The effect of excess weight on circulating inflammatory cytokines in drug-naïve first-episode psychosis individuals

Background: Low-grade inflammation has been repeatedly associated with both excess weight and psychosis. However, no previous studies have addressed the direct effect of body mass index (BMI) on basal serum cytokines in individuals with first-episode psychosis (FEP). Objectives: The aim of this study is to analyze the effect of BMI on basal serum cytokine levels in FEP patients and control subjects, separating the total sample into two groups: normal-weight and overweight individuals. Methods: This is a prospective and open-label study. We selected 75 FEP patients and 75 healthy controls with similar characteristics to patients according to the following variables: sex, age, and cannabis and tobacco consumption. Both controls and patients were separated into two groups according to their BMI: subjects with a BMI under 25 were considered as normal weight and those with a BMI equal to or more than 25 were considered as overweight. Serum levels of 21 cytokines/chemokines were measured at baseline using the Human High Sensitivity T Cell Magnetic Bead Panel protocol from the Milliplex® Map Kit. We compared the basal serum levels of the 21 cytokines between control and patient groups according to their BMI. Results: In the normal-weight group, IL-8 was the only cytokine that was higher in patients than in the control group (p = 0.001), whereas in the overweight group, serum levels of two pro-inflammatory cytokines (IL-6, p = 0.000; IL-1?, p = 0.003), two chemokines (IL-8, p = 0.001; MIP-1?, p = 0.001), four Th-1 and Th-2 cytokines (IL-13, p = 0.009; IL-2, p = 0.001; IL-7, p = 0.001; IL-12p70, p = 0.010), and one Type-3 cytokine (IL-23, p = 0.010) were higher in patients than in controls. Conclusions: Most differences in the basal serum cytokine levels between patients and healthy volunteers were found in the overweight group. These findings suggest that excess weight can alter the homeostasis of the immune system and therefore may have an additive pro-inflammatory effect on the one produced by psychosis in the central nervous system.Funding: The present study was carried out at the Hospital Marqués de Valdecilla, University of Cantabria, Santander, Spain, under the following grant support from MINECO SAF2013-46292-R, Instituto de Salud Carlos III, and Fundación Marqués de Valdecilla. No pharmaceutical company has participated in the study concept and design, data collection, analysis and interpretation of the results, and drafting of the manuscript. We thank the Valdecilla Biobank for blood sampling handling and storage. We also wish to thank the participants and their families for enrolling in this study. The study, designed and directed by B C-F, conformed to international standards for research ethics and was approved by the local institutional review board

The nosological significance of Folie à Deux: a review of the literature

BACKGROUND: Folie à Deux is a rare syndrome that has attracted much clinical attention. There is increasing doubt over the essence of the condition and the validity of the original description, such that it remains an elusive entity difficult to define. METHOD: We conducted a systematic review of the literature of all cases reporting the phenomenon of Folie à Deux, from the years 1993–2005. RESULTS: 64 cases were identified of which 42 met the inclusion criteria. The diagnoses in the primary and secondary were more heterogeneous than current diagnostic criteria suggest. There exists a high degree of similarity between the primary and secondary in terms of susceptibility to psychiatric illness, family and past psychiatric history, than previously thought. CONCLUSION: Folie à Deux can occur in many situations outside the confines of the current classification systems and is not as rare as believed, and should alert the clinician to unrecognized psychiatric problems in the secondary

Epidemiology of panic disorder and subthreshold panic symptoms in the Greek general population

