BIOMARKERS OF DEPRESSION ASSOCIATED WITH COMORBID SOMATIC DISEASES

Depression is heterogeneous clinical entity with different clinical symptoms, that imply diverse biological underpinning, different molecular substrates and pathways. Besides different psychiatric comorbidities, depression is frequently interrelated with somatic diseases. Multi-morbidities, i.e. somatic diseases associated with depression, reduce quality of life, worsen clinical picture and increase mortality. The most frequent somatic diseases co-occurring with depression are cardiovascular and metabolic diseases. Vulnerable individuals will develop depression, and the goal in modern research and in precision/personalized medicine is to determine vulnerability factors associated with development of depression and to find easy available biomarkers of depression, especially comorbid with somatic diseases. This mini-review aimed to describe the latest published data (from 2015-20120) considering biomarkers of depression related to somatic diseases. Biomarkers related to inflammatory processes, atherosclerosis, imbalance of the hypothalamic-pituitary-adrenal axis, autonomic nerve system, sympathetic and parasympathetic nervous system, heart rate variability and endothelial dysfunction could improve the understanding of the underlying biological mechanisms of the common pathways of depression comorbid with somatic diseases. These targeted biomarkers might be used to reduce the symptoms, improve the treatment of these interrelated diseases, and decrease the morbidity and mortality

REMISSION AND EMPLOYMENT STATUS IN SCHIZOPHRENIA AND OTHER PSYCHOSES: ONE-YEAR PROSPECTIVE STUDY IN CROATIAN PATIENTS TREATED WITH RISPERIDONE LONG ACTING INJECTION

Background: While numerous studies have confirmed the efficacy of risperidone long-acting injectable (RLAI) on many clinical outcomes in patients with schizophrenia, there is no data regarding its influence on employment status. Subject and methods: This was a 12-month observational study with flexible doses of RLAI on a Croatian population of patients with schizophrenia and other psychoses. Visits were at baseline and after 1, 3, 6 and 12 months of treatment. Treatment response was evaluated using Clinical Global Impression of Illness Severity (CGI-S) and Improvement (CGI-I) scales, while remission was defined by 8 items of Positive and Negative Syndrome Scale (PANSS). Employment status was determined at baseline and at study endpoint. Results: A total of 362 patients were included, with a median age of 37 (interquartile range 29-47) years, 63.5 % were males and 67.4% were hospitalised at baseline. Overall 258 (71.3%) patients completed the study. Improvements in CGI-S scores from baseline were significant (p<0.001) at all visits. Remission criteria were met in 9 (2.5%) patients at baseline, and in 199 (54.9%) at endpoint, while 144 patients (52.7%) achieved symptomatic remission. Female patients were five times more likely to achieve symptomatic remission (OR=5.2; 95%CI=2.64-10.19). At baseline, 74/362 (20.4%) patients were employed, compared to 77/257 (30.0%) at endpoint (p<0.001). Adverse events were spontaneously reported in 55 (15.2%) patients. Three patients died (judged not to be related to RLAI) and one patient committed homicide. Conclusions: Patients treated with RLAI had significant improvements in CGI-S scale scores, hospitalization status, rates of remission and employment status, indicating the benefits of continuous treatment over time. Further studies on the comparative impact of different treatment strategies on functional recovery are needed

THE PRESENCE OF MINOR PHYSICAL ANOMALIES OF A HAND IN PATIENTS WITH MENTAL DISORDERS

Introduction: Minor physical anomalies (MPA) are subtle morphological deviations with little to none clinical significance that are developed prenatally and therefore could be an indicator of structural changes in the brain developing at the same time. Aim of this study was to determine whether the MPA of the hand can distinguish psychotic patients from patients with non-psychotic diagnoses as well as from the healthy individuals. Subjects and methods: 100 consecutive patients from the University Hospital Center Zagreb, Department of psychiatry, were included in this case-control study along with 100 healthy control subjects. Investigators examined the dorsal and palmar side of the hand and were blind to the patient’s diagnoses previous to the examination. Examined MPA included thenar crease, proximal transverse crease, proximal interphalangeal joint, eponychium of the middle digit, fingernail size and digital flexibility. Results: Results showed significant differences in the quantity of MPA between the patients and the control group, as well as differences between patients with psychosis and the healthy subjects. Conclusions: Despite the fact that previous studies demonstrated characteristic distribution of specific MPA in schizophrenia, this study did not prove such results. Moreover, this study showed that all the MPA are equally common in both schizophrenia and other psychoses

REMISSION IS NOT ASSOCIATED WITH DRD2 RS1800497 AND DAT1 RS28363170 GENETIC VARIANTS IN MALE SCHIZOPHRENIC PATIENTS AFTER 6-MONTHS MONOTHERAPY WITH OLANZAPINE

