Publications by authors named "Hubertus Himmerich"

128 Publications

Reduced MIP-1β as a Trait Marker and Reduced IL-7 and IL-12 as State Markers of Anorexia Nervosa.

J Pers Med 2021 Aug 20;11(8). Epub 2021 Aug 20.

Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, UK.

Alterations in certain inflammatory markers have been found in individuals with anorexia nervosa (AN). However, their relation to clinical characteristics has not been extensively explored, nor is it clear whether they are trait or state features of the disorder. This cross-sectional study measured serum concentrations of 36 inflammatory markers in people with acute AN ( = 56), recovered AN (rec-AN; = 24) and healthy controls (HC; = 51). The relationship between body mass index (BMI), eating disorder psychopathology, depression symptoms and inflammatory markers was assessed. Statistical models controlled for variables known to influence cytokine concentrations (i.e., age, ethnicity, smoking status and medication usage). Overall, most inflammatory markers including pro-inflammatory cytokines were unchanged in AN and rec-AN. However, in AN and rec-AN, concentrations of macrophage inflammatory protein (MIP)-1β were lower than HCs. Interleukin (IL)-7 and IL-12/IL-23p40 were reduced in AN, and concentrations of macrophage-derived chemokine, MIP-1α and tumor necrosis factor-α were reduced in rec-AN compared to HC. In conclusion, a reduction in MIP-1β may be a trait marker of the illness, whereas reductions in IL-7 and IL-12/IL-23p40 may be state markers. The absence of increased pro-inflammatory cytokines in AN is contradictory to the wider literature, although the inclusion of covariates may explain our differing findings.
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http://dx.doi.org/10.3390/jpm11080814DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8399452PMC
August 2021

The negative relationship of dietary inflammatory index and sleeping quality in obese and overweight women.

Int J Vitam Nutr Res 2021 Aug 4. Epub 2021 Aug 4.

Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran.

: Substantial evidence have linked low grade inflammation with the pathophysiology of chronic diseases and psychological impairment. An integral component underlying the link is pro-inflammatory diet. While sleeping is another significant contributor, few studies have addressed the relationship between the sleep quality and inflammatory cascade with the dietary quality as a moderator. The current study assesses the relation between inflammatory potential of the diet and sleep quality in Iranian obese and overweight women. : A total of 219 obese and overweight adult women were enrolled in this cross-sectional study. A standard 147-item food-frequency-questionnaire was used to record the dietary intakes; then, the dietary inflammatosry index (DII) was derived from the result-consolidated questionnaires. Pittsburg Sleep Quality Index (PSQI) was utilized to withdraw the sleep quality and quantity. : The mean (±standard deviation) age, body mass index, and PSQI of individuals were 36.49 (8.38) years, 31.04 (4.31) kg/m, and 5.78(3.55), respectively. Patients in the highest DII quartile were the ones with the higher consumption of pro-inflammatory food, and, ~58% of participants who were in the higher quartile had a sleep disturbance status. Results revealed an inverse relationship between sleep quality and DII in the crude model (β=-0.17, p=0.01) as well as full-adjusted model (β=0.24, p<0.001), such that women with higher DII had the poorest sleep quality. : Based on the present observational study, obese and overweight females with higher adherence of the anti-inflammatory diet may have better sleeping status.
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http://dx.doi.org/10.1024/0300-9831/a000723DOI Listing
August 2021

Faster speed of onset of the depressive episode is associated with lower cytokine serum levels (IL-2, -4, -6, -10, TNF-α and IFN-γ) in patients with major depression.

J Psychiatr Res 2021 09 8;141:287-292. Epub 2021 Jul 8.

Department of Psychiatry and Psychotherapy, Charité -Universitätmedizin Berlin, Campus Mitte, Berlin, Germany. Electronic address:

Introduction: Cytokines might play a key role in the pathophysiology of major depressive disorder (MDD). The speed of onset of depressive episodes has been discussed as an important clinical parameter in MDD. The aim of this study was to investigate a potential influence of the speed of onset of the depressive episode on cytokine serum levels.

Method: Serum level of the cytokines interleukin (IL)-2, IL-4, IL-6, IL-8, IL-10, tumor necrosis factor alpha (TNF-α), interferon-gamma (IFN-γ) granulocyte and monocyte colony stimulating factor (GM-CSF) were measured in a total of 92 patients with MDD that did not respond to at least one previous antidepressant treatment. Patients were retrospectively divided in two groups: Faster (≤4 weeks) and slower (>4 weeks) onset of the depressive episode defined as the time passing from the first depressive symptoms to a full-blown depressive episode by using information from a clinical interview.

Results: We found significantly lower serum levels of IL-2, IL-4, IL-6, IL-10, TNF-α and IFN-γ in patients with a faster onset compared to patients with a slower onset of the depressive episodes. Furthermore, lower cytokine serum levels of IL-2, IL-8, IL-10 and IFN-γ were found in patients with a shorter duration (less than 6 months) compared to a longer duration (6-24 months) of the current depressive episode. This effect on cytokines was independent from the effect of the speed of onset of the depressive episode.

Conclusions: Patients with faster onset of the depressive episode might represent a biological subtype of MDD with lower serum levels of IL-2, IL-4, IL-6, IL-10, TNF-α and IFN-γ.
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http://dx.doi.org/10.1016/j.jpsychires.2021.06.033DOI Listing
September 2021

Attitudes Surrounding Music of Patients With Anorexia Nervosa: A Survey-Based Mixed-Methods Analysis.

Front Psychiatry 2021 2;12:639202. Epub 2021 Jun 2.

Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.

