Pharmacology and clinical potential of vortioxetine in the treatment of major depressive disorder

Vortioxetine is a new multimodal action antidepressant with two types of action: serotonin transporter (SERT) blockade and a strong affinity for several serotoninergic receptors. It is an antagonist of the 5-HT3 and 5-HT7 receptors, a partial agonist of 5-HT1B, and an agonist of 5-HT1A. Its combined action on SERT and four subtypes of serotoninergic receptors increases the extracellular concentration of serotonin, dopamine, and noradrenaline. Twelve clinical trials have been carried out, nine of which had positive results versus placebo. When active comparators were included in the study design, no significant differences were found except in one study in which the efficacy of vortioxetine was superior to the comparator (agomelatine) in depression resistant to selective serotonin reuptake inhibitors (SSRI)/serotonin-norepinephrine reuptake inhibitors (SNRI) treatment. Tolerability studies indicate that the drug does not cause any important problems on blood tests, vital signs, or on electrocardiography. The lack of weight gain and induction of metabolic syndrome and the lack of significant changes in the QTc are especially important. The incidence rate of sexual dysfunction is low and similar to placebo in various trials. Similarly, cognitive function remains intact with vortioxetine

Distinctive alterations in the functional anatomy of the cerebral cortex in pain-sensitized osteoarthritis and fibromyalgia patients

Pain-sensitized osteoarthritis and fibromyalgia patients characteristically show nociceptive system augmented responsiveness as a common feature. However, sensitization can be originally related to the peripheral injury in osteoarthritis patients, whereas pain and bodily discomfort spontaneously occur in fibromyalgia with no apparent origin. We investigated the distinct functional repercussion of pain sensitization in the cerebral cortex in both conditions. Thirty-one pain-sensitized knee osteoarthritis patients and 38 fibromyalgia patients were compared with matched control groups. And new samples of 34 sensitized knee osteoarthritis and 63 fibromyalgia patients were used to directly compare each condition. A combined measure of local functional connectivity was estimated to map functional alterations in the cerebral cortex at rest. In osteoarthritis, weaker local connectivity was identified in the insula, which is a cortical area processing important aspects of the brain response to painful stimulation. In contrast, fibromyalgia patients showed weaker connectivity in the sensorimotor cortex extensively affecting the cortical representation of the body. In osteoarthritis, weaker insular cortex connectivity is compatible with reduced neural activity during metabolic recovery after repeated activation. In the fibromyalgia neurophysiological context, weaker connectivity may better express both reduced neural activity and increased excitability, particularly affecting the sensorimotor cortex in patients with spontaneous body pain. Such a combination is compatible with a central gain enhancement mechanism, where low sensory tolerance results from the over-amplification of central sensory reception to compensate a presumably weak sensory input. We propose that deficient proprioception could be a factor contributing to weak sensory input. The online version contains supplementary material available at 10.1186/s13075-022-02942-3

Brain activity during traditional textbook and audiovisual-3D learning

Introduction: Audiovisual educational tools have increasingly been used during the past years to complement and compete with traditional textbooks. However, little is known as to how the brain processes didactic information presented in different formats. We directly assessed brain activity during learning using both traditional textbook and audiovisual-3D material. Methods: A homogeneous sample of 30 young adults with active study habits was assessed. Educational material on the subject of Cardiology was adapted to be presented during the acquisition of functional MRI. Results: When tested after image acquisition, participants obtained similar examination scores for both formats. Evoked brain activity was robust during both traditional textbook and audiovisual-3D lessons, but a greater number of brain systems were implicated in the processing of audiovisual-3D information, consistent with its multisource sensory nature. However, learning was not associated with group mean brain activations, but was instead predicted by distinct functional MRI signal changes in the frontal lobes and showed distinct cognitive correlates. In the audiovisual-3D version, examination scores were positively correlated with late-evoked prefrontal cortex activity and working memory, and negatively correlated with language-related frontal areas and verbal memory. As for the traditional textbook version, the fewer results obtained suggested the opposite pattern, with examination scores negatively correlating with prefrontal cortex activity evoked during the lesson. Conclusions: Overall, the results indicate that a similar level of knowledge may be achieved via different cognitive strategies. In our experiment, audiovisual learning appeared to benefit from prefrontal executive resources (as opposed to memorizing verbal information) more than traditional textbook learning

