Post-awakening salivary alpha-amylase as modulator of treatment response in patients with burnout and major depression

Around 50% of patients with major depression do not respond to standard first-line treatments, such as psychotherapy and pharmacotherapy. At the same time, a subgroup exhibits altered functioning of stress-responsive bodily systems, such as the central locus coeruleus/sympathetic nervous system and the hypothalamic-pituitary-adrenal (HPA) axis. Given that these systems impact arousal and cognition, it is possible that this subgroup contributes to the high rates of non-responders. Our aim was to investigate whether sympathetic and HPA axis activity modulate treatment outcomes in patients with stress-related major depression. A total of N = 74 inpatients (median age: 50, 62% male) with signs of burnout who fulfilled diagnostic criteria for major depression were recruited. Saliva samples were collected at awakening as well as 30 and 45 min later. Alpha-amylase activity and cortisol concentrations were determined before patients underwent evidence-based multimodal treatment. Non-responders were defined as patients exhibiting a <50% decrease in depression on the Beck Depression Inventory. Non-responders had significantly higher post-awakening alpha-amylase activity than responders (p = .025). In addition, alpha-amylase activity increased significantly over the course of treatment (p = .004), irrespective of responder status. Post-awakening cortisol was neither a predictor nor an indicator of treatment response. If future research confirms alpha-amylase activity as a modulator of treatment response, this may indicate a subgroup of patients with major depression which may benefit from augmentative treatments, such as heart rate variability biofeedback and/or cognitive interventions targeting high arousal

Post-awakening salivary alpha-amylase as modulator of treatment response in patients with burnout and major depression.

Around 50% of patients with major depression do not respond to standard first-line treatments, such as psychotherapy and pharmacotherapy. At the same time, a subgroup exhibits altered functioning of stress-responsive bodily systems, such as the central locus coeruleus/sympathetic nervous system and the hypothalamic-pituitary-adrenal (HPA) axis. Given that these systems impact arousal and cognition, it is possible that this subgroup contributes to the high rates of non-responders. Our aim was to investigate whether sympathetic and HPA axis activity modulate treatment outcomes in patients with stress-related major depression. A total of N = 74 inpatients (median age: 50, 62% male) with signs of burnout who fulfilled diagnostic criteria for major depression were recruited. Saliva samples were collected at awakening as well as 30 and 45 min later. Alpha-amylase activity and cortisol concentrations were determined before patients underwent evidence-based multimodal treatment. Non-responders were defined as patients exhibiting a <50% decrease in depression on the Beck Depression Inventory. Non-responders had significantly higher post-awakening alpha-amylase activity than responders (p = .025). In addition, alpha-amylase activity increased significantly over the course of treatment (p = .004), irrespective of responder status. Post-awakening cortisol was neither a predictor nor an indicator of treatment response. If future research confirms alpha-amylase activity as a modulator of treatment response, this may indicate a subgroup of patients with major depression which may benefit from augmentative treatments, such as heart rate variability biofeedback and/or cognitive interventions targeting high arousal

Mitochondrial Ubiquitin Ligase MARCH5 Promotes TLR7 Signaling by Attenuating TANK Action

The signaling of Toll-like receptors (TLRs) is the host's first line of defense against microbial invasion. The mitochondrion is emerging as a critical platform for antiviral signal transduction. The regulatory role of mitochondria for TLR signaling remains to be explored. Here, we show that the mitochondrial outer-membrane protein MARCH5 positively regulates TLR7 signaling. Ectopic expression or knockdown of MARCH5 enhances or impairs NF-κB-mediated gene expression, respectively. MARCH5 interacts specifically with TANK, and this interaction is enhanced by R837 stimulation. MARCH5 catalyzes the K63-linked poly-ubiquitination of TANK on its Lysines 229, 233, 280, 302 and 306, thus impairing the ability of TANK to inhibit TRAF6. Mislocalization of MARCH5 abolishes its action on TANK, revealing the critical role of mitochondria in modulating innate immunity. Arguably, this represents the first study linking mitochondria to TLR signaling

Burnout subtypes: Psychological characteristics, standardized diagnoses and symptoms course to identify aftercare needs

