"It doesn't do any harm, but patients feel better": a qualitative exploratory study on gastroenterologists' perspectives on the role of antidepressants in inflammatory bowel disease

Background: Interest in psychological factors in patients with inflammatory bowel disease (IBD) has increased in recent years. It has even been proposed that treating psychological co-morbidities with antidepressants may control disease activity and improve quality of life. Despite this, there is no data on gastroenterologists' attitudes to, and experiences with, antidepressant therapy in patients with IBD. Methods: We conducted semi-structured interviews with 18 gastroenterologists associated with metropolitan teaching hospitals. Qualitative content analysis was used to examine their responses. Results: Seventy-eight percent of gastroenterologists had treated IBD patients with antidepressants for pain, depression and/or anxiety, and insomnia. Antidepressants were reported to be useful in improving psychosocial well-being, quality of life, and self-management of the disease by patients. However, in this group of gastroenterologists, there appears to be skepticism towards psychological disorders themselves or antidepressant therapy having a central role in either the causation of IBD or its clinical course. Nevertheless, these gastroenterologists were receptive to the idea of conducting a trial of the role of antidepressants in IBD. Conclusion: While the majority of specialists have treated IBD patients with antidepressants, there is considerable skepticism with regard to efficacy of antidepressive therapy or the role of psychological factors in the outcome of IBD patients.Antonina A Mikocka-Walus, Deborah A Turnbull, Nicole T Moulding, Ian G Wilson, Jane M Andrews and Gerald J Holtman

Gene Expression Changes in the Prefrontal Cortex, Anterior Cingulate Cortex and Nucleus Accumbens of Mood Disorders Subjects That Committed Suicide

Suicidal behaviors are frequent in mood disorders patients but only a subset of them ever complete suicide. Understanding predisposing factors for suicidal behaviors in high risk populations is of major importance for the prevention and treatment of suicidal behaviors. The objective of this project was to investigate gene expression changes associated with suicide in brains of mood disorder patients by microarrays (Affymetrix HG-U133 Plus2.0) in the dorsolateral prefrontal cortex (DLPFC: 6 Non-suicides, 15 suicides), the anterior cingulate cortex (ACC: 6NS, 9S) and the nucleus accumbens (NAcc: 8NS, 13S). ANCOVA was used to control for age, gender, pH and RNA degradation, with P≤0.01 and fold change±1.25 as criteria for significance. Pathway analysis revealed serotonergic signaling alterations in the DLPFC and glucocorticoid signaling alterations in the ACC and NAcc. The gene with the lowest p-value in the DLPFC was the 5-HT2A gene, previously associated both with suicide and mood disorders. In the ACC 6 metallothionein genes were down-regulated in suicide (MT1E, MT1F, MT1G, MT1H, MT1X, MT2A) and three were down-regulated in the NAcc (MT1F, MT1G, MT1H). Differential expression of selected genes was confirmed by qPCR, we confirmed the 5-HT2A alterations and the global down-regulation of members of the metallothionein subfamilies MT 1 and 2 in suicide completers. MTs 1 and 2 are neuro-protective following stress and glucocorticoid stimulations, suggesting that in suicide victims neuroprotective response to stress and cortisol may be diminished. Our results thus suggest that suicide-specific expression changes in mood disorders involve both glucocorticoids regulated metallothioneins and serotonergic signaling in different regions of the brain

Suicide risk in schizophrenia: learning from the past to change the future

Suicide is a major cause of death among patients with schizophrenia. Research indicates that at least 5–13% of schizophrenic patients die by suicide, and it is likely that the higher end of range is the most accurate estimate. There is almost total agreement that the schizophrenic patient who is more likely to commit suicide is young, male, white and never married, with good premorbid function, post-psychotic depression and a history of substance abuse and suicide attempts. Hopelessness, social isolation, hospitalization, deteriorating health after a high level of premorbid functioning, recent loss or rejection, limited external support, and family stress or instability are risk factors for suicide in patients with schizophrenia. Suicidal schizophrenics usually fear further mental deterioration, and they experience either excessive treatment dependence or loss of faith in treatment. Awareness of illness has been reported as a major issue among suicidal schizophrenic patients, yet some researchers argue that insight into the illness does not increase suicide risk. Protective factors play also an important role in assessing suicide risk and should also be carefully evaluated. The neurobiological perspective offers a new approach for understanding self-destructive behavior among patients with schizophrenia and may improve the accuracy of screening schizophrenics for suicide. Although, there is general consensus on the risk factors, accurate knowledge as well as early recognition of patients at risk is still lacking in everyday clinical practice. Better knowledge may help clinicians and caretakers to implement preventive measures. This review paper is the results of a joint effort between researchers in the field of suicide in schizophrenia. Each expert provided a brief essay on one specific aspect of the problem. This is the first attempt to present a consensus report as well as the development of a set of guidelines for reducing suicide risk among schizophenia patients

