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Susac-syndrome is a rare autoimmune disease that manifests with mood alterations in up to 15% of cases and is usually treated with corticosteroids. We present the case of a 41-year-old woman with a first manic episode and history of Susac-syndrome, secondary Cushing's syndrome after receiving high doses of corticosteroids and a previous depressive episode. Differentiating between primary and secondary mania is difficult, as people with bipolar disorder are prone to multiple psychiatric and nonpsychiatric comorbidities, in this case, the differential diagnosis included secondary mania, corticoid-induced manic episode and primary bipolar disorder. Upon admission, corticosteroid treatment was suspended, and the patient was started on lithium and risperidone. Secondary causes of mania were discarded and, assessing temporal and dosage criteria, it was deemed unlikely that the present episode was corticosteroid-induced. One-year outpatient follow-up pointed towards a primary bipolar type I disorder, as a separate entity from her Susac-syndrome. Corticosteroid use or abrupt withdrawal pose an underestimated risk of inducing depressive or manic symptoms, which may unmask affective disorders in susceptible individuals. Many medical conditions share CNS involvement and/or high-dose/prolonged corticosteroid treatment. In such cases, psychiatric manifestations such as mania or depression should be regarded as secondary and studied to determine the existence of medical complications before considering primary psychiatric conditions.

Depression is a chronic disease with a complex multifactorial and still not fully clarified etiology. Due to new insights after recent investigations of the microbiota-gut-brain (MGB) axis, a relationship between a disrupted gut microbiota composition and the probability to develop a depression can be assumed. This hypothesis is supported by evidence that there is a strong communication between gut microbiota and the central nervous system (CNS) and that this communication is mediated through the MGB axis. Apparently, this bidirectional axis can be modulated by environmental factors, such as stress, pharmaceuticals (in particular antibiotics) and dietary habits. Moreover, modulation of this axis can also result in mood alterations. As the hypothalamic-pituitary-adrenal (HPA) axis is a key element regulating the MGB axis and is also related to the pathophysiology of depression, it is important to understand the relationship between both biological systems. An English language literature search was conducted using the biomedical database PubMed. We used combined terms, such as "gut microbiota", "depression", "hypothalamic-pituitary-adrenal axis" or "microbiota-gut-brain axis". The current literature supports the idea that the MGB axis has an impact on the risk to develop depression and that stress modulation through the HPA axis plays a key role in this context.

Acute pain events have been associated with persistent pain sensitization of nociceptive pathways increasing the risk of transition from acute to chronic pain. However, it is unclear whether injuryinduced persistent pain sensitization can promote long-term mood disorders. The receptor tyrosine kinase FLT3 is causally required for pain chronification after peripheral nerve injury, questioning its role in the development of pain-induced mood alterations. Here, we evaluated the emotional and sensorial components of pain after a single (SI) or double paw incision (DI). We then investigated the role of FLT3 either by inhibition using transgenic knock-out mice and functional antibodies or by activation with FLT3 ligand (FL) administrations.DI mice showed significant anxiodepressive-like and spontaneous pain behaviors as opposed to SI mice. DI also promoted and extended mechanical pain hypersensitivity compared to SI. This emotional and sensorial pain exaggeration correlated with spinal changes especially by increased microglia activation after DI versus SI. Intrathecal minocycline, a microglial inhibitor, specifically reversed DI inducedmechanical hypersensitivity in males. Repeated treatment with the microglia proliferation inhibitor GW2580 not only eliminated the exaggerated pain hypersensitivity produced by DI but also prevented anxiodepressive-related behaviors in DI animals. Finally, FL injections in naive animals provoked mechanical allodynia and anxiodepressive-like disorders concomitant with a strong microglial activation while Flt3 silencing in a genetic mouse line or FLT3 blocking via functional antibodies, blunted the development of persistent pain and depression after DI. Altogether our results show that the repetition of peripheral lesions facilitate not only exaggerated nociceptive behaviors but also induced anxiodepressive disorders supported by spinal central changes. The inhibition of FLT3 could thus become a promising therapy in the management of pain sensitization and related mood alterations.

