Subscribe: pubmed: 0160-6689
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pubmed: 0160-6689



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Effects of Cumulative Herpesviridae and Toxoplasma gondii Infections on Cognitive Function in Healthy, Bipolar, and Schizophrenia Subjects.

Effects of Cumulative Herpesviridae and Toxoplasma gondii Infections on Cognitive Function in Healthy, Bipolar, and Schizophrenia Subjects.

J Clin Psychiatry. 2016 Dec 06;:

Authors: Hamdani N, Daban-Huard C, Godin O, Laouamri H, Jamain S, Attiba D, Delavest M, Lépine JP, Le Corvoisier P, Houenou J, Richard JR, Yolken RH, Krishnamoorthy R, Tamouza R, Leboyer M, Dickerson FB

Abstract
OBJECTIVE: Schizophrenia and bipolar disorder are associated with cognitive impairment leading to social disruption. While previous studies have focused on the effect of individual infectious exposure, namely, Herpesviridae viruses or Toxoplasma gondii (T gondii), on cognitive functioning, the objective of the present study was to examine the effect of multiple infections on cognitive functioning in patients with schizophrenia and bipolar disorder and in healthy controls.
METHODS: Seropositivity to herpes simplex virus type 1 (HSV-1), herpes simplex virus type 2 (HSV-2), cytomegalovirus (CMV), and T gondii was related to cognitive status among 423 participants (recruited between 2008 and 2014; 138 patients with bipolar disorder, 105 patients with schizophrenia [DSM-IV criteria], and 180 healthy controls) for episodic verbal memory (California Verbal Learning Test), working memory (Wechsler Adult Intelligence Scale, third edition), and premorbid intelligence quotient (National Adult Reading Test).
RESULTS: Seropositivity to and antibody levels of HSV-1 were significantly associated with working memory, which persisted after correction (backward digit span: β = -0.10 [0.05], χ² = 33.89, P = .0001) in the overall sample. This association was particularly strong in the control group (β = -0.18 [0.08], P = .04, Z = -3.55, P = .0008; corrected P = .012). Further, cumulative exposure to HSV-1, HSV-2, and CMV viruses and T gondii parasite was also associated with lower scores on working memory as measured by backward digit span in the overall sample (Z = 2.86, P = .004; Z = 2.47, P = .01; and Z = 3.35, P = .01, respectively).
CONCLUSIONS: Exposures to Herpesviridae and T gondii parasite seem to impact cognitive functioning. Because infections caused by Herpesviridae and/or T gondii parasite are quite common in the (general) population, assessing and confirming the cognitive impairment among those who have cumulative exposures is useful and of interest.

PMID: 27929612 [PubMed - as supplied by publisher]




Switching the Antidepressant After Nonresponse in Adults With Major Depression: A Systematic Literature Search and Meta-Analysis.

Switching the Antidepressant After Nonresponse in Adults With Major Depression: A Systematic Literature Search and Meta-Analysis.

J Clin Psychiatry. 2016 Dec 06;:

Authors: Bschor T, Kern H, Henssler J, Baethge C

Abstract
OBJECTIVE: Nonresponders to antidepressant monotherapy during acute treatment of major depression are often switched to a new antidepressant. The objective of this meta-analysis was to compare the efficacy of switching to a new antidepressant with continuation of the first antidepressant.
DATA SOURCES: PubMed, Embase, PsycINFO, and Cochrane Central Register of Controlled Trials (CENTRAL) databases and additional sources were systematically searched independently by 2 authors up to March 2015 without language limitations. With employment of a sensitivity-enhancing search strategy, generic terms for major depression, switching, and randomized trials were combined.
STUDY SELECTION: Articles (3,234) were screened for trials of patients with major depression who had not responded to antidepressant monotherapy who were then randomized either to a new antidepressant or to continuation of the first antidepressant. Studies were subdivided into those not allowing for dose escalation in the continuation arm (strict analysis) and those allowing for dose escalation (broad analysis).
DATA EXTRACTION: Data were extracted and risk of bias was assessed independently by 2 authors, and data were pooled using random effects models.
RESULTS: Four randomized controlled trials were included in the strict analysis and 8 in the broad analysis. In both analyses, switching was not superior to continuation: the standardized mean difference in the strict analysis was -0.17 (95% CI, -0.59 to 0.26; P = .45; I² = 77.8%) and in the broad analysis was 0.031 (95% CI, -0.26 to 0.32; P = .836; I² = 85.3%). All secondary outcome analyses (response and remission rates, low risk of bias studies only, leave-one-out analysis, dropouts) supported the results. There was no indication of publication bias.
CONCLUSIONS: There is a dearth of randomized controlled trials investigating switching. There is no high-level evidence that switching the antidepressant is effective when compared to simply continuing the initial antidepressant. Since there are better treatment options than switching, physicians should be cautious to switch antidepressants.