Prevenció del suïcidi per a persones amb diagnòstic d'esquizofrènia : un nou enfocament basat en estratègies telemàtiques

Una revisió de la literatura científica troba resultats que suggereixen que les intervencions de prevenció del suïcidi mitjançant contacte telefònic semblen ser viables i eficaces per a reduir la ideació suïcida en pacients amb esquizofrènia i símptomes psicòtics.Una revisión de la literatura científica halla resultados que sugieren que las intervenciones de prevención del suicidio mediante contacto telefónico parecen ser viables y eficaces para reducir la ideación suicida en pacientes con esquizofrenia y síntomas psicóticosA review of the scientific literature finds results suggesting that suicide prevention interventions using telephone contact appear to be feasible and effective in reducing suicidal ideation in patients with schizophrenia and psychotic symptoms

Educació ambiental : diagnosi dels equipaments del Parc del Garraf

El present projecte es centra en l'estudi de l'educació ambiental als equipaments del Parc del Garraf. Amb l'estudi de les característiques d'aquest tipus d'educació en aquests equipaments, que es troben tant a l'interior del parc com fora, però amb influència directa sobre ell, s'ha pogut constatar que l'educació ambiental és l'eina principal utilitzada per a articular la coneixença del parc i apropar els usuaris al medi natural del Garraf, materialitzant-se en una elevada i diversificada oferta de programes i activitats. A l'anàlisi realitzat, es determina que segons la naturalesa dels equipaments estudiats, el tractament d'una mateixa temàtica es desenvolupa de manera molt diferent en funció de les seves característiques intrínseques i els recursos disponibles. Finalment s'ha elaborat un conjunt de propostes per tal de millorar els programes d'activitats, la infraestructura i el conjunt de característiques dels equipaments seleccionats, relacionats directa o indirectament amb l'educació ambiental.El presente proyecto se centra en el estudio de la educación ambiental en los equipamientos del Parque del Garraf. Con el estudio de las características de este tipo de educación en estos equipamientos, que se encuentran tanto en el interior del parque como fuera, pero con influencia directa sobre él, se ha podido constatar que la educación ambiental es el medio principal utilizado para articular el conocimiento del parque i acercar a los usuarios al medio natural del Garraf, materializándose en una elevada i diversificada oferta de programas y actividades. En el análisis realizado se determina que según la naturaleza de los equipamientos estudiados, el tratamiento de una misma temática se desarrolla de manera muy diferente en función de sus características intrínsecas y los recursos disponibles. Finalmente se ha elaborado un conjunto de propuestas por tal de mejorar los programas de actividades, la infraestructura y las características de los equipamientos seleccionados, relacionados directa o indirectamente con la educación ambiental.The present project tries to focuse on the environmental education's features about the equipments at the Parc del Garraf. With the study of this type of education features about these equipments, which are located both inside the parc as outside, but with direct influence on it, it has been shown that environmental education is the main tool which is been served to manage knowledge about the parc and to zoom the Garraf's environment to users, which is materialized in a high and diversified offer about schedules and activities. In the analysis we have done, depending on the type of the equipments we've studied, the treatment of a single subject is very different instead of their intrinsic features and available resources. Finally, it has been developed a set of proposals to improve the schedules of activities, infrastructure, and the features of the equipments we have selected related direct or indirectly with environmental education

Multidimensional predictors of negative symptoms in antipsychotic-naive first-episode psychosis.