The development of neuropathy and of mood alterations is frequent after chemotherapy. These complications, independent from the antitumoral mechanism, are interconnected due to an overlapping in their processing pathways and a common neuroinflammatory condition. This study aims to verify whether in mice the treatment with the proteasome inhibitor bortezomib (BTZ), at a protocol capable of inducing painful neuropathy, is associated with anxiety, depression and supraspinal neuroinflammation. We also verify if the therapeutic treatment with the antagonist of the prokineticin (PK) system PC1, which is known to contrast pain and neuroinflammation, can prevent mood alterations. Mice were treated with BTZ (0.4 mg/kg three times/week for 4 weeks), mechanical allodynia and locomotor activity were evaluated over time while anxiety (dark light and marble burying test), depression (sucrose preference and swimming test) and supraspinal neuroinflammation were checked at the end of the protocol. BTZ treated neuropathic mice develop anxiety and depression. The presence of mood alterations is related to the presence of neuroinflammation and PK system activation in prefrontal cortex, hippocampus and hypothalamus with high levels of PK2 and PKR2 receptor, IL-6 and TNF-α, TLR4 and an upregulation of glial markers. PC1 treatment, counteracting pain, prevented the development of supraspinal inflammation and depression-like behavior in BTZ mice.

This study examined the influence of a behavioural weight loss programme (BWLP) and social physique anxiety (SPA) on weight-loss success and subjective well-being in obese, sedentary women (N = 32 ...

Background Several studies have shown cerebellar abnormalities during depressive and manic states, although the specific cerebellar role in mood fluctuations remains poorly defined. Therefore, the study of pathologies characterized by frequent mood swings, such as bipolar disorder, is of great interest to investigate the relationship between the cerebellum and mood alterations. Methods A systematic literature search on the occurrence of mood disorders in patients with cerebellar pathologies (1st research strategy) and on the presence of cerebellar alterations in mood disorders (2nd research strategy) was conducted using the PubMed electronic Internet database. For this systematic review all information was written based on the PRISMA-P statement. Results The results of the 1st research strategy generated 9 articles, and in one of these, a direct correlation between cerebellar damage and the onset of mood disorder was reported. The 2nd research strategy generated 14 articles that were grouped according to the patient’s mood phase (manic or depressive) or diagnosis (bipolar I or bipolar II). Conclusions The present review suggests that the cerebellum should be considered a key structure involved in the regulation of mood.

Background The concept of creativity encompasses the ability to produce innovatively original solutions that exceed the status quo. Eminent creatives are frequently afflicted with bipolar disorders, and persons presenting certain forms of bipolar disorder might have enhanced creativity. The link between creativity and bipolar disorder has intrigued researchers but no definite liaison has been established between creativity and mood alterations. Methods We address this issue on this perspective by analysing various expression forms of creativity, as well as creative achievement according to the clinically diagnosed mood states at an eminent person, treated for bipolar disorder. Beside full agreement of the patient, an ethical committee approval has been granted for processing and publishing the case. Results Hypomania boosts visual artistic creativity and scientific work while mild to moderate depression facilitates literary performance. Severe depression and depressive mixed states do not promote either aspect of creativity, and euthymia, with blunted mood swings by medication, is also detrimental to creativity. Conclusions It appears that positive but also negative mood have curvilinear effects on creativity. We argue that there are different correlates of a creative process in one person, where mood functions as a lock gate to canalize various creativity forms, resulting in multiple creativity as a function of distinct mood states in bipolar disorder. Limitations The lack of performing the studies of personality is a limitation of the paper.