PMID: 27929611 [PubMed - as supplied by publisher]




Antisuicidal Response Following Ketamine Infusion Is Associated With Decreased Nighttime Wakefulness in Major Depressive Disorder and Bipolar Disorder.

Antisuicidal Response Following Ketamine Infusion Is Associated With Decreased Nighttime Wakefulness in Major Depressive Disorder and Bipolar Disorder.

J Clin Psychiatry. 2016 Dec 06;:

Authors: Vande Voort JL, Ballard ED, Luckenbaugh DA, Bernert RA, Richards EM, Niciu MJ, Park LT, Machado-Vieira R, Duncan WC, Zarate CA

Abstract
OBJECTIVE: Insomnia and disrupted sleep are associated with increased risk of suicide. The N-methyl-D-aspartate antagonist ketamine has been associated with reduced suicidal thoughts, but the mechanism of action is unknown. This study sought to evaluate differences in nocturnal wakefulness in depressed individuals who did and did not have an antisuicidal response to ketamine.
METHODS: Thirty-four participants with baseline suicidal ideation diagnosed with either DSM-IV major depressive disorder (n = 23) or bipolar depression (n = 11) between 2006 and 2013 completed nighttime electroencephalography (EEG) the night before and the night after a single ketamine infusion (0.5 mg/kg over 40 minutes). Suicidal ideation was assessed at baseline and the morning after ketamine infusion via several measures, including the Hamilton Depression Rating Scale suicide item, the suicide item of the Montgomery-Asberg Depression Rating Scale, and the first 5 items of the Scale for Suicide Ideation. A generalized linear mixed model evaluated differences in nocturnal wakefulness, as verified by EEG, between those who had an antisuicidal response to ketamine and those who did not, controlling for baseline nocturnal wakefulness. Results were also compared to the sleep of healthy controls (n = 22).
RESULTS: After analyses adjusted for baseline sleep, participants with an antisuicidal response to ketamine showed significantly reduced nocturnal wakefulness the night after ketamine infusion compared to those without an antisuicidal response (F₁,₂₂ = 5.04, P = .04). Level of nocturnal wakefulness after antisuicidal response to ketamine did not differ significantly from nocturnal wakefulness in the control sample but did differ at a trend level (F₁,₄₀ = 3.15, P = .08).
CONCLUSIONS: Reductions in wakefulness following ketamine may point to a biological mechanism underlying the effect of ketamine on suicidal ideation.
TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT00088699.

PMID: 27929610 [PubMed - as supplied by publisher]




Cadmium, Lead, and Depressive Symptoms: Analysis of National Health and Nutrition Examination Survey 2011-2012.

Cadmium, Lead, and Depressive Symptoms: Analysis of National Health and Nutrition Examination Survey 2011-2012.

J Clin Psychiatry. 2016 Dec 06;:

Authors: Buser MC, Scinicariello F

Abstract
BACKGROUND: Several studies have noted an association between tobacco smoke and depression. Cadmium and lead are neurotoxicant components of tobacco smoke. The objective of the present study is to investigate the potential association between blood cadmium (BCd) and blood lead (BPb) with current depressive symptoms in the US adult population.
METHODS: We conducted cross-sectional analyses of adult participants (≥ 20 years) from the National Health and Nutrition Examination Survey 2011-2012 (N = 3,905). Multivariate logistic regressions were used to analyze the association between BCd and BPb with depressive symptoms; analyses were also stratified on sex and age groups (20-47 years and ≥ 48 years). Presence or absence of depressive symptoms was determined using the Patient Health Questionnaire module.
RESULTS: Individuals in the highest quartile of BCd had higher odds of having depressive symptoms (odds ratio = 1.68; 95% confidence limits: 1.12, 2.51). This association was found only in male participants and, more specifically, in younger adult male participants (20-47 years). We found that BPb, cigarette smoking, and obesity were associated with depressive symptoms in younger female adults.
CONCLUSIONS: In this study, we report associations between BCd and BPb with current depressive symptoms that were modified by age and sex. Reverse causation cannot be ruled out as a possible explanation since depression may lead to behavioral changes that increase exposure to cadmium and lead (ie, tobacco smoke). The continued efforts at reducing cadmium through tobacco smoking cessation programs may decrease the prevalence of current depressive symptoms.

PMID: 27929609 [PubMed - as supplied by publisher]