The TNF-α System: Functional Aspects in Depression, Narcolepsy and Psychopharmacology

Changes of the tumor necrosis factor-alpha (TNF-α) system have been shown to be involved in the development of psychiatric disorders and are additionally associated with changes in body weight as well as endocrine and metabolic changes in psychiatric patients

Physical and Mental Health Consequences of Obesity in Women

Obesity and overweight are major health concerns and the leading preventable cause of death in developed and developing countries. Obesity affects men and women differently due to biological, socioeconomic, cultural and country-specific gender-related disparities. This book chapter outlines obesity as a risk factor for physical diseases and mental health disorders in women. Obesity has been shown to contribute to the risk of certain types of cancer, including breast, endometrial, gallbladder, oesophageal and renal cancer. In terms of reproductive health, obesity negatively affects both fertility and contraception. In addition, obesity is associated with early miscarriage, higher rates of caesarean section and high-risk obstetrical conditions, in addition to higher maternal and neonatal mortality rates, and congenital malformations. In terms of mental health, obesity is closely linked to depression, anxiety disorders, neurodegenerative diseases and sleep disorders. Socioeconomic, psychosocial and behavioural factors, factors associated with ageing, mechanisms related to the microbiome, gastrointestinal and vascular system, intracellular pathophysiology and metabolism in the body, hormones, adipocytokines and problems associated with medical treatment are important factors linking obesity with its negative consequences on physical and mental health

Editorial: Extreme Eating Behaviours

Editorial on the Research Topic. Extreme Eating Behaviours

JOHANN CHRISTIAN AUGUST HEINROTH: PSYCHOSOMATIC MEDICINE EIGHTY YEARS BEFORE FREUD

Most often it is assumed that the \u27psychosomatic\u27 concept originated from psychoanalysis. However, this term had already been introduced into medical literature about 80 years before Sigmund Freud - namely by Johann Christian August Heinroth, the first professor of psychiatry and psychotherapy in the western world. Widely through quotations from his works, the authors analyze Heinroth\u27s understanding of the interrelations between the body and the soul. For Heinroth both formed a unified, indivisable whole, which interacted in many ways, including pathologically. According to him, a mental illness had its cause in the patient’s leading a \u27wrong life\u27. This \u27wrong life\u27 deranged the soul from its normal functioning. In a second step, this derangement can have an impact on the body and produce the somatic symptoms that accompany a mental illness. Since both ‘components’ of the \u27indivisible whole\u27 were affected, it was clear for Heinroth that doctors needed to view their patients holistically and treat the whole person. Since in the end the somatic symptoms were caused by an underlying mental derangement, this needed to be treated in the first place - and the psyche could only be reached by direct psychological intervention. Hence what he called his ‘direct-psychische Methode’ ought to be the remedy of choice for mental illnesses. Through his clear understanding of the interactions of body and soul and by integrating somatic and psychological therapies into a holistic, unified treatment programm, Heinroth is of major importance for the history of psychosomatic medicine

Descriptions of Disordered Eating in German Psychiatric Textbooks, 1803–2017

The most common eating disorders (EDs) according to DSM-5 are anorexia nervosa (AN), bulimia nervosa (BN) and binge eating disorder (BED). These disorders have received increasing attention in psychiatry due to rising prevalence and high morbidity and mortality. The diagnostic category “anorexia nervosa,” introduced by Ernest-Charles Lasègue and William Gull in 1873, first appears a century later in a German textbook of psychiatry, authored by Gerd Huber in 1974. However, disordered eating behavior has been described and discussed in German psychiatric textbooks throughout the past 200 years. We reviewed content regarding eating disorder diagnoses but also descriptions of disordered eating behavior in general. As material, we carefully selected eighteen German-language textbooks of psychiatry across the period 1803–2017. Previously, in German psychiatry, disordered eating behaviors were seen as symptoms of depressive disorders, bipolar disorder or schizophrenia, or as manifestations of historical diagnoses no longer used by the majority of psychiatrists such as neurasthenia, hypochondria and hysteria. Interestingly, 19th and early 20th century psychiatrists like Kraepelin, Bumke, Hoff, Bleuler, and Jaspers reported symptom clusters such as food refusal and vomiting under these outdated diagnostic categories, whereas nowadays they are listed as core criteria for specific eating disorder subtypes. A wide range of medical conditions such as endocrinopathies, intestinal or brain lesions were also cited as causes of abnormal food intake and body weight. An additional consideration in the delayed adoption of eating disorder diagnoses in German psychiatry is that people with EDs are commonly treated in the specialty discipline of psychosomatic medicine, introduced in Germany afterWorld War II, rather than in psychiatry. Viewed from today’s perspective, the classification of disorders associated with disordered eating is continuously evolving. Major depressive disorder, schizophrenia and physical diseases have been enduringly associated with abnormal eating behavior and are listed as important differential diagnoses of EDs in DSM-5. Moreover, there are overlaps regarding the neurobiological basis and psychological and psychopharmacological therapies applied to all of these disorders