BACKGROUND: Despite a large body of schizophrenia research, we still have no reliable predictors to guide treatment from illness onset. The present study aimed to identify baseline clinical or neurobiological factors - including peripheral brain-derived neurotrophic factor (BDNF) levels and amygdala or hippocampal relative volumes - that could predict negative symptomatology and persistent negative symptoms in first-episode psychosis after 1 year of follow-up. METHODS: We recruited 50 drug-naive patients with first-episode psychosis and 50 age- and sex-matched healthy controls to study brain volumes. We performed univariate and multiple and logistic regression analyses to determine the association between baseline clinical and neurobiological variables, score on the PANSS negative subscale and persistent negative symptoms after 1 year of follow-up. RESULTS: Low baseline serum BDNF levels (p = 0.011), decreased left amygdala relative volume (p = 0.001) and more severe negative symptomatology (p = 0.021) predicted the severity of negative symptoms at 1 year, as measured by the PANSS negative subscale. Low baseline serum BDNF levels (p = 0.012) and decreased left amygdala relative volume (p = 0.010) predicted persistent negative symptoms at 1 year. LIMITATIONS: We were unable to assess negative symptoms and their dimensions with next-generation scales, which were not available when the study was initiated. CONCLUSION: This study shows that a set of variables at baseline, including low BDNF levels, smaller left amygdala relative volume and score on the PANSS negative subscale are significant predictors of outcomes in first-episode psychosis. These findings might offer an initial step for tailoring treatments in first-episode psychosis

Exploring the relation between childhood trauma, temperamental traits and mindfulness in borderline personality disorder

Background: Deficits in mindfulness-related capacities have been described in borderline personality disorder (BPD). However, little research has been conducted to explore which factors could explain these deficits. This study assesses the relationship between temperamental traits and childhood maltreatment with mindfulness in BPD. Methods: A total of 100 individuals diagnosed with BPD participated in the study. Childhood maltreatment was assessed using the Childhood Trauma Questionnaire (CTQ-SF), temperamental traits were assessed using the Zuckerman-Khulman Personality Questionnaire (ZKPQ), and mindfulness capabilities were evaluated with the Five Facet Mindfulness Questionnaire (FFMQ). Results: Hierarchical regression analyses were performed including only those CTQ-SF and ZKPQ subscales that showed simultaneous significant correlations with mindfulness facets. Results indicated that neuroticism and sexual abuse were predictors of acting with awareness; and neuroticism, impulsiveness and sexual abuse were significant predictors of non-judging. Temperamental traits did not have a moderator effect on the relationship between childhood sexual abuse and mindfulness facets. Conclusions: These results provide preliminary evidence for the effects of temperamental traits and childhood trauma on mindfulness capabilities in BPD individuals. Further studies are needed to better clarify the impact of childhood traumatic experiences on mindfulness capabilities and to determine the causal relations between these variables

Augmentation of EMDR with multifocal transcranial current stimulation (MtCS) in the treatment of fibromyalgia : study protocol of a double-blind randomized controlled exploratory and pragmatic trial

Fibromyalgia (FM) is a generalized, widespread chronic pain disorder affecting 2.7% of the general population. In recent years, different studies have observed a strong association between FM and psychological trauma. Therefore, a trauma-focused psychotherapy, such as eye movement desensitization and reprocessing (EMDR), combined with a non-invasive brain stimulation technique, such as multifocal transcranial current stimulation (MtCS), could be an innovative adjunctive treatment option. This double-blind randomized controlled trial (RCT) analyzes if EMDR therapy is effective in the reduction of pain symptoms in FM patients and if its potential is boosted with the addition of MtCS. Forty-five patients with FM and a history of traumatic events will be randomly allocated to Waiting List, EMDR + active-MtCS, or EMDR + sham-MtCS. Therapists and patients will be kept blind to MtCS conditions, and raters will be kept blind to both EMDR and MtCS. All patients will be evaluated at baseline, post-treatment, and follow-up at 6 months after post-treatment. Evaluations will assess the following variables: sociodemographic data, pain, psychological trauma, sleep disturbance, anxiety and affective symptoms, and wellbeing. This study will provide evidence of whether EMDR therapy is effective in reducing pain symptoms in FM patients, and whether the effect of EMDR can be enhanced by MtCS. ClinicalTrials.gov . Registered on 2 August 2019. The online version contains supplementary material available at 10.1186/s13063-021-05042-w

