Our staff editors continue to share brilliant, thoughtful, and meaningful topics and articles in the recommended series.
This week, we would like to share several the latest articles on anxiety and depression related to neurodegenerative diseases.
Title: Inflammation as a mediator of stress-related psychiatric disorders
Authors: M.C. Flux, Christopher A. Lowry
Type: Book Chapter
The field of psychoneuroimmunology has made significant advances in understanding mechanisms underlying signaling between the immune system and central nervous system since the initial coinage of the term in 1975 and especially in the past 25 years. The current review explores the research supporting the premise that the immune system impacts behavior, including risk of developing stress-related psychiatric disorders (e.g., anxiety disorders, affective disorders, and trauma- and stressor-related disorders such as posttraumatic stress disorder). Beginning with the recent call to examination of interoception as a mental health-relevant signal, inflammation is explored as an important interoceptive signal. Inflammation is viewed through the lens of sickness behavior, before broadening to include the impact of the immune system on a collection of mental-health-related symptoms. This is explored mechanistically through the direct effects of cytokine signaling on the brain, the impact of afferent vagus nerve signaling, and through examination of the role of bone-marrow-derived monocytes in relaying peripheral immune signals to the brain. Immature bone-marrow-derived monocytes contribute to increased peripheral inflammation, but also have the capacity to traffic to brain regions relevant to stress-related psychiatric disorders. This trafficking can increase neuroinflammation causing anxiety-like defensive behavioral responses in mouse models and has been linked to symptoms of stress-related psychiatric disorders in humans. Additionally, the commensal bacteria inhabiting the gut (gut microbiota) exert a modulating effect on inflammation and behavior through several mechanisms, including signaling in the systemic circulation, shifting the body's stress dynamics, and altering inflammatory balance in the gut and the rest of the body. These mechanisms are discussed in the context of mental health conditions, including mood disorders, anxiety disorders, and trauma- and stressor-related disorders. There is a preponderance of evidence supporting the fact that peripheral immune activity and neuroinflammation impact behavior and mental health. Further research will continue to elucidate the mechanisms involved.
Access this article: https://doi.org/10.1016/B978-0-323-85654-6.00052-6
Title: Correlation between anxiety and depression risk and atopic dermatitis severity in Taiwan: A cross-sectional study
Authors: Chia-Jung Hsu, Dereck Shen, Tom C. Chan, Yung-Tsu Cho, Chao-Hsiun Tang, Chia-Yu Chu
Type: Research Article
Limited studies on atopic dermatitis (AD) have investigated the possible covariance of sociodemographic factors with the Hospital Anxiety and Depression Scale (HADS).
This study aimed to examine the possible covariance between AD severity and HADS scores of patients in Taiwan.
Patients with AD from a medical center and 2 regional hospitals in Taiwan were enrolled in this cross-sectional study from April 2018 to April 2019. AD severity was measured using the “scoring atopic dermatitis” index, and anxiety and depression were screened based on HADS.
A total of 200 patients were included. After correcting for sociodemographic variables, significantly more borderline (≥8) and abnormal (≥11) cases of anxiety/depression (P < .05) were noted in patients with moderate-to-severe AD.
First, the cross-sectional study design cannot show causality. Second, baseline data, including a history of underlying cancer or previous psychiatric disorder, were not obtained in the questionnaire and may confound the HADS scores. Finally, a standardized psychiatric clinical interviews study design should be used for higher accuracy in the assessment of psycho-comorbidities.
Higher anxiety and depression risks were noted in patients with moderate-to-severe AD. Except for psychosomatic symptoms, all kinds of anxiety and depression symptoms occurred more frequently in patients with moderate-to-severe AD.
●This study aimed to examine the covariance between atopic dermatitis severity and Hospital Anxiety and Depression Scale scores.
●Except for psychosomatic symptoms, all kinds of anxiety and depression symptoms occurred more frequently in patients with moderate-to-severe atopic dermatitis.
Access this article: https://doi.org/10.1016/j.jdin.2021.12.008
Title: Effects of Xinkeshu tablets on coronary heart disease patients combined with anxiety and depression symptoms after percutaneous coronary intervention: A meta-analysis
Authors: Mingtai Chen, Mengnan Liu, Xin Guo, Jie Zhou, Huayi Yang, Guofu Zhong, Ling Men, Ying Xie, Guangdong Tong, Qiang Liu, Jienan Luan, Hua Zhou
Type: Review Article
Xinkeshu tablets (XKS), a well-known Chinese patent drug, have been administered to coronary heart disease (CHD) patients with anxiety and depression after percutaneous coronary intervention (PCI).
