•Post-operative cognitive dysfunction (POCD) is an established risk of surgery.•The proposed feed-forward inflammatory process of POCD is well supported.•Perioperative use of COX-II inhibitors and ...dexmedetomidine preserves cognition.•Evidence for other agents is thin and heterogeneous.
Post-Operative Cognitive Dysfunction (POCD) is a highly prevalent condition with significant clinical, social and financial impacts for patients and their communities. The underlying pathophysiology is becoming increasingly understood, with the role of neuroinflammation and oxidative stress secondary to surgery and anaesthesia strongly implicated. This review aims to describe the putative mechanisms by which surgery-induced inflammation produces cognitive sequelae, with a focus on identifying potential novel therapies based upon their ability to modify these pathways.
•Oxidation and neuroinflammation modulate cognition through a variety of vectors.•NAC mitigates the cognitive effects of neuroinflammation in animals.•Evidence that NAC can modulate human cognition ...is promising but inconsistent.•Combined antioxidants are effective, but the specific contribution of NAC is unknown.•Further exploration of NAC’s ability to modify cognitive change is warranted.
Oxidative stress, neuroinflammation and neurogenesis are commonly implicated as cognitive modulators across a range of disorders. N-acetylcysteine (NAC) is a glutathione precursor with potent antioxidant, pro-neurogenesis and anti-inflammatory properties and a favourable safety profile. A systematic review of the literature specifically examining the effect of NAC administration on human cognition revealed twelve suitable articles for inclusion: four examining Alzheimer's disease; three examining healthy participants; two examining physical trauma; one examining bipolar disorder, one examining schizophrenia, and one examining ketamine-induced psychosis. Heterogeneity of studies, insufficiently powered studies, infrequency of cognition as a primary outcome, heterogeneous methodologies, formulations, co-administered treatments, administration regimes, and assessment confounded the drawing of firm conclusions. The available data suggested statistically significant cognitive improvements following NAC treatment, though the paucity of NAC-specific research makes it difficult to determine if this effect is meaningful. While NAC may have a positive cognitive effect in a variety of contexts; larger, targeted studies are warranted, specifically evaluating its role in other clinical disorders with cognitive sequelae resulting from oxidative stress and neuroinflammation.
Abstract
11β-hydroxysteroid dehydrogenase type 1 (11β-HSD1) activity is implicated as a moderator of the progression of multiple diseases and disorders in medicine and is actively subject to ...investigation as a therapeutic target. Here we summarize the mechanisms of the enzyme and detail the novel agents under investigation. Such agents modulate peripheral cortisol and cortisone levels in hypertension, type 2 diabetes, metabolic disorders, and Alzheimer’s disease models, but there is mixed evidence for transduction into symptom management. There is inchoate evidence that 11β-HSD1 modulators may be useful pharmacotherapies for clinical improvement in psychiatry and neurology; however, more research is required.
School-based mental health intervention programs have demonstrated efficacy for the prevention and reduction of depressive symptoms, though the effect tends to be variable and is often unsustained ...longitudinally. However, it is possible that these intervention programs may have an indirect impact on adolescent functioning via positive mediators, and that this influence may predict more durable protective benefits. This study evaluated the efficacy of the Resilient Families program for improving social-emotional skills and depressive symptoms for adolescents over a two-year period. Twenty-four secondary schools in Melbourne, Australia were randomly allocated to either Resilient Families or a control condition. 1826 students (
M
=
12.3, SD = .05 years at W1; 56% female) completed the curricula and subsequent surveys. Inconsistent with hypotheses, analysis with Structural Equation Modelling revealed that the program had no significant effect on social-emotional skills and these skills had no significant effects on adolescent depressive symptoms. However, family attendance at parent education events within the intervention schools was associated with longitudinal reductions in depressive symptoms. The findings highlight the importance of increasing emphasis on family and community protective factors in adolescent social-emotional development and depression prevention programs.
Literature suggests that acceptance and commitment therapy (ACT) is effective in improving well‐being and in reducing psychopathological symptoms commonly experienced by people with chronic illness ...(CI). Compassion‐focused therapy (CFT) reduces psychological distress, especially in individuals with high levels of shame and self‐criticism, but few studies have explored CFT in CI. Additionally, studies almost exclusively compared ACT and CFT with inactive controls (wait‐list; treatment as usual). Also, there is an interest in developing cost‐effective mental health solutions, such as low‐intensity online psychological interventions. This randomized controlled trial (RCT) aimed to assess the acceptability and compare the efficacy of four‐session online ACT (n = 25) and CFT (n = 24) interventions in a sample of people with CI. Results showed both interventions were acceptable, with attrition rates at post‐intervention comparable to those found in similar studies (around 50%). Intention‐to‐treat analyses showed that participants presented significantly less illness‐related shame, less uncompassionate self‐responding and more valued living after the intervention, although no difference was found between conditions. Results were sustained at 3‐ and 6‐month follow‐up. Results did not find statistical differences between conditions through reliable change index (RCI). Correlation between demographics and RCI showed that, at post‐intervention, younger participants presented more behavioural awareness, men presented more valued action, and participants with CI for shorter periods presented less uncompassionate self‐responding and less anxiety. Results suggest that low‐intensity (four sessions) online ACT and CFT are cost‐effective approaches to promote mental health of individuals with CI. Results and limitations are thoroughly discussed.