Poden els registres d'atenció primària ajudar a detectar el risc de suïcidi? : Un estudi de cas a Barcelona

El suïcidi és un greu problema de salut pública que s'ha vist incrementat en les últimes dècades, la qual cosa ha portat a la creació de diferents programes d'intervenció que tenen com a finalitat identificar i ajudar la persona afectada. En aquest article, un grup d'investigadors de l'àrea de Medicina presenta el resum d'un estudi en el qual intenten trobar a partir de registres electrònics del sistema sanitari, quins factors poden ajudar a identificar pacients amb alt risc de suïcidi. Una de les primeres conclusions és que molts d'ells queden recollits de manera rutinària en aquests registres, la qual cosa suposa un bon punt de partida per elaborar estratègies de prevenció.El suicidio es un grave problema de salud pública que se ha visto incrementado en las últimas décadas, lo que ha llevado a la creación de diferentes programas de intervención que tienen como finalidad identificar y ayudar a la persona afectada. En este artículo, un grupo de investigadores del área de Medicina presenta el resumen de un estudio que han llevado cabo para intentar encontrar a partir de registros electrónicos del sistema sanitario, qué factores pueden ayudar a identificar pacientes con alto riesgo de suicidio. Una de Llas primeras conclusiones es que muchos de ellos quedan recogidos de manera rutinaria en estos registros, lo que supone un buen punto de partida para elaborar estrategias de prevención.Suicide is a serious public health problem that has increased in recent decades, and this has led to the creation of different intervention programs that aim to identify and help the affected person. In this article, a group of medical researchers presents the summary of a study they conducted, using electronic records of the health system, to find the factors which could help to identify patients with a high risk of suicide. One of the first conclusions is that many of them are routinely collected in these registries, which is a good starting point for developing prevention strategies

Emotional responses to a negative emotion induction procedure in Borderline Personality Disorder

The aim of this study was to determine if patients with Borderline Personality Disorder (BPD) present higher emotional response than healthy controls in a laboratory setting. Fifty participants (35 patients with BPD and 15 healthy controls) underwent a negative emotion induction procedure (presentation of standardized unpleasant images). Subjective emotional responses were assessed by means of self-reported questionnaires while biological reactivity during the procedure was measured through levels of salivary cortisol (sCORT) and alpha-amylase (sAA). Patients with BPD exhibited significant lower cortisol levels and higher sAA levels compared to controls. Self-reported emotional reactivity did not give rise to differences between groups but participants with BPD did present higher levels of negative emotional intensity at baseline and during the entire procedure. The findings do not give support to the emotional hyperreactivity hypothesis in BPD. However, BPD patients presented heightened negative mood intensity at baseline, which should be considered a hallmark of the disorder. Further studies using more BPD-specific emotion inductions are needed to confirm the trends observed in this studyEl presente estudio pretende determinar si existe o no una mayor reactividad emocional en el Trastorno Límite de la Personalidad (TLP) en un contexto de laboratorio. Se realizó una inducción emocional negativa (presentación de imágenes estandarizadas con contenido negativo) a cincuenta participantes (35 pacientes con TLP y 15 controles sanos). Para evaluar la respuesta emocional subjetiva se utilizaron cuestionarios auto-informados; los niveles de cortisol (sCORT) y alfa-amilasa (sAA) salivares se utilizaron para medir la reactividad biológica al procedimiento. En el grupo de TLP, se observaron niveles de sCORT más bajos y niveles de sAA más elevados en comparación al grupo control. No se observaron diferencias significativas en relación a la reactividad emocional auto-informada, pero los pacientes con TLP reportaron mayor intensidad de emociones negativas a nivel basal así como también durante todo el procedimiento. Los resultados no apoyan la hipótesis de hiperreactividad emocional en el TLP. Sin embargo, los pacientes con TLP presentaron mayor intensidad de emociones negativas a nivel basal, característica que debería ser considerada como esencial en el trastorno. Futuros estudios deberán incorporar otros paradigmas de inducción emocional más específicos para TLP con el fin de confirmar las tendencias observadas en el presente estudi