This meta-analysis aimed to systematically evaluate the clinical effects of XKS for treating CHD patients with anxiety and depression after PCI.
Randomized controlled trials (RCTs) about XKS alone or combined with conventional drugs for the treatment of CHD patients with anxiety and depression after PCI were retrieved from 7 databases (MEDLINE, EMBASE, the Cochrane Library, China National Knowledge Infrastructure (CNKI), Chinese Scientific Journals Database (VIP) Database, Chinese Biomedical Database (CBM) and Wanfang Database) through November 2021. First, the studies were reviewed and screened by two independent assessors according to the eligibility criteria. Second, the methodological quality of the eligible studies was evaluated based on the Cochrane Collaboration's tool for assessing the risk of bias. Subsequently, meta-analysis was performed by using RevMan 5.4 software, and publication bias was evaluated by Stata 12.0 software. Finally, the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was applied to rate the quality of the evidence.
In total, 11 clinical RCTs involving 1000 patients were included in this study. This meta-analysis found that compared with conventional treatment alone, XKS combined with conventional treatment significantly improved the anxiety scale scores (SMD = -1.97, 95% CI -3.13 to -0.82; p = 0.0008; I2 = 98%), the depression scores (SMD = -2.80, 95% CI -4.49 to -1.10; p = 0.001; I2 = 98%), the scores on the Medical Outcomes Study 36 Item Short Form Health Survey (SF36) (MD = 11.22, 95% CI 4.19 to 18.26; p =0.002; I2 = 95%) and the blood lipid levels of total cholesterol (TC) (MD = -0.38, 95% CI -0.62 to -0.13; p = 0.003; I2 = 0%) and triglyceride (TG) (MD = -0.31, 95% CI -0.46 to -0.17; p < 0.0001; I2 = 0%).
The current evidence suggests that XKS might benefit CHD patients experiencing anxiety and depression after PCI by helping to improve their depression symptoms, TC and TG blood lipid levels. However, due to insufficient methodological quality of the studies, several risks of bias and inadequate reporting of the clinical data, more rigorous, multicenter, sufficient-sample and double-blind randomized clinical trials are warranted.
Access this article: https://doi.org/10.1016/j.phymed.2022.154243
Title: Anxiety and depression in older adult patients undergoing elective liver surgery in allopatry medical treatment
Authors: Lining Xu, Yingying Xu, Guiping Li, Bo Yang
Type: Original Article
Allopatry medical treatment is common in China. However, allopatry medical therapy can result in many problems, including a negative psychological impact on patients. Patients undergoing liver surgery often experience anxiety and depression. To understand the psychological status of older adult patients undergoing surgery better, this study was designed to investigate the incidence of anxiety and depression in older adult patients undergoing elective liver surgery and to analyze factors associated with it in allopatry medical therapy.
A total of 173 older adult patients undergoing elective liver surgery were included in the study. Patients were evaluated using the hospital anxiety and depression scale (HADS). The contributing factors affecting the psychological state of older adult patients undergoing elective surgery were analyzed using a linear regression method.
The HADS-A (hospital anxiety and depression scale-anxiety). The correlation (scale) score of the older adult patients undergoing elective liver surgery was (8.69 ± 2.38), including 53 asymptomatic patients, 86 suspicious patients, and 34 symptomatic patients. The HADS-D (hospital anxiety and depression scale-depression) score was (8.31 ± 2.90), including 83 asymptomatic patients, 56 suspicious patients, and 34 symptomatic patients. Multivariate analysis showed that residence and complication grade (Clavien–Dindo Classification of Surgical Complications or Accordion Severity Grading System) significantly correlated with the anxiety level of patients undergoing elective surgery. Residence, a requirement of blood transfusion, total transfusion volume, and Accordion complication grade showed a significant correlation with depression in patients undergoing elective surgery.
Anxiety and depression in older adult patients undergoing elective liver surgery were common. Regional differences (local patients vs non local patients) and the severity of complications were the risk factors for anxiety and depression in older adult patients undergoing elective liver surgery. Reducing both regional differences and the severity of complications would be beneficial to alleviate the risk of anxiety and depression in older adult patients undergoing elective liver surgery and thus promote their physical and mental health.
Access this article: https://doi.org/10.1016/j.iliver.2022.05.002