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Mental stress caused by city life By 2050, two-thirds of the world's population will be living in cities. Although city living has many advantages, rapidly increasing urbanization has major health implications — schizophrenia is more common in people born in cities than in those from less heavily populated districts, and living in cities increases the rates of depression and anxiety disorders. It has been suggested that social stress plays a part in these effects, but the mechanisms involved are unknown. Now, in a study of healthy German volunteers using functional magnetic resonance imaging, a key brain structure for negative emotion (the amygdala) was found to be more active during stress in city dwellers, and a regulatory brain area (the cingulate cortex) more active in people born in cities. These results identify potential mechanisms linking social environment and mental illness, and might contribute to planning healthier urban surroundings. More than half of the world’s population now lives in cities, making the creation of a healthy urban environment a major policy priority 1 . Cities have both health risks and benefits 1 , but mental health is negatively affected: mood and anxiety disorders are more prevalent in city dwellers 2 and the incidence of schizophrenia is strongly increased in people born and raised in cities 3 , 4 , 5 , 6 . Although these findings have been widely attributed to the urban social environment 2 , 3 , 7 , 8 , the neural processes that could mediate such associations are unknown. Here we show, using functional magnetic resonance imaging in three independent experiments, that urban upbringing and city living have dissociable impacts on social evaluative stress processing in humans. Current city living was associated with increased amygdala activity, whereas urban upbringing affected the perigenual anterior cingulate cortex, a key region for regulation of amygdala activity, negative affect 9 and stress 10 . These findings were regionally and behaviourally specific, as no other brain structures were affected and no urbanicity effect was seen during control experiments invoking cognitive processing without stress. Our results identify distinct neural mechanisms for an established environmental risk factor, link the urban environment for the first time to social stress processing, suggest that brain regions differ in vulnerability to this risk factor across the lifespan, and indicate that experimental interrogation of epidemiological associations is a promising strategy in social neuroscience.

The main objective of this study was to evaluate the effect of left anodal transcranial direct current stimulation (tDCS) on hypothalamic–pituitary–adrenal axis (HPAA) activity in individuals with depression. We conducted a 3-week, randomized, triple-blind pilot trial with 47 participants (dropout rate: 14.89%) randomly assigned to either the tDCS or control group (sham stimulation). Salivary cortisol was used as an HPAA activity marker since cortisol is the effector hormone of the HPAA. The primary outcome was the effect of tDCS on the diurnal cortisol pattern (DCP and area under the curve with respect to ground -AUCg-). Secondary outcomes included tDCS effects on cortisol awakening response (CAR) and cortisol decline (CD), as well as the variation of cortisol concentrations between the initiation of tDCS and 2 weeks later. Intention-to-treat and per-protocol analyses were conducted. Our primary outcome showed an absent effect of tDCS on DCP and AUCg. Additionally, tDCS had an absent effect on CAR, CD, and cortisol concentration variation before-after stimulation. Our pilot study suggests that anodal tDCS showed an absent effect on HPAA activity in individuals with depression. More studies are needed to confirm these findings.

Tryptophan breakdown metabolites formed along the kynurenine pathway play a significant role in pregnancy and fetal development. To understand their involvement, it is crucial to quantify the levels of tryptophan (TRP), kynurenine (KYN), and kynurenic acid (KYNA) in relevant biological samples such as the placenta, fetal membranes, and umbilical cord. This study used liquid chromatography-tandem mass spectrometry (LC–MS/MS) to determine TRP, KYN, and KYNA levels. The LC–MS/MS method was optimized for high sensitivity and specificity, demonstrating good reproducibility with a precision of < 10% CV and an accuracy of 85–115%. The lower limit of quantification for both TRP and KYN was 0.5 µg/ml, while for KYNA, it was 0.5 ng/mL. The method exhibited linearity within the examined range of concentrations in the homogenate, ranging from 0.5 to 30 µg/ml for TRP and KYN and from 0.5 to 25 ng/ml for KYNA. Using this method, we found significant differences in the concentrations of these substances in investigated maternal–fetal compartments. Placenta samples exhibited higher KYN and lower KYNA concentrations than the umbilical cord and fetal membrane, indicating a potentially important role for kynurenines in late pregnancy. Collectively, this finding may facilitate further research and provide inside into the involvement of the kynurenine pathway of TRP metabolism in fetal development.