Modelling Safety of Baltic Port and Shipping Critical Infrastructure Network

In the paper, the three critical infrastructure networks are introduced, i.e. port, shipping, and ship traffic and port operation information. For every of them the main safety paremeters are defined. Furthermore, the multistate system component and the multistate system main safety characteristics, i.e. their mean values of the lifetimes and in the safety state subsets and in the particular safety states and standard deviations and the moment when the system risk function exceeds a fixed permitted level are determined. Finally, the Baltic Port and Shipping Critical Infrastructure Network is defined and described in the same way

Optimization of Operation and Safety of Baltic Port and Shipping Critical Infrastructure Network with Considering Climate-Weather Change Influence – Maximizing Lifetime in the Set of Safety States Not Worse Than a Critical Safety State

The paper is devoted the optimization of operation process and maximization of safety lifetimes for Baltic Port and Shipping Critical Infrastructure Network (BPSCIN) at variable operation conditions related to the climateweather change. For this network, the optimal transient probabilities of BPSCIN operation process at operation states related to climate-weather change that maximize the mean value of BPSCIN safety lifetimes are found. Finally, the optimal safety and resilience indicators of considered network are presented

Joint Network of Port, Shipping, Ship Traffic and Port Operation Information Critical Infrastructure Network

The main aim of the paper is to define the Baltic Port, Shipping, Ship Traffic and Port Operation Information Joint Critical Infrastructure Network (BPSIJN). The particular components of this joint network are firstly defined as the single critical infrastructure networks. Based on these, the BPSIJN is defined and described. Furthermore, the operation process for the network is initially introduced

An approach to Baltic Port, Shipping, Ship Traffic and Operation Information Critical Infrastructure Network operation process

The goal of the article is to analysis of static and dynamic industry installations existing in the Baltic Sea Region performed to classify them as a network of networks. As the result of this analysis, the Baltic Port, Shipping, Ship Traffic and Port Operations Information Critical Infrastructure Network composed of three single critical infrastructure networks are distinguished. In the next step, the operation process for every installations and finally for network of networks are defined

Reliability analysis of multi-state ageing consecutive „k out of n: F” systems

A multi-state approach to reliability analysis of systems composed of ageing components is introduced and basic reliability characteristics for such systems are defined. Further, a multi-state consecutive “ k out of n : F” system composed of ageing components is defined and the recurrent formulae for its reliability function are proposed. Moreover, the application of the proposed reliability characteristics and formulae to reliability evaluation of the steel cover composed of ageing sheets is illustrated

EU-CIRCLE: A pan-European framework for strengthening critical infrastructure resilience to climate change Project taxonomy and methodology : Resilience terminology and methodology

The main aim of the paper is to present resilience terminology and methodology. The terms and definitions have been outlined alphabetically, with accordance to notations for resilience, risk, response, business continuity and communications, that are analysed within the scope of the EU-CIRCLE project. Moreover, the resilience indicators are defined and presented as the basic methodology in the field of strengthening critical infrastructure resilience to climate change, covered by the further EU-CIRCLE reports

Optimization of Operation and Safety of Baltic Port and Shipping Critical Infrastructure Network with Considering Climate-Weather Change Influence – Minimizing Critical Infrastructure Network Operation Cost

The paper is devoted the optimization of operation process and minimization of operation cost for Baltic Port and Shipping Critical Infrastructure Network (BPSCIN) at variable operation conditions related to the climateweather change. For this network, the optimal transient probabilities that minimize the mean value of the total operation costs are found. Finally, cost analysis of BPSCIN operation impacted by climate-weather change is presented in case the BPSCIN is non-repairable and in case it is repairable after exceeding its critical safety state