Anorexia nervosa (AN) is one of the main eating disorders. It has the highest mortality of all psychiatric disorders, and the success rates of current therapies are not fully satisfactory. Thus, there is a need for novel interventions. We investigated the attitudes surrounding music of 41 patients with clinically-diagnosed AN as well as their thoughts on the potential therapeutic uses of music using a questionnaire of 50 questions. Free text responses were qualitatively analyzed for reoccurring themes with NVivo 12 software. Yes/no questions and questions of best fit were analyzed using the IBM SPSS Statistics version 25. The most prevalent theme was the positive effect of music. Most patients reported that listening to music evokes varying emotions in them (83%) which may be of positive or negative nature. Similarly, patients associated certain music with particular positive, but also with particular negative memories. A majority of patients stated that music helps to distract them (85%), helps with loneliness (59%) and helps them feel more connected to others (58%). This data indicates that people with AN make nonclinical use of music which seems to elicit positive as well as negative emotions and memories. Patients felt music is beneficial with regard to important aspects of AN, such as emotional problems, loneliness, and relationship difficulties. Most of them would also like to attend music therapy.
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http://dx.doi.org/10.3389/fpsyt.2021.639202DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8206484PMC
June 2021

Cytokines and Water Distribution in Anorexia Nervosa.

Mediators Inflamm 2021 2;2021:8811051. Epub 2021 Apr 2.

Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF, UK.

In patients with anorexia nervosa (AN), decreased intracellular (ICW), extracellular (ECW), and total body water (TBW) as well as changes in serum cytokine concentrations have been reported. In this exploratory study, we measured body composition and serum cytokine levels in patients with AN ( = 27) and healthy controls (HCs; = 13). Eating disorder symptom severity was assessed using the Eating Disorder Examination-Questionnaire (EDE-Q). Body composition was determined by bioimpedance analysis (BIA) which provided information on ICW, ECW, and TBW. Following blood collection, 27 cytokines and chemokines were quantified using multiplex ELISA-based technology: Eotaxin, Eotaxin-3, granulocyte-macrophage colony-stimulating factor (GM-CSF), interferon- (IFN-) , interleukin- (IL-) 1, IL-1, IL-2, IL-4, IL-5, IL-6, IL-7, IL-8, IL-10, IL-12/IL-23p40, IL-12p70, IL-13, IL-15, IL-16, IL-17A, interferon -induced protein- (IP-) 10, macrophage inflammatory protein- (MIP-) 1, MIP-1, monocyte chemoattractant protein- (MCP-) 1, MCP-4, thymus and activation-regulated chemokine (TARC), TNF-, and TNF-. ICW, ECW, and TBW volumes were significantly lower in patients with AN than in HCs. In the whole sample, GM-CSF, MCP-4, and IL-4 were positively, whereas IFN-, IL-6, and IL-10 were negatively associated with all three parameters of body water. In AN participants, we found a statistically significant negative correlation of IL-10 with ICW, ECW, and TBW. Our results suggest an interaction between body water and the cytokine system. Underlying mechanisms are unclear but may involve a loss of water from the gut, kidneys, or skin due to AN-associated inflammatory processes.
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http://dx.doi.org/10.1155/2021/8811051DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8035023PMC
April 2021

Lower pattern recognition memory scores in anorexia nervosa.

J Eat Disord 2021 Apr 17;9(1):49. Epub 2021 Apr 17.

Section of Eating Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 103 Denmark Hill, London, SE5 8AF, UK.

Background: There is extensive evidence for volumetric reductions in the hippocampus in patients with anorexia nervosa (AN), however the impact on function is unclear. Pattern separation and recognition are hippocampus-dependent forms of learning thought to underlie stimulus discrimination.

Methods: The present study used the Mnemonic Similarity Task to investigate pattern separation and recognition for the first time in patients with AN (N = 46) and healthy controls (N = 56). An Analysis of Covariance examined between-group differences, controlling for age, antidepressant use and method of task delivery (remote vs. in person).

Results: When controlling for covariates, pattern recognition memory scores were lower in the AN group with a medium effect size (d = 0.51). In contrast, there was a small effect whereby patients with AN had a greater pattern separation score than controls (d = 0.34), albeit this difference was not significant at the p = 0.05 threshold (p = 0.133). Furthermore, pattern separation and recognition memory abilities were not related to age, body mass index, eating disorder psychopathology or trait anxiety levels.

Conclusions: This preliminary study provides initial evidence for an imbalance in pattern separation and recognition abilities in AN, a hippocampus-dependent cognitive ability. Further studies should endeavour to investigate pattern separation and recognition performance further in AN, as well as investigate other hippocampus-dependent functions.
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http://dx.doi.org/10.1186/s40337-021-00406-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8052530PMC
April 2021

Diet, Obesity, and Depression: A Systematic Review.

J Pers Med 2021 Mar 3;11(3). Epub 2021 Mar 3.

Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF, UK.

Background: Obesity and depression co-occur in a significant proportion of the population. Mechanisms linking the two disorders include the immune and the endocrine system, psychological and social mechanisms. The aim of this systematic review was to ascertain whether weight loss through dietary interventions has the additional effect of ameliorating depressive symptoms in obese patients.

Methods: We systematically searched three databases (Pubmed, Medline, Embase) for longitudinal clinical trials testing a dietary intervention in people with obesity and depression or symptoms of depression.

Results: Twenty-four longitudinal clinical studies met the eligibility criteria with a total of 3244 included patients. Seventeen studies examined the effects of calorie-restricted diets and eight studies examined dietary supplements (two studies examined both). Only three studies examined people with a diagnosis of both obesity and depression. The majority of studies showed that interventions using a calorie-restricted diet resulted in decreases in depression scores, with effect sizes between ≈0.2 and ≈0.6. The results were less clear for dietary supplements.

Conclusions: People with obesity and depression appear to be a specific subgroup of depressed patients in which calorie-restricted diets might constitute a promising personalized treatment approach. The reduction of depressive symptoms may be related to immunoendocrine and psychosocial mechanisms.
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http://dx.doi.org/10.3390/jpm11030176DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7999659PMC
March 2021

Editorial: Extreme Eating Behaviours.

Front Psychiatry 2020 25;11:639219. Epub 2021 Jan 25.

Medical Faculty, Rudolf Boehm Institute of Pharmacology and Toxicology, University of Leipzig, Leipzig, Germany.

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http://dx.doi.org/10.3389/fpsyt.2020.639219DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7868438PMC
January 2021

Descriptions of Disordered Eating in German Psychiatric Textbooks, 1803-2017.

Front Psychiatry 2020 14;11:504157. Epub 2021 Jan 14.