Posttraumatic stress disorder (PTSD) rates are higher in military veterans than in the civilian population. Meta-analyses have found strong and consistent associations between PTSD and suicide risk. Several studies have demonstrated a concurrent reduction in suicidal ideation (SI) with reduction of PTSD symptoms during trauma-focused treatment. However, it is unclear whether changes in specific PTSD symptom clusters are most strongly associated with these changes in SI. This study prospectively examined associations between PTSD symptom clusters and SI to better specify mechanisms of change during treatment. Participants were 160 veterans (87% male, 63% Caucasian, 64% combat trauma) who completed a course of evidence-based trauma-focused therapy at a VA hospital. The Patient Health Questionnaire-9 and Posttraumatic Stress Disorder Checklist-5 were used to assess depression, SI frequency, and PTSD symptoms. Binary logistic regression analyses found that the cognitive/mood alteration cluster was the only significant independent predictor of SI at termination. Post hoc analysis of variance Bonferroni tests indicated those who decreased SI frequency had a greater reduction in intrusive, cognitive/mood alteration, and hyperarousal symptoms relative to those who increased or had no change in SI. A within-cluster item analysis revealed that baseline symptom D3 (blame self/others) was the only significant independent predictor for baseline SI, whereas baseline symptom D6 (detachment) was the only significant independent predictor for SI at termination. This discrepancy may be explained by reductions in guilt during treatment, as 79% of the sample elected to receive cognitive processing therapy. Given these associations, PTSD patients with SI may benefit from a treatment emphasis on reducing cognitive/mood alteration symptoms. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Mistiming of circadian rhythms impairs quality of life. The sleep fragmentation that results can lead to fatigue, mood alteration, and short-term memory problems. Unfortunately, this suite occurs in humans as we age. In the current study, we used high-resolution monitors to track how circadian patterns of locomotor activity change in female Drosophila ananassae as they enter mid-to-late life. This equipment is a more recent addition to the fly circadian field and has not been previously used for long-term activity tracking. At 2–3 days post-eclosion, D. ananassae were placed into climate-controlled vivariums for 60 days. Daily actograms were generated for each animal, along with a time series of activity across the observational period. Consistent with findings from older rodents and humans, older D. ananassae exhibited degraded patterns of wake and sleep that were fragmented—but still rhythmic—across the 24-h cycle. Overall levels of daily activity declined with age, with particular loss of circadian arousal in the wake-maintenance zone a few hours before bedtime. Interestingly, our high-resolution monitoring strategy was also able to document a sleep correlation previously associated with human aging in flies: displacement of sleep timing arising from possible changes in circadian and homeostatic regulation. Future experiments may determine whether the age-related impairments seen in the sleep-circadian system of D. ananassae can be mitigated through precision light treatment.

Spinocerebellar ataxia type 1 (SCA1) is a fatal neurodegenerative disease caused by abnormal expansion of glutamine-encoding CAG repeats in the Ataxin-1 (ATXN1) gene. SCA1 is characterized by progressive motor deficits, cognitive decline, and mood changes including anxiety and depression, with longer number of repeats correlating with worse disease outcomes. While mouse models have been very useful in understanding etiology of ataxia and cognitive decline, our understanding of mood symptoms in SCA1 has lagged. It remains unclear whether anxiety or depression stem from an underlying brain pathology or as a consequence of living with an untreatable and lethal disease. To increase our understanding of the etiology of SCA1 mood alterations, we used the elevated-plus maze, sucrose preference and forced swim tests to assess mood in four different mouse lines. We found that SCA1 knock-in mice exhibit increased anxiety that correlated with the length of CAG repeats, supporting the idea that underlying brain pathology contributes to SCA1-like anxiety. Additionally, our results support the concept that increased anxiety is caused by non-cerebellar pathology, as Purkinje cell specific SCA1 transgenic mice exhibit decreased anxiety-like behavior. Regarding the molecular mechanism, partial loss of ATXN1 may play a role in anxiety, based on our results for Atxn1 haploinsufficient and null mice.

The relationship between temperament as a manifestation of personality and mood disorders comes from Greek antiquity. Throughout history, the relationship between personality and depression has been conceptualized in at least four ways: (1) Personality is a predisposing or vulnerability factor for the development of depression. (2) Personality changes are a consequence of mood alteration resulting from depression. (3) Personality is a subclinical manifestation of depression (affective temperaments). And (4) personality characteristics influence the manner in which depression clinically manifests. Currently, there is a tendency to recover the concept of affective temperaments (depressive, hypertensive, cyclothymic, irritable, and anxious), considering them as subclinical manifestations of some disorder within the affective spectrum. These temperaments have been shown to be universal, with distinctive characteristics and without gender differences. Although in depressive illness there is important evidence regarding both functional and structural neurobiological alterations, much less is known about the biological findings of personality dysfunction in depression. One reason, in part, is that explanatory models are required that integrate various levels of analysis, including the different types of gene-environment relationships. In this chapter, we will review the relationship between personality and depression, then we will describe the main neurobiological findings underlying personality dysfunction in depression, and finally we will analyze the relationship between genes and environment in depression, taking into account the approach of differential sensitivity to environmental stimuli. We will conclude with some recommendations for future research.

