Alexithymia and Emotional Deficits Related to Posttraumatic Stress Disorder: An Investigation of Content and Process Disturbances.

BACKGROUND: Posttraumatic stress disorder (PTSD) is a debilitating mental disorder that develops in the aftermath of traumatic life experiences, especially those that occurred in childhood. PTSD is associated with intrusive memories, distressing dreams, dissociative reactions, avoidance of trauma-related stimuli, negative mood and sense of well-being, increased arousal and irritability, and clinically significant distress and impaired functioning. Case Presentation. The following case report presents a 42-year-old male displaying symptoms of PTSD, alexithymia, and depression. CONCLUSION: Untreated alexithymia may aggravate the trauma and cause the development of PTSD and depression.

[Mental health protection associated with COVID-19]. / Ochrona zdrowia psychicznego w COVID-19.

Mental health is a state of mental well-being in which people are able to cope with stressful situations in life and can bring their life potential to their communities. Good mental health enables people to fulfill their roles in both family and society. When crises affect social life, people should be expected to experience high levels of stress. The COVID-19 pandemic, in addition to the physical health crisis, may also contribute to the exacerbation of stress and the emergence of mental illnesses. Many individuals suffer due to forced isolation or feel socially excluded. Also, many of them fear infection, death and losing family members. Moreover, specific population groups show varying degrees of COVID-19-related psychological stress.The paper presents the psychological problems of the consequences of COVID-19 in society based on a review of the latest articles available in the PubMed and Google Scholar databases.The discussed material points to different needs in terms of psychological support in the society. People in unstable living conditions are at a greater risk of losing their mental health. Moreover, their mental health needs may be completely overlooked. Emotional difficulties may worsen among children and adolescents as a result of both family stress and social isolation. It is essential to include mental health protection in health policy in response to the COVID-19 pandemic to accelerate the recovery of communities.

The association between inflammatory markers (iNOS, HO-1, IL-33, MIP-1ß) and depression with and without posttraumatic stress disorder.

BACKGROUND: Both major depression and posttraumatic stress disorder (PTSD) are characterized by inflammation, increased concentration levels of proinflammatory cytokines, decreased neurogenesis followed by neuroprogression, as well as mitochondrial and the hypothalamic-pituitary-adrenal axis dysfunction. Elevated levels of oxidative stress caused by an increased activity of prooxidants over antioxidants are also observed. Based on several reports, depressive episodes can lead to the sensitization of immune-inflammatory pathways. Thus, depression, PTSD, and depression comorbid with PTSD are associated with immune-inflammatory markers. The study aimed at evaluating concentration levels of iNOS, HO-1, IL-33, and MIP-1ß in depression with and without PTSD. METHODS: A total number of participants enrolled in the study was 460. Out of them, 420 subjects with various levels of depression severity constituted the study group (210 males and 210 females), and 40 subjects (20 males and 20 females) constituted the control group. Each study group comprised 60 patients (30 males and 30 females) with mild depression (MD), moderate depression (MOD), severe depression (SeD), MD and PTSD (MD+PTSD), MOD and PTSD (MOD+PTSD), SeD and PTSD (SeD+PTSD), and with PTSD alone. At 7:00 a.m., all patients had serum concentrations of iNOS, HO-1, IL-33, MIP-1ß determined using ELISA. RESULTS: Both depression exacerbation and PTSD comorbidity led to elevated levels of iNOS, HO-1, IL-33, and MIP-1ß. CONCLUSION: Depression both with and without PTSD leads to elevated levels of inflammation and an oxidant/antioxidant imbalance. Alterations in both cytokines and oxidative stress are related to the mechanisms responsible for the development of depressive symptoms.

The impact of antipsychotics as a risk factor for thromboembolism.