Archiv für Leipziger Psychiatriegeschichte, Klinik und Poliklinik für Psychiatrie und Psychotherapie, Medizinische Fakultät der Universität Leipzig, Leipzig, Germany.

The most common eating disorders (EDs) according to DSM-5 are anorexia nervosa (AN), bulimia nervosa (BN) and binge eating disorder (BED). These disorders have received increasing attention in psychiatry due to rising prevalence and high morbidity and mortality. The diagnostic category "anorexia nervosa," introduced by Ernest-Charles Lasègue and William Gull in 1873, first appears a century later in a German textbook of psychiatry, authored by Gerd Huber in 1974. However, disordered eating behavior has been described and discussed in German psychiatric textbooks throughout the past 200 years. We reviewed content regarding eating disorder diagnoses but also descriptions of disordered eating behavior in general. As material, we carefully selected eighteen German-language textbooks of psychiatry across the period 1803-2017. Previously, in German psychiatry, disordered eating behaviors were seen as symptoms of depressive disorders, bipolar disorder or schizophrenia, or as manifestations of historical diagnoses no longer used by the majority of psychiatrists such as neurasthenia, hypochondria and hysteria. Interestingly, 19th and early 20th century psychiatrists like Kraepelin, Bumke, Hoff, Bleuler, and Jaspers reported symptom clusters such as food refusal and vomiting under these outdated diagnostic categories, whereas nowadays they are listed as core criteria for specific eating disorder subtypes. A wide range of medical conditions such as endocrinopathies, intestinal or brain lesions were also cited as causes of abnormal food intake and body weight. An additional consideration in the delayed adoption of eating disorder diagnoses in German psychiatry is that people with EDs are commonly treated in the specialty discipline of psychosomatic medicine, introduced in Germany after World War II, rather than in psychiatry. Viewed from today's perspective, the classification of disorders associated with disordered eating is continuously evolving. Major depressive disorder, schizophrenia and physical diseases have been enduringly associated with abnormal eating behavior and are listed as important differential diagnoses of EDs in DSM-5. Moreover, there are overlaps regarding the neurobiological basis and psychological and psychopharmacological therapies applied to all of these disorders.
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http://dx.doi.org/10.3389/fpsyt.2020.504157DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7840701PMC
January 2021

A Systematic Review of Scientific Studies on the Effects of Music in People with or at Risk for Eating Disorders.

Psychiatr Danub 2020 Autumn - Winter;32(3-4):334-345

Department of Psychological Medicine, King's College London, 103 Denmark Hill, London SE5 8AF, UK.

Background: The prevalence of the three main eating disorders (EDs) anorexia nervosa (AN), bulimia nervosa (BN) and binge eating disorder (BED) is increasing, and a growing number of patients with EDs is seeking professional help. Thus, there is a need for additional treatment strategies in EDs. The aim of this review was to summarize the literature on the benefits and risks of music as well as the evidence for its therapeutic application in people with EDs.

Methods: Following the PRISMA guidelines, we performed a systematic literature review on scientific studies on the effect of music in people with or at risk for EDs using PubMed and the Web of Science database. The search terms used were: "music", "music therapy", "eating disorders", "anorexia nervosa", "bulimia nervosa" and "binge eating disorder".

Results: 16 out of 119 identified and screened articles qualified as scientific studies involving a total of 3,792 participants. They reported on the use of music or music therapy in individuals with or at risk of AN and BN, but not BED. In inpatients with AN, listening to classical music was beneficial to food consumption. Singing in a group reduced post-prandial anxiety in AN inpatients and outpatients. Vodcasts which also included positive visual or autobiographical stimuli helped BN patients with anxiety and body image perception. Songwriting and sessions with a Body Monochord helped with the processing of therapeutically relevant topics in AN. Watching music videos, however, reinforced body dissatisfaction, drive for thinness, bodyweight concerns, preoccupation with physical appearance in pre-teenage and teenage girls, and drive for muscularity in adolescent boys.

Conclusions: These findings suggest that the therapeutic application of music may be beneficial in patients with AN and BN. However, the availability of studies with a rigorous randomized controlled trial (RCT) design is scarce.
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http://dx.doi.org/10.24869/psyd.2020.334DOI Listing
January 2021

Hippocampal volume, function, and related molecular activity in anorexia nervosa: A scoping review.

Expert Rev Clin Pharmacol 2020 Dec 25;13(12):1367-1387. Epub 2020 Nov 25.

Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology & Neuroscience ,UK.

Introduction: Anorexia nervosa (AN) is a serious and persistent eating disorder, characterized by severe dietary restriction and weight loss, with a third of patients developing a  severe-enduring form. The factors contributing to this progression are poorly understood, although there is evidence for impairments in neural structures such as the hippocampus, an area particularly affected by malnutrition and chronic stress.

Areas Covered: This study aimed to map the evidence for alterations in hippocampal volume, function, and related molecular activity in anorexia nervosa. PubMed, PsycINFO, and Web of Science were searched for studies related to hippocampal function and integrity using a range of methodologies, such as neuropsychological paradigms, structural and functional magnetic resonance imaging, and analysis of blood components.

Expert Opinion: Thirty-nine studies were included in this review. The majority were neuroimaging studies, which found hippocampus-specific volumetric and functional impairments. Neuropsychological studies showed evidence for a specific memory and learning impairments. There was some evidence for molecular abnormalities (e.g. cortisol), although these were few studies. Taken together, our review suggests that the hippocampus might be a particular region of interest when considering neurobiological approaches to understanding AN. These findings warrant further investigation and may lead to novel treatment approaches.
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http://dx.doi.org/10.1080/17512433.2020.1850256DOI Listing
December 2020

Effects of IL-6 Signaling Pathway Inhibition on Weight and BMI: A Systematic Review and Meta-Analysis.

Int J Mol Sci 2020 Aug 31;21(17). Epub 2020 Aug 31.

Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF, UK.