Background: Symptomatic remission is an achievable goal in the treatment of schizophrenia. The type of antipsychotic medication and particular genetic variants of the dopaminergic system might be associated with remission. Potential pharmacogenetic markers of the treatment response to antipsychotic medication are missing. This study assessed the possible association between dopamine receptor type 2 (DRD2 rs1800497) and dopamine transporter (DAT1 rs28363170) gene variants with symptomatic remission in schizophrenia. Subjects and methods: Olanzapine (5-20 mg/d) monotherapy was administered for 6 months to 150 male Caucasian subjects with schizophrenia. Remission was evaluated according to "Remission in Schizophrenia Working Group" criteria. Genotyping was performed by PCR-RFLP. Results: Symptomatic remission was found in 31% of patients. DRD2 rs1800497 and DAT1 rs28363170 gene variants were not significantly associated with symptomatic remission. The limitations are a relatively small sample size of patients with schizophrenia (N=150), especially of group with symptomatic remission (N=45). However, the study had moderate but adequate sample sizes for most of the comparisons. Only two dopaminergic polymorphisms were analyzed, and plasma concentration of olanzapine was not determined. Conclusion: These results revealed a lack of association between DRD2 rs1800497 and DAT1 rs28363170 genetic variants and symptomatic remission in male patients treated with olanzapine, suggesting that these genetic variants could not be used to predict symptomatic remission to olanzapine monotherapy. Negative results should be further confirmed or rejected in the larger samples, including haplotype analyses, to detect clinically useful and easy obtainable pharmacogenetic markers that might predict therapeutic response or remission in schizophrenia

Genetic Variants of the Brain-Derived Neurotrophic Factor and Metabolic Indices in Veterans With Posttraumatic Stress Disorder

Posttraumatic stress disorder (PTSD) is a trauma and stressor related disorder that may develop after exposure to an event that involved the actual or possible threat of death, violence or serious injury. Its molecular underpinning is still not clear. Brain-derived neurotrophic factor (BDNF) modulates neuronal processes such as the response to stress, but also weight control, energy and glucose homeostasis. Plasma BDNF levels and a functional BDNF Val66Met (rs6265) polymorphism were reported to be associated with PTSD, as well as with increased body mass index (BMI) and dyslipidaemia in healthy subjects and patients with cardio-metabolic diseases, but these results are controversial. The other frequently studied BDNF polymorphism, C270T (rs56164415), has been associated with the development of different neuropsychiatric symptoms/disorders. As far as we are aware, there are no data on the association of BDNF Val66Met and C270T polymorphisms with metabolic indices in PTSD. Due to high rates of obesity and dyslipidaemia in PTSD, the aim of this study was to elucidate the association of BDNF Val66Met and C270T polymorphisms with BMI and lipid levels in veterans with PTSD. We hypothesized that BDNF variants contribute to susceptibility to metabolic disturbances in PTSD. The study included 333 Caucasian males with combat related PTSD, diagnosed according to DSM-5 criteria. Genotyping of the BDNF Val66Met and C270T polymorphisms was performed using the real-time PCR method. Results were analyzed using hierarchical multiple linear regression and the Mann–Whitney test, with p-value corrected to 0.005. The results showed that BDNF Val66Met and BDNF C270T polymorphisms were not significantly associated with BMI, total cholesterol, LDL-cholesterol, HDL-cholesterol or triglycerides. Although the BDNF C270T polymorphism was nominally associated only with HDL-cholesterol in veterans with PTSD, this significance disappeared after controlling for the effect of age. Namely, slightly higher plasma HDL values in T allele carriers, compared to CC homozygotes, were associated with differences in age. Our results, controlled for the critical covariates, revealed that BDNF Val66Met and C270T were not significantly associated with metabolic indices in veterans with PTSD and that these genetic variants do not contribute to susceptibility to metabolic disturbances in PTSD

Unidad de Currícum y Evaluación : objetivos fundamentales y contenidos mínimos obligatorios de la Educación Básica y Media de Adultos

Contiene el Decreto Supremo de Educación 239 del Ministerio de Educación del Gobierno de Chile, publicado el 15 de noviembre de 2004, por el que se establecen los objetivos fundamentales y objetivos mínimos obligatorios para la enseñanza de adultos en sus tres subdivisiones: Enseñanza Básica, Enseñanza Media Humanístico-Científica y Enseñanza Media Técnico-Profesional. También se incluyen los planes de estudio para cada uno de los niveles de cada etapa, donde se recoge la fundamentación, principios básicos, objetivos fundamentales y contenidos mínimos de todas las materias de cada nivel. Los objetivos fundamentales y contenidos mínimos obligatorios de la Educación de Adultos fueron enriquecidos y precisados por los resultados del proceso de Consulta Nacional, que tuvo lugar en el año 2003 y en el que participaron cuatro mil ciento treinta directivos y docentes de este nivel de enseñanza.Ministerio Educación. RIEJACH