Patients with schizophrenia are predisposed toward developing cardiovascular disease. Although neuroleptics affect the cardiovascular system, it is also important to consider the consequences of the disease itself such as lower physical activity due to living on disability pension, inadequate nutrition, and/or nicotine addiction, being more common among patients with schizophrenia versus the general population. All these factors combined lead to an increased risk of death caused by cardiovascular conditions in schizophrenic patients. Individuals receiving typical antipsychotic drugs have been reported to have elevated concentrations of antiphospholipid antibodies, including anticoagulants and anticardiolipin antibodies. The presence of both antibodies is associated with an increased risk for thromboembolism. It is also likely that mental illness is accompanied by increased procoagulant activity. Patients with acute psychosis have been shown to have a statistically significant increase in the concentrations of D-dimer, P-selectin, and in the expression of platelet glycoprotein IIb/IIIa receptors. Learning about causes and mechanisms of venous thromboembolism could help to reduce or neutralize the adverse effects of antipsychotic treatment and facilitate the identification of appropriate markers necessary to monitor changes and provide preventive care against hazardous and potentially fatal complications such as deep venous thrombosis and pulmonary embolism. Before atypical neuroleptic treatment is administered to hospitalized patients, all possible risk factors for thromboembolism should be considered to allow the application of lower risk drugs. Also, other preventive measures should be taken into account, including hydration, compression stockings, regular exercise of lower extremities, and low-molecular-weight heparin injections.

Changes in the concentrations of inflammatory and oxidative status biomediators (MIP-1 α, PMN elastase, MDA, and IL-12) in depressed patients with and without posttraumatic stress disorder.

BACKGROUND: Both proinflammatory cytokines and oxidative stress are considered an imbalance between the cellular production of reactive oxygen species and the antioxidant defense mechanisms. An inflammatory response that occurs in depression leads to a synergy between pro-inflammatory cytokines and oxidative stress. This synergy induces common signal transduction pathways that boost the inflammatory cascade. The object of this study was to assess the concentrations of inflammatory and oxidative status biomediators such as MIP-1α, PMN elastase, MDA, and IL-12 in depressed patients with and without posttraumatic stress disorder (PTSD), and with PTSD alone. METHODS: The number of participants enrolled in the study was 460. Out of them, 420 were determined to be suffering from depression, and 40 (20 males and 20 females) comprised the control group. The subjects were divided into groups, each consisting of 60 participants (30 males and 30 females) with: mild depression (MD), moderate depression (MOD), severe depression (SeD), MD and PTSD (MD+PTSD), MOD and PTSD (MOD+PTSD), SeD and PTSD (Sed+PTSD), and PTSD alone. At 7:00 a.m. all patients had blood samples collected to assess serum concentrations of the studied parameters using the Elisa method. RESULTS: Depression became more severe as the concentration levels of MIP-1α, PMN elastase, MDA, and IL-12 changed. CONCLUSION: Studied parameters can be used as markers of chronic stress in both depression and PTSD, either comorbid or alone, to make an early diagnosis and evaluate disease severity. Revealed changes confirm the presence of a biological response in depression.

Assessing the serum concentration levels of NT-4/5, GPX-1, TNF-α, and l-arginine as biomediators of depression severity in first depressive episode patients with and without posttraumatic stress disorder.

BACKGROUND: Neurotrophin-4/5 (NT-4/5) and glutathione peroxidase-1 (GPX-1) have been shown to play a major role in neuronal processes including depression and posttraumatic stress disorder (PTSD). They protect the body from oxidative damage by affecting neuronal growth, development and plasticity. The aim of the study was to evaluate the concentrations of NT-4/5, GPX-1, tumor necrosis factor-α (TNF-α), and l-arginine in patients suffering from varying levels of depression severity, PTSD, and depression comorbid with PTSD. METHODS: The study involved 460 participants, 360 of whom were diagnosed with different types of depressive episodes. They included: 60 patients with mild depression (MD), 60 patients with moderate depression (MOD), 60 patients with severe depression (SeD), 60 patients with MD and PTSD (MD+PTSD), 60 patients with MOD and PTSD (MOD+PTSD), 60 patients with SeD and PTSD (SeD+PTSD), and 60 patients with PTSD alone. Each group of 60 subjects comprised 30 females and 30 males. The control group comprised 40 subjects. The 10th revision of the International Statistical Classification of Diseases and Related Health Problems was utilized to diagnose depression and PTSD. At 7a.m. blood samples were collected and serum NT-4/5, GPX-1, TNF-α and l-arginine concentrations were assessed using the ELISA method. RESULTS: Depressive episodes with and without PTSD and PTSD alone became more severe as the levels of TNF-α, l-arginine increased and the levels of NT-4/5, GPX-1 decreased. CONCLUSION: l-arginine, TNF-α, NT-4/5 and GPX-1 can be markers of depression severity in both males and females with first depressive episode with or without posttraumatic stress disorder.