Inhibitors of the IL-6 signaling pathway, such as tocilizumab, are frequently administered for the treatment of immune diseases, e.g., rheumatoid arthritis and multicentric Castleman's disease. The aim of this systematic review and meta-analysis was to ascertain the effects of IL-6 pathway inhibitors on weight and body mass index (BMI). Using PRISMA guidelines, we systematically reviewed relevant articles from three databases (PubMed, OVID, EMBASE). A random effects model was used to estimate standardized mean change (SMCC). Ten studies with a total of 1531 patients were included in the meta-analysis for weight and ten studies with a total of 1537 patients were included in the BMI meta-analysis. The most commonly administered IL-6 pathway inhibitor was tocilizumab. IL-6 pathway inhibitors were associated with increases in weight (SMCC = 0.09, = 0.016, 95% CI [0.03, 0.14]) and BMI (SMCC = 0.10, = 0.0001, 95% CI [0.05, 0.15]). These findings suggest that the IL-6 pathway is involved in weight regulation. Modulating IL-6 signaling may be a potential future therapeutic avenue used as an adjunct for the treatment of disorders associated with weight changes, such as cancer cachexia and anorexia nervosa.
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http://dx.doi.org/10.3390/ijms21176290DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7504579PMC
August 2020

Pharmacological treatment of eating disorders, comorbid mental health problems, malnutrition and physical health consequences.

Pharmacol Ther 2021 01 25;217:107667. Epub 2020 Aug 25.

Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF, UK; South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent BR3 3BX, UK.

The pharmacological treatment of patients with an eating disorder (ED) often includes medications to treat their ED, comorbid mental health problems, malnutrition and the physical health problems resulting from it. The currently approved pharmacological treatment options for EDs are limited to fluoxetine for bulimia nervosa (BN) and - in some countries - lisdexamfetamine for binge eating disorder (BED). Thus, there are no approved pharmacological options for anorexia nervosa (AN), even though study results for olanzapine and dronabinol are promising. Topiramate might be an additional future option for the treatment of BN and BED. Selective serotonin reuptake inhibitors (SSRI), mirtazapine and bupropion could be considered for the treatment of comorbid unipolar depression. However, AN and BN are contraindications for bupropion. For ED patients with a manic episode, we recommend olanzapine in AN and risperidone in BN and BED; whereas for bipolar depression, olanzapine (plus fluoxetine) seems appropriate in AN and lamotrigine in BN and BED. Acute anxiety or suicidality may warrant benzodiazepine treatment with lorazepam. Proton-pump inhibitors, gastroprokinetic drugs, laxatives and hormones can alleviate certain physical health problems caused by EDs. Therapeutic drug monitoring, pharmacogenomic testing, a more restrictive use of "pro re nata" (PRN) medication, an interdisciplinary treatment approach, shared decision making (SDM) and the formulation of common treatment goals by the patients, their family or carers and clinicians could improve treatment success and safety. Novel genetic, immunological, microbiome and brain imaging research as well as new pharmacological developments like the use of psychedelics, stimulants, novel monoaminergic drugs, hormone analogues and drugs which enhance the effects of psychotherapy may extend our therapeutic options in the near future.
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http://dx.doi.org/10.1016/j.pharmthera.2020.107667DOI Listing
January 2021

Is There an Association or Not?-Investigating the Association of Depressiveness, Physical Activity, Body Composition and Sleep With Mediators of Inflammation.

Front Psychiatry 2020 25;11:563. Epub 2020 Jun 25.

Department of Psychiatry and Psychotherapy, University of Leipzig Medical Center, Leipzig, Germany.

Background: Cytokines are mediators of inflammation that contribute to a low-grade inflammation in different disorders like major depression and obesity. It still remains unclear which psychological and medical factors interact with cytokine regulation. In the current investigation, the association between levels of pro-and anti-inflammatory cytokines and anthropometrics, mood state (depressiveness), physical activity and sleep were investigated in a sample of community-dwelled adults.

Methods: Forty-nine subjects met the inclusion criteria for analyses and were assessed at two time-points (baseline (T1) and follow-up (T2), average T1-T2-interval = 215 days). Serum cytokine measures included the pro-inflammatory cytokines interleukin (IL)-2, IL-12, IFN-γ and TNF-α, the anti-inflammatory cytokines IL-4, IL-5, IL-10 and IL-13 and the granulocyte-macrophage colony-stimulating factor (GM-CSF); anthropometrics were assessed physical examination, depressiveness was assessed Beck Depression Inventory (BDI)2, parameters of physical activity (steps, METs) and sleep (night/total sleep duration) were measured a 1-week actigraphy.

Results: Correlation analyses showed low-to moderate significant relationships between the majority of cytokines and the BDI2 at T1, positive correlation with weight and BMI at T1 and T2, and negative correlations with the number of steps and METs at T2 and T2. Regression analyses for T1 revealed that the BDI2 score was the best positive predictor for the concentrations of all nine cytokines, followed by the number of steps and the nightsleep duration as negative predictors. At T2, the amount of steps was found to be negatively associated with IL-4, IL5, IL-10, GM-CSF, IFN-γ, and TNF-α, whereas the BMI could significantly predict IL-12 and IL-13. The BDI2-score was not significantly associated with any of the cytokines. No associations could be found between dynamics in cytokines from T1 and T2 and changes in any of the variables.

Discussion: The present results indicate an influence of physical activity, subjective well-being and body composition on inflammatory mediators. Since there was no standardized intervention targeting the independent variables between T1 and T2, no assumptions on causality can be drawn from the association results.
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http://dx.doi.org/10.3389/fpsyt.2020.00563DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7330708PMC
June 2020

Impact of TNF-α Inhibitors on Body Weight and BMI: A Systematic Review and Meta-Analysis.

Front Pharmacol 2020 15;11:481. Epub 2020 Apr 15.

Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom.

Objective: The aim of this systematic review and meta-analysis of longitudinal studies was to ascertain to effects of TNF-α inhibitor therapy on body weight and BMI.

Methods: Three databases (PubMed, OVID, and EMBASE) were systematically searched from inception to August 2018. We identified prospective, retrospective, and randomized controlled studies in adults with immune-mediated inflammatory diseases treated with TNF-α inhibitors based on pre-specified inclusion criteria. A random-effects model was used to estimate standardised mean change (SMCC).