BackgroundNowadays, both researchers and clinicians alike have to deal with increasingly larger datasets, specifically also in the context of mental health data. Sophisticated tools for dataset visualization of information from various item-based instruments, such as questionnaire data or data from digital applications or clinical documentations, are still lacking, specifically for an integration at multiple levels and for use in both data organization and appropriate construction for its valid use in subsequent analyses.MethodsHere, we introduce ItemComplex, a Python-based framework for ex-post visualization of large datasets. The method exploits the comprehensive recognition of instrument alignments and the identification of new content networks and graphs based on item similarities and shared versus differential conceptual bases within and across data and studies.ResultsThe ItemComplex framework was evaluated using four existing large datasets from four different cohort studies and demonstrated successful data visualization across multi-item instruments within and across studies. ItemComplex enables researchers and clinicians to navigate through big datasets reliably, informatively, and quickly. Moreover, it facilitates the extraction of new insights into construct representations and concept identifications within the data.ConclusionsThe ItemComplex app is an efficient tool in the field of big data management and analysis addressing the growing complexity of modern datasets to harness the potential hidden within these extensive collections of information. It is also easily adjustable for individual datasets and user preferences, both in the research and clinical field.

Background Repetitive transcranial magnetic stimulation (rTMS) has recently gained relevance in treating different psychiatric disorders. Limited evidence suggests that the beneficial effects of rTMS on psychopathology could be at least partly mediated through changes in inflammatory response. This systematic review summarizes the literature on whether rTMS can modulate inflammatory markers and thus positively influence the course of psychiatric illnesses. Materials and methods A systematic review of rTMS and inflammatory markers in psychiatric diseases was conducted according to PRISMA guidelines. Information on the association between rTMS treatment response and changes of inflammatory markers was extracted. The quality of the studies was assessed using the National Heart, Lung, and Blood Institute for human studies and the Systematic Review Center for Laboratory Animal Experimentation for animal studies. Results This review includes 17 studies (2 animal and 15 human studies) on the relationship between rTMS treatment response and changes of inflammatory markers. Positive changes in microglial activity and anti-inflammatory effects were associated with behavioral improvement in animal models of depression. However, these findings have not been consistently replicated in human studies focusing on treatment-resistant depression. While several studies reported rTMS-induced alterations in peripheral inflammatory markers, only two could demonstrate their association to clinical treatment response. Notably, most studies showed poor or moderate quality in the bias assessment. Conclusions While certain human studies suggest an association between rTMS-induced anti-inflammatory effects and improvement in psychopathology, heterogeneity, and underpowered analyses constrain the generalizability of these results. The discrepancy between animal and human findings highlights the need for larger, standardized human studies. Trial registration (PROSPERO Registration: CRD42023492732).

Background Depression associated with occupational stress is highly prevalent, causing high rates of sick leave and thus posing significant societal and economic burden. Meta-analyses of the few studies on psychological and work-focused interventions for common mental disorders including depression report small effects on depressive symptomatology and occupational outcomes. There is an urgent need for more controlled studies on work-directed interventions assessing work outcomes. Methods This is an interventional, multicentre, active-controlled, cluster-randomised, observer-blinded clinical trial with two parallel groups conducted in 6 clinical centres throughout Germany over the course of 3 years. A sample of 144 outpatients with work stress related depression will be cluster-randomised to either a specific interpersonal group intervention for depression and work stress (IPT-Work) or a nonspecific supportive group psychotherapy (SP). Each group consists of 10 sessions over 8 weeks of 90 min duration with 4–6 participants. Patients will be assessed at baseline, post-treatment and at 3 months follow-up. The primary endpoint is the relative change in HRSD-24 score from baseline to follow-up 3 months after end of treatment. Secondary outcome measures include the Occupational Depression Inventory (ODI), the Work Ability Index (WAI), the Return to Work Attitude (RTW-SE), the Effort-Reward-Imbalance (ERI), the Job Content Questionnaire 2 (JCQ2), and the Connor-Davidson Resilience Scale (CD-RISC). In addition, Quality of Life (WHOQOL-BREF) and days of sick leave throughout the study period will be assessed. Effects of treatment will be analysed with a linear mixed model for repeated measures including randomised arm, time point and their interaction as well as HRSD-24 baseline scores and their interaction with time point as fixed effects. Discussion Results will provide a comparison of a nonwork-directed psychological intervention and a specific, work-directed approach with respect to symptom improvement and increase in work ability. The aim is to improve quality of mental health care for depressed employees to facilitate recovery, improve work ability, and reduce the risk of long-term occupational incapacity. Ultimately, findings will inform the practice of the efficiency of using psychological group treatment in depressed individuals with work stress. Trial registration German Clinical Trials Register (DRKS00035259); prospectively registered on 15th January 2025.