The role of PON-1, GR, IL-18, and OxLDL in depression with and without posttraumatic stress disorder.

BACKGROUND: Both oxidative stress markers and inflammatory markers are important when diagnosing depression. Oxidative stress occurs due to an imbalance between free radical generation and antioxidant potential. Both adenosine triphosphate and reactive oxygen/nitrogen species are released during oxidative phosphorylation. When neuroinflammation and free radical production are increased, oxidative stress occurs and causes damage to all major cellular macromolecules. The aim of the study was to compare the concentrations of paraoxonase-1 (PON-1), glutathione reductase (GR), interleukin-18 (IL-18), and oxidized low-density lipoproteins (OxLDL) in depressed patients with and without posttraumatic stress disorder (PTSD), and PTSD alone. METHODS: The number of participants was 460, including 230 males and 230 females. Each study group involved 60 subjects (30 males and 30 females). These were patients with mild depression (MD), moderate depression (MOD), severe depression (SeD), MD and PTSD (MD+PTSD), MOD and PTSD (MOD+PTSD), SeD and PTSD (SeD+PTSD), and with PTSD alone. The control group comprised 40 individuals (20 males and 20 females). At 7:00 a.m. all patients had blood samples collected to determine serum PON-1, GR, IL-18, and OxLDL concentrations using the ELISA test. RESULTS: Depression became more severe as GR, IL-18 and OxLDL concentrations increased and PON-1 concentrations decreased. CONCLUSION: All studied parameters can be considered markers of chronic stress in the above cases. They can be useful when making an early diagnosis and evaluating disease severity. Changes in the concentration levels of GR, IL-18, PON-1, and OxLDL may constitute a biological response to oxidative stress typical of depression.

Evaluation of ADMA, carbonyl groups, CAT and NKA in depressed patients with and without posttraumatic stress disorder.

BACKGROUND: It has been shown that asymmetric dimethylarginine (ADMA), carbonyl groups, catalase (CAT) and neurokinin A (NKA) are actively involved in neuronal processes such as depression and posttraumatic stress disorder (PTSD). One of their roles is to protect the body from oxidative damage. This is done by affecting neuronal growth, development and plasticity. The study aimed at assessing the concentrations of ADMA, carbonyl groups, CAT and NKA in patients with varying levels of depression severity, PTSD, and depression concurrent with PTSD. METHODS: The study covered 460 people. Out of them, 120 suffered from different types of depression. The study groups comprised: 60 subjects with mild depression (MD), 60 subjects with moderate depression (MOD), 60 subjects with severe depression (SeD), 60 subjects with MD and PTSD (MD+PTSD), 60 subjects with MOD and PTSD (MOD+PTSD), 60 subjects with SeD and PTSD (SeD+PTSD), and 60 subjects with PTSD alone. Each group of 60 participants included 30 males and 30 females. The concentrations of all blood parameters were determined at 7 a.m. using the ELISA method. RESULTS: Depressive episodes became more severe as the concentration levels of studied markers increased. CONCLUSIONS: ADMA, carbonyl groups, CAT and NKA can be useful markers of chronic stress in both males and females with depression, PTSD, and depression concurrent with PTSD. They can be utilized when making an initial diagnosis and evaluating the severity of disease. Changes in their concentration levels may show a biological response to oxidative stress characteristic of depression.

Melatonin and neurotrophins NT-3, BDNF, NGF in patients with varying levels of depression severity.