Results: Twenty-six longitudinal studies with a total of 1,245 participants were included in the meta-analysis. We found evidence for a small increase in body weight (SMCC = 0.24, p = .0006, 95% CI [0.10, 0.37]) and in BMI (SMCC = 0.26, p < .0001, 95% CI [0.13, 0.39]). On average, patients gained 0.90kg (SD = 5.13) under infliximab, 2.34kg (D = 5.65) under etanercept and 2.27kg (SD = 4.69) during treatment with adalimumab within the duration of the respective studies (4-104 weeks).

Conclusion: Our results yield further support the for the view that TNF-α inhibitors increase body weight and BMI as a potential side effect. Modulating cytokine signaling could be a future therapeutic mechanism to treat disorders associated with weight changes such as anorexia nervosa.
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http://dx.doi.org/10.3389/fphar.2020.00481DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7174757PMC
April 2020

Phosphatidylcholine Containing Long Chain Omega-3 Fatty Acids: a Treatment Adjunct for Patients with Anorexia Nervosa?

Psychiatr Danub 2020 ;32(1):55-59

Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 103 Denmark Hill, London SE5 8AF, UK.

Background: Anorexia nervosa (AN) is a serious mental disorder with a high mortality rate and often a chronic course. In contrast to many other common mental disorders, there is no drug therapy approved for AN.

Methods: We performed a narrative literature review to consider whether a choline-containing molecule, such as phosphatidylcholine (PC), with an omega (ω)-3 long chain polyunsaturated fatty acid (LCPUFA) could be a potential future medicinal treatment for AN.

Results: Choline and LCPUFAs have individually shown benefit for mental health. Case series and pilot studies suggest ω-3 LCPUFAs may be effective in eating disorders. However, pharmacodynamic and pharmacokinetic considerations suggest a greater benefit from the combination of both components.

Conclusion: The combination of a choline-containing molecule with an ω-3 LCPUFA may be clinically effective and well tolerated. This idea is supported by the current literature on the role of inflammation, the microbiome, the gut-brain-axis, hormonal, neurotransmitter and intracellular signalling, and on the structure and fluidity of nerve cells membranes in patients with AN.
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http://dx.doi.org/10.24869/psyd.2020.55DOI Listing
April 2020

Reported and Recorded Sleepiness in Obesity and Depression.

Front Psychiatry 2020 2;11:200. Epub 2020 Apr 2.

Institute for Statistics, Ludwig-Maximilians-Universität München, München, Germany.

Background: Obesity and depression are both associated with changes in sleep/wake regulation, with potential implications for individualized treatment especially in comorbid individuals suffering from both. However, the associations between obesity, depression, and subjective, questionnaire-based and objective, EEG-based measurements of sleepiness used to assess disturbed sleep/wake regulation in clinical practice are not well known.

Objectives: The study investigates associations between sleep/wake regulation measures based on self-reported subjective questionnaires and EEG-derived measurements of sleep/wake regulation patterns with depression and obesity and how/whether depression and/or obesity affect associations between such self-reported subjective questionnaires and EEG-derived measurements.

Methods: Healthy controls (HC, N = 66), normal-weighted depressed (DEP, N = 16), non-depressed obese (OB, N = 68), and obese depressed patients (OBDEP, N = 43) were included from the OBDEP (Obesity and Depression, University Leipzig, Germany) study. All subjects completed standardized questionnaires related to daytime sleepiness (ESS), sleep quality and sleep duration once as well as questionnaires related to situational sleepiness (KSS, SSS, VAS) before and after a 20 min resting state EEG in eyes-closed condition. EEG-based measurements of objective sleepiness were extracted by the VIGALL algorithm. Associations of subjective sleepiness with objective sleepiness and moderating effects of obesity, depression, and additional confounders were investigated by correlation analyses and regression analyses.

Results: Depressed and non-depressed subgroups differed significantly in most subjective sleepiness measures, while obese and non-obese subgroups only differed significantly in few. Objective sleepiness measures did not differ significantly between the subgroups. Moderating effects of obesity and/or depression on the associations between subjective and objective measures of sleepiness were rarely significant, but associations between subjective and objective measures of sleepiness in the depressed subgroup were systematically weaker when patients comorbidly suffered from obesity than when they did not.

Conclusion: This study provides some evidence that both depression and obesity can affect the association between objective and subjective sleepiness. If confirmed, this insight may have implications for individualized diagnosis and treatment approaches in comorbid depression and obesity.
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http://dx.doi.org/10.3389/fpsyt.2020.00200DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7144401PMC
April 2020

A Meta-Analysis of Dropout and Metabolic Effects of Antipsychotics in Anorexia Nervosa.

Front Psychiatry 2020 17;11:208. Epub 2020 Mar 17.

Psychological Medicine, King's College London, London, United Kingdom.

Background: Second-generation antipsychotics are often used off-label in the treatment of anorexia nervosa (AN) across the clinical spectrum. Patients with anorexia nervosa often cite concerns about metabolic effects, such as weight gain, as reasons for their reluctance to start or continue second-generation antipsychotics. Improving our understanding of the metabolic effect patients experience and reasons underlying their disinclination will enable us to build rapport and guide our clinical decisions. We therefore aimed to conduct a comprehensive review of dropouts, metabolic effects, and patient-reported outcomes associated with second-generation antipsychotic in people with AN.

Method: EMBASE, Medline, and PsycINFO were searched for all relevant studies published until 2019, and retrieved studies were assessed for eligibility as per predefined inclusion criteria. A random-effects meta-analysis was conducted to assess overall dropout rates.

Results: Of 983 citations retrieved, 21 studies met the inclusion criteria for the systematic review and 10 studies had appropriate data for meta-analysis. Using the random effects model, the pooled dropout rate in the intervention arm (95% confidence interval) from psychopharmacological trials was 28% (19 to 38%) in people with AN. Personal reasons or factors associated with study were commonest reason for dropout, not adverse events or metabolic effects as hypothesized.

Conclusion: Compared to personal reasons, drug-related factors such as side effects seem to play a lesser role for the discontinuation of antipsychotic treatment under trial conditions. This suggests an urgent need to consider and fully examine potential individual and patient-related factors that influence dropout rates in psychopharmacological trials and treatment compliance in clinical settings.
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http://dx.doi.org/10.3389/fpsyt.2020.00208DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7090227PMC
March 2020

A Meta-Analysis of Dropout and Metabolic Effects of Antipsychotics in Anorexia Nervosa.