Theories and research regarding aggression have variously implicated low self-esteem, high self-esteem, and unstable self-esteem as a moderator of aggressive behaviours. Given that narcissism is ...rooted in self-esteem issues, it is a personality construct relevant to the study of aggression. Two fluctuating, and sometimes vacillating, narcissism phenotypes, grandiosity, and vulnerability, may display differing relationships with aggression and aggressive behaviours. One coping mechanism for self-esteem issues, problematic alcohol use behaviours, shows positive independent associations with both narcissism and aggression and therefore may act as an exacerbating factor. Given this complexity, the current study aimed to model grandiose and vulnerable narcissism phenotypes together and examine their relation to both observable manifestations and cognitive measures of aggression, while simultaneously examining the potential contributing effect of alcohol use behaviours in an online community-based survey;
N
= 1883, aged between 18 and 77 years (M = 33.33, SD = 13.76). While grandiose narcissism is uniquely associated with verbal aggression, vulnerable narcissism appears to be more critical in understanding a variety of forms of aggression. Alcohol use behaviours, while related to aggression, did not influence these associations. Our findings suggest that vulnerable narcissism is a far more severe concern for predicting several types of aggression than the grandiose dimension. Implications for future research and practice are explored.
Minocycline has anti-inflammatory, antioxidant, and anti-apoptotic properties that explain the renewed interest in its use as an adjunctive treatment for psychiatric and neurological conditions. ...Following the completion of several new clinical trials using minocycline, we proposed an up-to-date systematic review and meta-analysis of the data available. The PICO (patient/population, intervention, comparison and outcomes) framework was used to search 5 databases aiming to identify randomized controlled trials that used minocycline as an adjunctive treatment for psychiatric and neurological conditions. Search results, data extraction, and risk of bias were performed by two independent authors for each publication. Quantitative meta-analysis was performed using RevMan software. Literature search and review resulted in 32 studies being included in this review: 10 in schizophrenia, 3 studies in depression, and 7 in stroke, with the benefit of minocycline being used in some of the core symptoms evaluated; 2 in bipolar disorder and 2 in substance use, without demonstrating a benefit for using minocycline; 1 in obsessive-compulsive disorder, 2 in brain and spinal injuries, 2 in amyotrophic lateral sclerosis, 1 in Alzheimer's disease, 1 in multiple systems atrophy, and 1 in pain, with mixes results. For most of the conditions included in this review the data is still limited and difficult to interpret, warranting more well-designed and powered studies. On the other hand, the studies available for schizophrenia seem to suggest an overall benefit favoring the use of minocycline as an adjunctive treatment.
Increasing screen time in childhood has raised concerns about potential effects on academic achievement, with speculation that this is due in part to an overall decrease in sleep. However, research ...does not often distinguish between different types of screen time, such as that dedicated to home or other educational pursuits. Further, family factors such as socioeconomic status are known to predict academic performance but are rarely examined in concert. The current study aimed to examine the association between screen time and academic achievement and to extend the current research by exploring whether the association was moderated by the type of screen time and family socioeconomic status. Participants were 651 children from Australia and New Zealand (M
age
= 10.09, SD = 3.64). Participants completed an academic achievement test, and parents reported screen time activities. Homework, but not sleep, was associated with better academic achievement. Educational television viewing (TV), but not entertainment TV, was associated with lower academic achievement. Socioeconomic status moderated the association between educational TV and academic achievement (B = −.29, p = .007). The results suggest that while screen time type does appear to be implicated in academic achievement, the mechanism appears to be specific to higher socioeconomic status families.
This study tested the acceptability and efficacy of an Acceptance and Commitment Therapy and compassion-based intervention (LIFEwithIBD) in people with IBD through a two-arm RCT.
Participants were ...recruited at the Gastroenterology Department of the Coimbra University Hospital between June and September 2019. Of the 355 patients screened, those who accepted to participate were randomly assigned to one of two conditions: experimental group (LIFEwithIBD;
= 25) or control group (waitlist;
= 29). Participants completed self-report measures at baseline (T0), post-intervention (T1), and 3-month (T2) and 12-month (T3) follow-ups. Intervention acceptability was assessed. Efficacy was examined using intent-to-treat ANCOVA at post-intervention after adjusting for baseline values of depressive, anxiety, and stress symptoms (primary outcomes). Linear mixed models for all longitudinal outcomes were also analysed. Inflammatory and disease biomarkers were determined at T0 and T3.
Acceptability results revealed a high level of satisfaction and perceived usefulness regarding the intervention. Both groups experienced a significant decrease in stress symptoms and IBD symptom perception at T1. No significant differences were observed at follow-up for the primary outcomes. The experimental group reported significantly lower Crohn's disease Symptom severity at T2 than the control group. Post-hoc analyses designed to mitigate floor effects revealed substantial treatment effects for the experimental group regarding anxiety symptoms. No significant differences were observed in clinical biomarkers from T0 to T3.
The LIFEwithIBD intervention shows promising, although preliminary, benefits for managing disease activity and reducing anxiety symptoms in IBD patients with high severity of psychological distress.
: https://www.clinicaltrials.gov/ct2/show/NCT03840707, identifier NCT03840707.
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