Patients’ and Carers’ Perspectives of Psychopharmacological Interventions Targeting Anorexia Nervosa Symptoms

In clinical practice, patients with anorexia nervosa (AN), their carers and clinicians often disagree about psychopharmacological treatment. We developed two corresponding questionnaires to survey the perspectives of patients with AN and their carers on psychopharmacological treatment. These questionnaires were distributed to 36 patients and 37 carers as a quality improvement project on a specialist unit for eating disorders at the South London and Maudsley NHS Foundation Trust. Although most patients did not believe that medication could help with AN, the majority thought that medication for AN should help with anxiety (61.1%), concentration (52.8%), sleep problems (52.8%) and anorexic thoughts (55.6%). Most of the carers shared the view that drug treatment for AN should help with anxiety (54%) and anorexic thoughts (64.8%). Most patients had concerns about potential weight gain, increased appetite, changes in body shape and metabolism during psychopharmacological treatment. By contrast, the majority of carers were not concerned about these specific side effects. Some of the concerns expressed by the patients seem to be AN-related. However, their desire for help with anxiety and anorexic thoughts, which is shared by their carers, should be taken seriously by clinicians when choosing a medication or planning psychopharmacological studies

A systematic review of scientific studies and case reports on music and obsessive-compulsive disorder

Obsessive-compulsive disorder (OCD) is a severe psychiatric disorder, which can be associated with music-related symptoms. Music may also be used as an adjunct treatment for OCD. Following the PRISMA guidelines, we performed a systematic literature review exploring the relationship between music and OCD by using three online databases: PubMed, the Web of Science, and PsycINFO. The search terms were “obsessive compulsive disorder”, “OCD”, “music”, and “music therapy”. A total of 27 articles were utilised (n = 650 patients/study participants) and grouped into three categories. The first category comprised case reports of patients with musical obsessions in patients with OCD. Most patients were treated with selective serotonin reuptake inhibitors (SSRIs) or a combination of an SSRI and another pharmacological or a non-pharmacological treatment, with variable success. Studies on the music perception of people with OCD or obsessive-compulsive personality traits represented the second category. People with OCD or obsessive-compulsive personality traits seem to be more sensitive to tense music and were found to have an increased desire for harmony in music. Three small studies on music therapy in people with OCD constituted the third category. These studies suggest that patients with OCD might benefit from music therapy, which includes listening to music

PHOSPHATIDYLCHOLINE CONTAINING LONG CHAIN OMEGA-3 FATTY ACIDS: A TREATMENT ADJUNCT FOR PATIENTS WITH ANOREXIA NERVOSA?

Background: Anorexia nervosa (AN) is a serious mental disorder with a high mortality rate and often a chronic course. In contrast to many other common mental disorders, there is no drug therapy approved for AN. Methods: We performed a narrative literature review to consider whether a choline-containing molecule, such as phosphatidylcholine (PC), with an omega (ω)-3 long chain polyunsaturated fatty acid (LCPUFA) could be a potential future medicinal treatment for AN. Results: Choline and LCPUFAs have individually shown benefit for mental health. Case series and pilot studies suggest ω -3 LCPUFAs may be effective in eating disorders. However, pharmacodynamic and pharmacokinetic considerations suggest a greater benefit from the combination of both components. Conclusion: The combination of a choline-containing molecule with an ω-3 LCPUFA may be clinically effective and well tolerated. This idea is supported by the current literature on the role of inflammation, the microbiome, the gut-brain-axis, hormonal, neurotransmitter and intracellular signalling, and on the structure and fluidity of nerve cells membranes in patients with AN