BACKGROUND: Disrupted circadian rhythm of melatonin secretion in depression shows a relationship with the exacerbation of inflammatory processes. Proinflammatory mechanisms of depression are sustained by oxidative stress. This contributes to melatonin deficiency and to the malfunction of the defense mechanisms in the brain. Disrupted melatonin secretion in depression may have an influence on the concentrations of neurotrophic factors (NF), such as neurotrophin-3 (NT-3), brain-derived neurotrophic factor (BDNF) and nerve growth factor (NGF). Disturbance in neurotrophin release may affect synaptic plasticity and cause exacerbation of neurodegenerative processes in the central nervous system. The aim of this study was to assess the concentrations of melatonin and NF of the brain in patients with varying levels of depression severity. METHOD: 160 males and females were enrolled in the study, 120 of whom were diagnosed with various types of depression. The control group comprised 40 healthy individuals. At 3:00a.m. all patients had salivary melatonin concentrations determined utilizing a competitive enzyme immunoassay technique (ELISA). In addition, at 7:00a.m. all patients had serum neurotrophin (NT-3, BDNF, NGF) concentrations determined by means of ELISA. RESULTS: The highest melatonin secretion was observed at 3:00a.m. in severely depressed females. In the groups with mild and moderate depression, melatonin secretion at 3:00a.m. was comparable between males and females. In addition, a decrease in the concentrations of neurotrophins was revealed in patients at all levels of depression severity. CONCLUSION: Melatonin may be a significant marker of depression severity. Melatonin and NF in depressed patients show neuroprotective effects.

Sense of alexithymia in patients with anxiety disorders comorbid with recurrent urticaria.

AIM: Alexithymia is associated with limited cognitive processing of emotions by an individual suffering from recurrent urticaria and alexithymia and makes them focus on somatic manifestations of emotional arousal and on poorly controlled compulsive reactions to negative stimulation. Alexithymia is considered to be a personality trait, which, along with other factors, predisposes individuals toward developing somatic diseases. The aim of the study was to assess the measurement of alexithymic features in patients with recurrent urticaria and to assess the types of concurrent anxiety disorders and overall anxiety level. METHODS: In order to diagnose clinical anxiety symptoms in patients, the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition and the Hamilton Anxiety Rating Scale were applied. Alexithymic features were measured by means of a shortened version of the Toronto Alexithymia Scale, characterized by high discrimination power, internal coherence, and reliability. RESULTS: According to the Toronto Alexithymia Scale results, the greatest contributing factor was "inability to differentiate between feelings and bodily sensations". This was observed in both males and females. Most frequently, the patients were found to suffer from generalized anxiety disorder and social phobia. CONCLUSION: Alexithymia may result from the difficulty associated with expressing emotions caused by anxiety disorders. Undergoing treatment for anxiety disorders may contribute to reduced exacerbation of urticaria.

A study of chemokines, chemokine receptors and interleukin-6 in patients with panic disorder, personality disorders and their co-morbidity.

BACKGROUND: Stress may induce inflammatory changes in the immune system and activate pro-inflammatory cytokines and their receptors by activating the hypothalamic-pituitary-adrenal axis. METHODS: 460 hospitalized patients with panic disorders (PD) and/or personality disorders (P) were studied. The study group comprised subjects with PD, avoidant personality disorder (APD), borderline personality disorder (BPD), obsessive-compulsive personality disorder (OCPD), and concomitant (PD+APD; PD+BPD; PD+OCPD). Each study group consisted of 60 subjects (30 females and 30 males). The control group included 20 females and 20 males without any history of mental disorder. ELISA was used to assess the levels of chemokines: CCL-5/RANTES (regulated on activation, normal T-cell expressed and secreted), CXCL-12/SDF-1 (stromal derived factor), their receptors CXCR-5 (C-C chemokine receptor type-5), CXCR-4 (chemokine C-X-C motif receptor-4), and IL-6. RESULTS: Statistically significant differences in the levels of CCL-5 and CCR-5 were revealed between all study groups. The greatest differences were found between the groups with PD+OCPD and PD+APD. Moreover, concomitance of PD with P significantly increased the level of chemokines and their receptors in all study groups versus the subjects with P alone. CONCLUSIONS: The results of the study show differences between the groups. To be specific, inflammatory markers were more elevated in the study groups than the controls. Therefore, chemokines and chemokine receptors may be used as inflammatory markers in patients with PD co-existent with P to indicate disease severity. PD was found to be a factor in maintaining inflammatory activity in the immune system in patients with P.

Serum concentrations of chemokines (CCL-5 and CXCL-12), chemokine receptors (CCR-5 and CXCR-4), and IL-6 in patients with posttraumatic stress disorder and avoidant personality disorder.