Front Psychiatry 2020 17;11:208. Epub 2020 Mar 17.

Psychological Medicine, King's College London, London, United Kingdom.

Background: Second-generation antipsychotics are often used off-label in the treatment of anorexia nervosa (AN) across the clinical spectrum. Patients with anorexia nervosa often cite concerns about metabolic effects, such as weight gain, as reasons for their reluctance to start or continue second-generation antipsychotics. Improving our understanding of the metabolic effect patients experience and reasons underlying their disinclination will enable us to build rapport and guide our clinical decisions. We therefore aimed to conduct a comprehensive review of dropouts, metabolic effects, and patient-reported outcomes associated with second-generation antipsychotic in people with AN.

Method: EMBASE, Medline, and PsycINFO were searched for all relevant studies published until 2019, and retrieved studies were assessed for eligibility as per predefined inclusion criteria. A random-effects meta-analysis was conducted to assess overall dropout rates.

Results: Of 983 citations retrieved, 21 studies met the inclusion criteria for the systematic review and 10 studies had appropriate data for meta-analysis. Using the random effects model, the pooled dropout rate in the intervention arm (95% confidence interval) from psychopharmacological trials was 28% (19 to 38%) in people with AN. Personal reasons or factors associated with study were commonest reason for dropout, not adverse events or metabolic effects as hypothesized.

Conclusion: Compared to personal reasons, drug-related factors such as side effects seem to play a lesser role for the discontinuation of antipsychotic treatment under trial conditions. This suggests an urgent need to consider and fully examine potential individual and patient-related factors that influence dropout rates in psychopharmacological trials and treatment compliance in clinical settings.
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http://dx.doi.org/10.3389/fpsyt.2020.00208DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7090227PMC
March 2020

Ligands and receptors of the TNF superfamily are decreased in major depression and during early antidepressant therapy.

J Psychiatr Res 2019 12 24;119:116-121. Epub 2019 Sep 24.

Department of Psychological Medicine, King's College London, London, UK.

Background: The up-regulation of pro-inflammatory agents, amongst them tumor necrosis factor (TNF), may represent low-grade inflammation in major depression. To further elucidate inflammatory mechanisms related to TNF in depression, the aim of the current study was to investigate the involvement of ligands and receptors of the TNF/TNF-receptor-superfamily yet un- or little explored in major depression.

Methods: Serum levels of ligands (TNF, TNF-related weak inducer of apoptosis [TWEAK], B-cell activating factor [BAFF], tumor necrosis factor superfamily member 14 [TNFSF14; LIGHT], A proliferation-inducing ligand [APRIL]) and receptor molecules (TNF receptor superfamily member 8 [TNFRSF8; sCD30], soluble TNF receptor type 1 [sTNFR1] and type 2 [sTNFR2]) of the TNF/TNF-receptor-superfamily were measured in 50 unmedicated patients suffering from major depression and 48 healthy controls and were reassessed in 37 of the depressed patients two weeks after the initiation of antidepressive treatment.

Results: In comparison to the healthy controls, the interrelated serum levels of TWEAK, BAFF, TNFSF8, sTNFR1 and sTNFR2 were reduced both in the unmedicated and medicated depressed patients. Serum levels of BAFF and TNF significantly increased during the initiation of antidepressive treatment. In the combined sample of unmedicated depressed and healthy controls, but not the separate groups, scores of the BDI-II inversely correlated with levels of TWEAK, BAFF, sTNFR1, sTNFR2 and TNFSF8.

Conclusion: The current findings give evidence for a role of the TNF/TNF-receptor-superfamily in the pathophysiology of major depression that may involve reduced tissue regeneration and neurogenesis rather than an acceleration of pro-inflammatory pathways.
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http://dx.doi.org/10.1016/j.jpsychires.2019.09.010DOI Listing
December 2019

The therapeutic effect of physical activity in a day-hospital patient with anorexia nervosa.

Psychiatr Danub 2019 06;31(2):201-203

Step-Up Eating Disorders Service, Tyson West 2, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, BR3 3BX, UK,

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http://dx.doi.org/10.24869/psyd.2019.201DOI Listing
June 2019

A longitudinal analysis of cytokines in anorexia nervosa.

Brain Behav Immun 2020 03 9;85:88-95. Epub 2019 May 9.

Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF, UK; South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent BR3 3BX, UK.

Objective: Inflammation has been proposed to have a pathophysiological role in anorexia nervosa (AN) and to contribute to the maintenance of the disorder. Longitudinal cytokine research in AN has focused on only a few pro-inflammatory cytokines. We assessed a broad range of cytokines over time in people undergoing specialised treatment for AN.

Method: We measured serum concentrations of 27 cytokines in people with AN (n = 23). Body mass index (BMI), eating disorder (ED) symptoms and general psychopathology were assessed and blood samples were collected within four weeks of the commencement of specialised ED treatment (baseline) and at 12- and 24-week follow-ups.

Results: Both BMI and ED symptoms improved over the assessment period. Linear mixed models showed that log IL-6 decreased between baseline and week 12 assessments. By week 12, log IL-6 values were comparable to levels in healthy individuals. Log IL-7 increased from week 12 to week 24.

Discussion: Initially elevated IL-6 serum concentrations appear to 'normalize' during the first 3-months of specialised treatment for AN and this co-occurs with improvements in ED symptoms. Therefore, IL-6 has the potential to be a state biomarker for AN.
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http://dx.doi.org/10.1016/j.bbi.2019.05.012DOI Listing
March 2020

A longitudinal analysis of cytokines in anorexia nervosa.

Brain Behav Immun 2020 03 9;85:88-95. Epub 2019 May 9.

Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF, UK; South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent BR3 3BX, UK.

Objective: Inflammation has been proposed to have a pathophysiological role in anorexia nervosa (AN) and to contribute to the maintenance of the disorder. Longitudinal cytokine research in AN has focused on only a few pro-inflammatory cytokines. We assessed a broad range of cytokines over time in people undergoing specialised treatment for AN.