Background: To better understand individual differences between burnout inpatients and improve individually tailored treatments in a psychiatric hospital, cluster analysis based on a number of self-report measures was used to investigate psychosocial characteristics of 96 participants. Method: Group membership was analyzed regarding associations with standardized measures of psychiatric and personality disorders. Moreover, symptom levels of burnout, depression, and general mental health were used to characterize the groups and to observe differential trajectories at admission, discharge, and follow-up. Results: As in previous research, we identified four subtypes that differed in comorbidity, psychological characteristics and treatment outcome. This calls for tailored interventions for the more vulnerable patients. Conclusion: The replicated and enriched characterization of burnout inpatients can help to optimally meet the differential needs of burnout patients

Burnout subtypes: Psychological characteristics, standardized diagnoses and symptoms course to identify aftercare needs

BACKGROUND: To better understand individual differences between burnout inpatients and improve individually tailored treatments in a psychiatric hospital, cluster analysis based on a number of self-report measures was used to investigate psychosocial characteristics of 96 participants. METHOD: Group membership was analyzed regarding associations with standardized measures of psychiatric and personality disorders. Moreover, symptom levels of burnout, depression, and general mental health were used to characterize the groups and to observe differential trajectories at admission, discharge, and follow-up. RESULTS: As in previous research, we identified four subtypes that differed in comorbidity, psychological characteristics and treatment outcome. This calls for tailored interventions for the more vulnerable patients. CONCLUSION: The replicated and enriched characterization of burnout inpatients can help to optimally meet the differential needs of burnout patients

Burnout und Burnouttherapie

Patienten, die unter einem Burnout leiden, haben meistens ­einmal für etwas gebrannt. Das Ausgebranntsein zeigt sich ­häufig in ­Erschöpfung und innerer Distanzierung von der Arbeit. ­Psychotherapeutische Interventionen können Energie und Sinn bei der Arbeit wiederherstellen und so nachhaltig zu einer gleichzeitig produktiven und befriedigenden Arbeitstätigkeit beitragen

Emotional competence predicts outcome of an inpatient treatment program for burnout.

BACKGROUND Previous research has shown an association between burnout and low emotional competence (EC), defined as the ability to adequately regulate the intensity and expression of emotions. EC might also play a maintaining role in depression. The current paper aimed at studying the effect of improved EC on the course of burnout and depression. METHODS 113 psychiatric inpatients completed a set of standardized self-report questionnaires at intake, discharge and three months after treatment, assessing EC, burnout, and depression. Multi-level analyses investigated the effect of improved EC on burnout and depression. RESULTS Improved EC including a better emotion regulation during treatment predicted favourable treatment outcomes regarding burnout and depression symptoms. LIMITATIONS The present results should be considered in light of some methodological limitations. Most importantly, the patient sample consists of patients of one inpatient ward and is therefore not representative of all burnout patients. CONCLUSIONS This study supports EC as a putative mechanism of change in the multimodal treatment of inpatients with a stress-related depressive disorder and burnout. Clinical and research consequences of the findings will be discussed

Protein expression profiles in human breast ductal carcinoma and histologically normal tissue.

Reference two-dimensional (2-D) gels are presented for human breast ductal carcinoma and histologically normal tissue. Whole biopsy fragments were analyzed, including epithelial and nonepithelial components. Thirty-five spots have been assigned by gel matching to the human liver SWISS-2DPAGE reference map and/or to the human primary keratinocyte IPG map from the Danish Center for Human Genome. N-terminal microsequencing was applied to confirm randomly chosen matching assignments and to identify six new spots. Protein expression profiles in ductal carcinoma and in normal breast tissue appeared to be similar, except for a pattern consisting of 32 spots, which were highly expressed in all carcinoma specimens, and less intense and occasionally undetectable in normal tissue. This difference was statistically significant. Assignment has been obtained for several spots, namely GRP94, GRP78, GRP75, mitochondrial HSP60, calreticulin, protein disulfide isomerase, peptidyl-prolyl cis-trans isomerase, collagen-binding protein 2, fructose bisphosphate aldolase, glyceraldehyde-3-phosphate dehydrogenase, thioredoxin, cytochrome c oxidase VA subunit, tubulin beta isoform and macrophage migration inhibitory factor (MIF). The cancer- and tissue-specificity of the described pattern was assessed by matching to the Swiss-2DPAGE human liver, hepatoma, lymphoma, erythroleukemia reference maps. The pattern of 32 spots was found to be indicative of epithelial neoplasia