BACKGROUND: Posttraumatic stress disorder (PTSD) can be perceived as a psychoneuroimmunological disorder in which cytokines affecting the neurochemical and neuroendocrine functions of the body play an important role. Among cytokines, chemokines participating in activation of the inflammatory response are considered to be crucial. METHOD: 220 men and women were enrolled in the study. 180 of them constituted the study group. The studied groups consisted of: 60 patients with a diagnosed avoidant personality disorders (APD), 60 patients with a diagnosed APD and with PTSD and of 60 patients with PTSD but without a APD. There were 30 women and 30 men in each group of 60 subjects. The control group consisted of 40 healthy individuals. The plasma levels of chemokines and their receptors (CCL-5, CXCR-5, CXCL-12 and CXCR-4), as well as IL-6, were assessed by ELISA. RESULTS: There was an increase in the CXCL-12 and CCL-5 levels in women and men with the PTSD versus the control group. Also, increased levels of IL-6 and the receptors CXCR-4, CCR-5 were observed in women and men with PTSD. The levels of CXCL-12 and CCL-5 chemokines, as well as CCR-5 and CXCR4 receptors were higher in women than in men. The results of this study indicate a need for assessment of the CCL-5 and CXCL-12 chemokine levels, as they are likely markers of PTSD. CONCLUSIONS: Measurement of the concentrations of chemokines, chemokine receptors and IL-6 in women and men with PTSD along with concomittant APD may be useful for early detection of mental disorders.

The MCP-1, CCL-5 and SDF-1 chemokines as pro-inflammatory markers in generalized anxiety disorder and personality disorders.

INTRODUCTION: The co-occurrence of generalized anxiety disorder and personality disorders suggests the existence of association between the neurobiological predispositions leading to the development of these disorders and activation of cytokine system. Pro-inflammatory chemokines such as CCL-5/RANTES (regulated upon activation normal T cell expressed and secreted) and CXCL12/SDF-1 (stromal derived factor) play an important role in immune response. METHODS: A total of 160 participants were enrolled in the study, 120 of whom comprised the study group (people with the dual diagnosis of personality disorder and generalized anxiety disorder). The mean age was 41.4 ± 3.5 years (range: 20-44 years). The control group consisted of 40 healthy individuals in the mean age of 40.8 ± 3.1 years (range: 20-43 years). A blood sample was collected from each participant and the plasma levels of the CCL-2/MCP-1 (monocyte chemoattractant protein-1), RANTES and SDF-1 chemokines were determined by ELISA. RESULTS: Increased levels of MCP-1 and SDF-1 were found both in women and in men versus the control group for all types of personality disorders. The levels of CCL-5 in men were significantly increased versus the control group and significantly higher in women than in men. Neither women nor men with avoidant or obsessive-compulsive personality disorder showed any significant differences in MCP-1 or SFD-1 levels. In subjects with borderline personality disorder, the levels of the study chemokines were higher in women than in men. CONCLUSIONS: Our study has shown the need for determination of proinflammatory interleukins which are considered as biomarkers of personality disorders and generalized anxiety disorders.

Comparison of chemokines (CCL-5 and SDF-1), chemokine receptors (CCR-5 and CXCR-4) and IL-6 levels in patients with different severities of depression.

BACKGROUND: Depression can be perceived as a psychoneuroimmunological disorder in which cytokines affecting the body's neurochemical and neuroendocrine functions play an important role. Among cytokines, chemokines participating in activation of the inflammatory response are considered to be crucial. METHODS: 160 men and women were enrolled in the study. 120 of them were diagnosed with various types of depression. The mean age was 45.2 ± 4.5 years (range: 19-47 years). The control group consisted of 40 healthy individuals. The average age in this group was 42.4 ± 4.1 years. Plasma levels of chemokines and their receptors (CCL-5 - RANTES and CXCR-5, SDF-1 and CXCR-4), as well as of IL-6, were assessed by ELISA. RESULTS: There was an increase in SDF-1 and CCL-5 levels in women and men with different severities of depression, versus the control group. Also, an increase in the IL-6 levels, CXCR4 and CCR-5 receptors was observed in both women and men with all types of depression. Levels of SDF-1 and CCL-5 chemokines, as well as of CCR-5 and CXCR4 chemokine receptors, were higher in women than in men. CONCLUSIONS: The results of this study indicate the need for assessment of CCL-5 and SDF-1 chemokines levels, as they are likely markers of developing depression. Early measurement of these chemokines levels may be helpful in choosing the best pharmacotherapy.