculas aqui estudadas, mas que considerem mensurações em regiões específicas cerebrais.It is considered one of the most challenging disorders, despite advances in studies that attempt to elucidate its pathophysiology, schizophrenia continues to be the subject of research in the search for new treatment options. Explanations that go beyond the dopaminergic theory of schizophrenia, have stimulated research, in particular, those related to glutamatergic neurotransmission (focusing on N-methyl-D-Aspartate - NMDA receptors), a receptor influenced by several substances besides glutamate, , amino acids D-serine and glycine, as well as neuroactive steroids, such as pregnenolone. With the existence of clinical studies already suggesting positive effects of D-serine and pregnenolone, as an adjunctive treatment to antipsychotics, interest has been accumulated in the study of its role in the pathophysiology of schizophrenia. At the same time, it is questioned whether antipsychotics would not, in some way, influence gabaergic and glutamatergic neurotransmission, through changes in the levels of pregnenolone and / or neuroactive amino acids, such as D-serine. Thus, this study aimed to evaluate the effects of atypical antipsychotics clozapine and ziprasidone on brain levels of neuroactive amino acids, such as D-serine, as well as pregnenolone. Tests were performed on rat brains after treatment with the medications or placebo, after acute (1, 3 and 24 hours) and subacute (7 and 21 days) use. With groups of 4 to 5 mice, measurements of amino acids and pregnenolone in the brains were made by high performance liquid chromatography (CLAP) for amino acids and gas chromatography / mass spectroscopy for pregnenolone. Data were analyzed using SPSS 17 software, using ANOVA and Student Newman Keuls post hoc test. As a result, we did not observe changes in amino acid levels after the use of the medications when compared to placebo. Regarding pregnenolone, it was shown to be increased after the use of antipsychotics, but this increase did not maintain its significance after post-test analysis. Although studies have shown differences in amino acid levels after antipsychotic use in rat brain regions, our study failed to demonstrate such an influence on overall amino acid concentrations in the brains studied, as well as to demonstrate changes in pregnenolone levels after use acute and subacute antipsychotics. Considering previous data, which pointed to neuroactive steroid alterations after the use of psychotropic drugs, including studies showingpreviously effects of clozapine on pregnenolone levels, our study obtained discordant data, which can be explained by the design of acute use of medications. The observations made in the present study bring new data in relation to what already existed in the literature, regarding the potential of alterations of the cerebral levels of aminoacids and neuroactive steroids. Thus, we hope to contribute in some way to a better understanding of the mechanism of action of antipsychotic medications, although it emphasizes the need for broader studies that assess changes in the levels of the molecules studied here, but that consider measures in specific regions of the brain