Method: We measured serum concentrations of 27 cytokines in people with AN (n = 23). Body mass index (BMI), eating disorder (ED) symptoms and general psychopathology were assessed and blood samples were collected within four weeks of the commencement of specialised ED treatment (baseline) and at 12- and 24-week follow-ups.

Results: Both BMI and ED symptoms improved over the assessment period. Linear mixed models showed that log IL-6 decreased between baseline and week 12 assessments. By week 12, log IL-6 values were comparable to levels in healthy individuals. Log IL-7 increased from week 12 to week 24.

Discussion: Initially elevated IL-6 serum concentrations appear to 'normalize' during the first 3-months of specialised treatment for AN and this co-occurs with improvements in ED symptoms. Therefore, IL-6 has the potential to be a state biomarker for AN.
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http://dx.doi.org/10.1016/j.bbi.2019.05.012DOI Listing
March 2020

Facets of shared decision-making on drug treatment for adults with an eating disorder.

Int Rev Psychiatry 2019 06 14;31(4):332-346. Epub 2019 Mar 14.

a South London and Maudsley NHS Foundation Trust , Bethlem Royal Hospital , London , UK.

Shared decision-making (SDM) means that clinicians and the patient make decisions about the treatment together. Regarding drug treatment in eating disorders (EDs), such decisions may include psychopharmacological treatment for the ED itself, medications for potential co-morbid psychiatric disorders, pharmacological strategies to alleviate the health consequences of an ED, or 'pro re nata' (PRN) medication which is given in acute care when required. Decisions regarding drug treatment in EDs should be specific in terms of the active pharmacological substance, its dose, its route of administration, and the duration of treatment. Decisions should be made with regard to the specific health risks of patients with EDs and the entire treatment approach, and should take alternative measures, additional therapies, and specific combinations of therapies into account. The differences in the expectations of patients, carers, and clinicians towards drug treatment, the lack of specific suggestions in clinical practice guidelines, and the lack of approved psychopharmacological treatment options make SDM necessary, but also a challenge. However, SDM may be limited due to the patient's impaired insight or limited capacity due to the ED. Thus, the legal framework must be taken into consideration.
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http://dx.doi.org/10.1080/09540261.2019.1571995DOI Listing
June 2019

Genetic risk factors for eating disorders: an update and insights into pathophysiology.

Ther Adv Psychopharmacol 2019 12;9:2045125318814734. Epub 2019 Feb 12.

Department of Psychological Medicine, King's College London, London, UK.

Genome-wide-association studies (GWASs), epigenetic, gene-expression and gene-gene interaction projects, nutritional genomics and investigations of the gut microbiota have increased our knowledge of the pathophysiology of eating disorders (EDs). However, compared with anorexia nervosa, genetic studies in patients with bulimia nervosa and binge-eating disorder are relatively scarce, with the exception of a few formal genetic and small-sized candidate-gene-association studies. In this article, we review important findings derived from formal and molecular genetics in order to outline a genetics-based pathophysiological model of EDs. This model takes into account environmental and nutritional factors, genetic factors related to the microbiome, the metabolic and endocrine system, the immune system, and the brain, in addition to phenotypical traits of EDs. Shortcomings and advantages of genetic research in EDs are discussed against the historical background, but also in light of potential future treatment options for patients with EDs.
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http://dx.doi.org/10.1177/2045125318814734DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6378634PMC
February 2019

Cytokine Research in Depression: Principles, Challenges, and Open Questions.

Front Psychiatry 2019 7;10:30. Epub 2019 Feb 7.

Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom.

Cytokines have been implicated in the pathology of depression. Currently, the evidence is based on cross-sectional studies and meta-analytic research comparing blood concentrations of T helper type 1 (T1), T helper type 2 (T2), pro-inflammatory or anti-inflammatory cytokines of patients with a depressive disorder to those of healthy controls. Additionally, multiple longitudinal studies have investigated cytokine levels during antidepressant treatment. According to the current literature, it seems that peripheral levels of interleukin (IL)-6, IL-10, IL-12, IL-13, and tumor necrosis factor (TNF)-α are elevated and that interferon (IFN)-γ levels are lower in patients with depression compared to healthy controls. However, the overlap of cytokine values between acutely depressed patients, remitted and recovered patients and healthy controls is considerable. Thus, the discriminative power of cytokine concentrations between depressed and non-depressed people is likely weak. Treatment with certain antidepressants appears to decrease peripheral levels of IL-6, IL-10, and TNF-α. However, weight gain-inducing psychopharmacological substances, such as the antidepressant mirtazapine, have been reported to potentially increase the production of pro-inflammatory cytokines. Even though cytokines are often discussed as biomarkers for depression, they have also been shown to be altered in other psychiatric disorders. Moreover, many environmental, social, psychological, biological, and medical factors are also associated with cytokine changes. Thus, cytokine alterations seem extremely unspecific. The interpretation of the results of these studies remains a challenge because it is unknown which type of cells are most responsible for cytokine changes measured in the blood nor have the main target cells or target tissues been identified. The same cytokine can be produced by multiple cell types, and the same cell can produce various cytokines. Additionally, redundancy, synergy, antagonism, and signaling cascades of cytokine signaling must be considered. Cytokines might not be associated with the diagnosis of depression according to the currently used diagnostic manuals, but rather with specific subtypes of depression, or with depressive symptoms across different psychiatric diagnoses. Therefore, the currently available diagnostic systems may not be the ideal starting point for psychiatric cytokine research.
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http://dx.doi.org/10.3389/fpsyt.2019.00030DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6374304PMC
February 2019

Psychiatric comorbidity as a risk factor for the mortality of people with bulimia nervosa.

Soc Psychiatry Psychiatr Epidemiol 2019 Jul 11;54(7):813-821. Epub 2019 Feb 11.

Department of Psychological Medicine, King's College London, London, UK.

Background: Bulimia nervosa (BN) is associated with increased mortality. Frequent comorbidities of BN include substance use disorders, affective disorders and personality disorders (PD). These comorbidities may add an additional risk for mortality.