Background Cigarette smoking has severe adverse health consequences in adults and in the offspring of mothers who smoke during pregnancy. One of the most widely reported effects of smoking during pregnancy is reduced birth weight which is in turn associated with chronic disease in adulthood. Epigenome-wide association studies have revealed that smokers show a characteristic “smoking methylation pattern”, and recent authors have proposed that DNA methylation mediates the impact of maternal smoking on birth weight. The aims of the present study were to replicate previous reports that methylation mediates the effect of maternal smoking on birth weight, and for the first time to investigate whether the observed mediation effects are sex-specific in order to account for known sex-specific differences in methylation levels. Methods Methylation levels in the cord blood of 313 newborns were determined using the Illumina HumanMethylation450K Beadchip. A total of 5,527 CpG sites selected on the basis of evidence from the literature were tested. To determine whether the observed association between maternal smoking and birth weight was attributable to methylation, mediation analyses were performed for significant CpG sites. Separate analyses were then performed in males and females. Results Following quality control, 282 newborns eventually remained in the analysis. A total of 25 mothers had smoked consistently throughout the pregnancy. The birthweigt of newborns whose mothers had smoked throughout pregnancy was reduced by >200g. After correction for multiple testing, 30 CpGs showed differential methylation in the maternal smoking subgroup including top “smoking methylation pattern” genes AHRR , MYO1G , GFI1 , CYP1A1 , and CNTNAP2 . The effect of maternal smoking on birth weight was partly mediated by the methylation of cg25325512 ( PIM1 ); cg25949550 ( CNTNAP2 ); and cg08699196 ( ITGB7 ). Sex-specific analyses revealed a mediating effect for cg25949550 ( CNTNAP2 ) in male newborns. Conclusion The present data replicate previous findings that methylation can mediate the effect of maternal smoking on birth weight. The analysis of sex-dependent mediation effects suggests that the sex of the newborn may have an influence. Larger studies are warranted to investigate the role of both the identified differentially methylated loci and the sex of the newborn in mediating the association between maternal smoking during pregnancy and birth weight.

Study Objectives: In nightmare etiology, trait and state factors play important roles. However, the interaction of state and trait factors has never been studied in a longitudinal design. Methods: The current sample included 406 pregnant women who were followed up approximately 6 months after giving birth (n = 375) and 4 years later (n = 302). A nightmare frequency scale and several stress-related questionnaires were presented at three measurement points. Results: Despite the major life events in this sample, nightmare frequency was very stable over this time period and decreased slightly. In line with previous findings, cross-sectional analyses showed that stressors were associated with current nightmare frequency but longitudinal analyses indicated that previously measured nightmare frequency showed even stronger effects on current nightmare frequency. Conclusions: Because the nightmare frequencies were very stable, it would be desirable to carry out intervention studies treating nightmares as early as possible—even in childhood—and study whether nightmare occurrence is lower even years after the intervention. Citation: Schredl M, Gilles M, Wolf I, Peus V, Scharnholz B, Sütterlin M, Bardtke S, Send TS, Samaras A, Deuschle M. Nightmares and stress: a longitudinal study. J Clin Sleep Med. 2019;15(9):1209–1215.

We admitted a 42‐year‐old patient with severe treatment‐resistant depression and with psychiatric comorbidities. The patient attempted suicide 5 weeks after admission. Subsequently, we initiated dextromethorphan/bupropion based on prior evidence. As a result, the patient demonstrated an improvement in mood symptoms and a reduction in suicide risk, leading to her discharge.

Background Sleep-related eating may occur in the context of mental illness, sleep disorders, or psychopharmacological treatment. Frequently, sleep-related eating leads to severe weight gain and, so far, there are no treatment options for the condition. Case presentation We report the case of a 54-year-old white woman with depression, panic disorder, and sleep apnea under treatment with various antidepressants who developed severe sleep-related eating. Her sleep-related eating completely vanished after addition of agomelatine, it reoccurred after cessation of agomelatine, and vanished again after her re-exposure to another melatonergic drug, extended melatonin. Conclusions This case suggests that melatonergic drugs lead to relief from sleep-related eating, even when the condition occurs in the context of physical and mental disorders as well as psychopharmacological treatment.