Panic disorder (PD) is a common anxiety disorder with severe social and health consequences in the lives of individuals who suffer from it. General population studies that attempt to measure the prevalence of this disorder across the world suggest that a 1.7% to 4.7 % of adults and adolescents suffer from Panic Disorder. In Greece, research analyzing the abovementioned matters is limited, and previous studies were put forward in small samples. The aim of the present study was to describe the prevalence and sociodemographic associations of panic disorder (PD) and related subthreshold panic symptoms in the general population of Greece and to appraise the comorbidity, use of services and impact on quality of life of these syndromes. This was a secondary analysis of the 2009-2010 psychiatric morbidity survey carried out in a representative sample of the Greek general population (4894 participants living in private households, 18-70 years, response rate 54%). Psychiatric disorders were assessed with the computerized version of the revised Clinical Interview Schedule (CIS-R). Quality of life was assessed with the EuroQoL EQ-5D generic instrument. The utilization of health services was examined by making relevant questions. Finally, direct questions were used to assess sociodemographic and socioeconomic factors According to our findings, 1.87% of the participants (95% confidence interval [CI]: 1.50-2.26%) met criteria for PD and 1.61% met criteria for subclinical PD (95% CI: 1.26-1.96%). There was a clear female preponderance for both PD (p=0.001) and Sub-PD (p=0.01). In addition, 3.48% of the participants reported having experienced panic attacks during the past week (95% confidence interval [CI]: 2.98-4.01%). PD or subclinical PD was independently associated with a limited number of sociodemographic and socioeconomic variables especially after the adjusted analysis. Both panic related conditions involved significant reductions in quality of life and elevated utilization of health services for both medical and psychological reasons in comparison to healthy participants. In conclusion, PD and subclinical panic symptoms were common in the general Greek population with substantial comorbidity and impaired quality of life. The observed use of the general and psychological health services among adults with panic symptoms and its temporal and economic consequences calls for more efficient diagnostic and treatment policies

Greater extracellular free-water in first-episode psychosis predicts better neurocognitive functioning

Free Water Imaging is a novel diffusion magnetic resonance (MR) imaging method that is able to separate changes affecting the extracellular space from those that reflect changes in neuronal cells and processes. A previous Free Water Imaging study in schizophrenia identified significantly greater extracellular water volume in the early stages of the disorder; however, its clinical and functional sequelae have not yet been investigated. Here, we applied Free Water Imaging to a larger cohort of 63 first-episode patients with psychosis and 70 healthy matched controls to better understand the functional significance of greater extracellular water. We used diffusion MR imaging data and the Tract-Based Spatial Statistics analytic pipeline to first analyze fractional anisotropy (FA), the most commonly employed metric for assessing white matter. This comparison was then followed by Free Water Imaging analysis, where two parameters, the fractional volume of extracellular free-water (FW) and cellular tissue FA (FA-t), were estimated and compared across the entire white matter skeleton between groups, and correlated with cognitive measures at baseline and following 12 weeks of antipsychotic treatment. Our results indicated lower FA across the whole brain in patients compared with healthy controls that overlap with significant increases in FW, with only limited decreases in FA-t. In addition, higher FW correlated with better neurocognitive functioning following 12 weeks of antipsychotic treatment. We believe this is the first study to suggest that an extracellular water increase during the first-episode of psychosis, which may be indicative of an acute neuroinflammatory process, and/or cerebral edema may predict better functional outcome

Glucose disturbances, cognitive deficits and white matter abnormalities in first-episode drug-naive schizophrenia

Disturbance of glucose metabolism may be implicated in cognitive deficits of schizophrenia in its early phases. Many studies have reported the important role of widespread disruption of white matter (WM) connectivity in pathogenesis, cognitive deficit and psychopathology of schizophrenia. However, no study has investigated their inter-relationships in drug-naive first episode (DNFE) patients with schizophrenia. Glucose metabolism parameters including fasting glucose, insulin and homeostasis model of assessment-insulin resistance (HOMA-IR) index, cognitive performance on the MATRICS Consensus Cognitive Battery (MCCB) and the voxel-wised WM fractional anisotropy (FA) values were examined using DTI in 39 DNFE schizophrenia and 31 control subjects. The Positive and Negative Syndrome Scale was utilized for clinical symptoms. The patients showed significantly greater fasting plasma levels of glucose and insulin and HOMA-IR, and poorer cognitive scores, together with widespread reduced FA values in five brain areas, including left and right corpus callosum, superior longitudinal fasciculus, posterior thalamic radiation, and corona radiata (all p<0.05). Association analysis showed that glucose level was positively associated with Digital Sequence Test and Continuous Performance Test, but negatively with FA values in posterior thalamic radiation and left corpus callosum in patients (all p<0.05). Furthermore, multiple regression analysis revealed that the interactions of glucosexFA in left corpus callosum, longitudinal fasciculus and corona radiata were independent contributors to the Brief Visuospatial Memory Test (BVMT) of MCCB, while the interaction of glucosexFA in left corpus callosum, or in longitudinal fasciculus was associated with MCCB mazes and Trail Making A Test, respectively. Therefore, abnormal glucose metabolism, cognitive impairment and widespread disruption of WM structure occur in an early course of schizophrenia onset. An interaction between glucose metabolism abnormality and the WM dysconnectivity may lead to cognitive impairment