Methods: We investigated the influence of these psychiatric comorbidities on all-cause mortality with demographic and socioeconomic factors considered as confounders over an observation period from January 2007 to March 2016 for 1501 people with BN using anonymised health records data from the South London and Maudsley NHS Foundation Trust (SLaM), retrieved through its Clinical Records Interactive Search (CRIS) data resource. Mortality was ascertained through monthly linkages to the nationwide tracing system administered by the Office for National Statistics (ONS). We used Cox proportional hazards regression to calculate hazard ratios (HRs) with 95% confidence intervals (CIs). Multivariable analyses were also performed to estimate effects when controlling for confounding of age, sex, ethnicity, borough, marital status and deprivation score.

Results: A total of 18 patients with BN died during the observation period. The standardised mortality ratio (SMR) for our study cohort (against the population of England and Wales in 2012 as a standard) was 2.52 (95% CI 1.49-3.97). Cox regressions revealed significant associations of mortality with older age and male gender. Comorbid PD (HR: 3.36; 95% CI 1.05-10.73) was significantly associated with all-cause mortality, even after controlling for demographic and socioeconomic covariates.

Conclusions: These results highlight increased mortality in patients with BN and the importance of recognising and treating PDs in patients with BN.
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http://dx.doi.org/10.1007/s00127-019-01667-0DOI Listing
July 2019

Serum Markers of Inflammation Mediate the Positive Association Between Neuroticism and Depression.

Front Psychiatry 2018 20;9:609. Epub 2018 Nov 20.

Leipzig University Medical Center, IFB Adiposity Diseases, Leipzig, Germany.

The personality trait neuroticism has been implicated in a poor response to stress, may relate to increased concentrations of cytokines and the development of depression. Inflammatory mechanisms may also be associated with the onset, severity and symptoms of depression. Both are related to poor antidepressant treatment outcome. Therefore, mediators of inflammation may bridge the relationship between neuroticism and depression. To disentangle these interrelationships, the associations between neuroticism (according to NEO-PIR-N), depressive symptoms (BDI-II scores) and serum levels of hsCRP, TNF-α, IFN-γ, IL-2, IL-4, IL-5, IL-10, IL-12, IL-13, GM-CSF were investigated in a group of 212 participants, consisting of 37 depressed and 175 non-depressed subjects. A mediation model was used to investigate whether the impact of neuroticism on depressive symptoms may be mediated by cytokines. Regression analyses revealed that IFN-γ, IL-5, and IL-12-levels, but none of the anti-inflammatory cytokines, were associated with the overall neuroticism score and several of the cytokines were related to the different facets of neuroticism. TNF-α, IFN-γ, IL-5, IL-12, and IL-13 were further related to the severity of depressive symptoms, as well as the somatic-affective and the cognitive dimensions of depression. Pro-inflammatory IFN-γ, IL-5 and IL-12 were identified as mediators of the positive prediction of depression severity by the degree of neuroticism. The current findings demonstrate that conditions related to long-term stress, such as depression and high neuroticism, are related to an up-regulation of inflammatory agents. Neuroticism may increase stress perception and, thus, increase the production of pro-inflammatory messenger molecules which are involved in the development of depression. This evidence may contribute to future anti-inflammatory interventions, particularly in subjects with high neuroticism who are at risk for developing depression. Furthermore, depressed patients with high neuroticism and cytokine levels may require early escalations in the intensity of treatment, along with additional therapeutic elements to increase the rate of treatment success.
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http://dx.doi.org/10.3389/fpsyt.2018.00609DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6256194PMC
November 2018

Inflammatory Markers in Anorexia Nervosa: An Exploratory Study.

Nutrients 2018 Oct 24;10(11). Epub 2018 Oct 24.

Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF, UK.

Inflammation has been suggested to play a pathophysiological role in anorexia nervosa (AN). In this exploratory cross-sectional study, we measured serum concentrations of 40 inflammatory markers (including cytokines, chemokines, and adhesion molecules) and brain-derived neurotrophic factor (BDNF) in people with AN ( = 27) and healthy controls (HCs) ( = 13). Many of these inflammatory markers had not been previously quantified in people with AN. Eating disorder (ED) and general psychopathology symptoms were assessed. Body mass index (BMI) and body composition data were obtained. Interleukin (IL)-6, IL-15, and vascular cell adhesion molecule (VCAM)-1 concentrations were significantly elevated and concentrations of BDNF, tumor necrosis factor (TNF)-β, and vascular endothelial growth factor (VEGF)-A were significantly lower in AN participants compared to HCs. Age, BMI, and percentage body fat mass were identified as potential confounding variables for several of these inflammatory markers. Of particular interest is that most of the quantified markers were unchanged in people with AN, despite them being severely underweight with evident body fat loss, and having clinically significant ED symptoms and severe depression and anxiety symptoms. Future research should examine the replicability of our findings and consider the effect of additional potential confounding variables, such as smoking and physical activity, on the relationship between AN and inflammation.
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http://dx.doi.org/10.3390/nu10111573DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6266841PMC
October 2018

A systematic review of in vitro cytokine production in eating disorders.

Mol Cell Endocrinol 2019 11 6;497:110308. Epub 2018 Oct 6.

Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; South London and Maudsley NHS Foundation Trust, London, UK.

Background: Eating disorders (EDs) have been associated with alterations in cytokine concentrations and production. This review examines whether in vitro cytokine production (i) is altered in people with EDs compared to healthy participants; and (ii) changes in response to treatment?

Methods: Using PRISMA guidelines, we systematically reviewed articles reporting group comparisons or longitudinal assessments of spontaneous and/or stimulated cytokine production in vitro in people with EDs.

Results: Twelve studies were included. Cross-sectional results were mixed in anorexia nervosa. Only one study measured cytokine production in bulimia nervosa. Two longitudinal studies showed that daily yoghurt consumption increases phytohemagglutinin-stimulated interferon-γ production in anorexia nervosa.

Conclusion: The mixed results could be accounted for by variations in experimental design. Our findings suggest that cytokine production could possibly be modulated through dietary interventions. However, due to the methodological heterogeneity and shortcomings of the included studies, it seems unreasonable to draw further conclusions.
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http://dx.doi.org/10.1016/j.mce.2018.10.006DOI Listing
November 2019
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