Inter-individual differences in emotional reactivity predict susceptibility versus resilience to mood pathology. Using experimentally-naive outbred rats that vary in locomotor reactivity to the mild stress of an inescapable novel environment [i.e., top and bottom 1/3rd of the population identified as high responders (HR) and low responders (LR) respectively], we determined baseline variations in immune functions. Innate and adaptive immune responses vary basally in LRHR rats, namely a shift towards TH1 in LRs and TH2 in HRs was observed. These inter-individual variations in immune profiles in LRHRs could have significant implications in mood alterations and immune reactivity to microbes and cancer.

BACKGROUND: Chronic pain and mood disorders share common neuroanatomical substrates involving disruption of the reward system. Although increase in negative affect (NA) and decrease in positive affect (PA) are well-known factors complicating the clinical presentation of chronic pain patients, our understanding of the mechanisms underlying the interaction between pain and PA/NA remains limited. Here, we used a validated task probing behavioral and neural responses to monetary rewards and losses in conjunction with functional magnetic resonance imaging (fMRI) to test the hypothesis that dysfunction of the striatum, a key mesolimbic structure involved in the encoding of motivational salience, relates to mood alterations comorbid with chronic pain. METHODS: Twenty-eight chronic musculoskeletal pain patients (chronic low back pain, n=15; fibromyalgia, n=13) and 18 healthy controls underwent fMRI while performing the Monetary Incentive Delay (MID) task. Behavioral and neural responses were compared across groups and correlated against measures of depression (Beck Depression Inventory) and hedonic capacity (Snaith-Hamilton Pleasure Scale). RESULTS: Compared to controls, patients demonstrated higher anhedonia and depression scores, and a dampening of striatal activation and incentive-related behavioral facilitation (reduction in reaction times) during reward and loss trials of the MID task (ps

In the last decade the influence of nonmotor symptoms on the motor performance of Parkinson's disease (PD) patients has been the subject of several studies. In this chapter we focus on the role played by emotional processes that have been studied through research conducted in laboratory or clinical settings. The studies reviewed in this chapter clearly show how PD negatively influences the affective life of patients. More specifically, research on emotional processes and expressions suggests that PD patients may exhibit significant deficits in nonverbal communication, with difficulties in producing emotional facial movements and recognizing the emotions of other people. Several studies demonstrate how patients with PD may display deficits in performing emotion recognition tasks; this seems particularly true for experimental tasks involving prosodic stimuli with a negative valence. Other studies have shown mood alterations and emotional dysfunctions including depression, apathy, and anxiety as well as alexithymia.

For moderate sedation to be a viable and successful technique, an understanding of the nature of pain, fear, and anxiety is essential. Moderate sedation reduces anxiety and attenuates the cardiovascular response to stress. This helps stabilize physiologic parameters to the extent that vital signs remain close to baseline, even in the presence of potentially noxious stimuli. The level of sedation is tailored to the level of patient anxiety. This is known as the spectrum of pain control. Thus, moderate sedation can change a patient’s perception, turning an objectionable procedure into something acceptable. Objectives of moderate sedation include mood alteration and pain threshold elevation while maintaining consciousness. The levels of sedation are distinctly defined for the purpose of establishing training and practice guidelines.

Mindfulness is the state of paying attention to the present moment on purpose and meditation is the technique to obtain this state. This study aims to develop a robot assistant that facilitates mindfulness training by means of a Brain Computer Interface (BCI) system. To achieve this goal, we collected EEG signals from two groups of subjects engaging in a meditative vs. nonmeditative human robot interaction (HRI) and evaluated cerebral hemispheric asymmetry, which is recognized as a well defined indicator of emotional states. Moreover, using self reported affective states, we strived to explain asymmetry changes based on pre and post experiment mood alterations. We found that unlike earlier meditation studies, the frontocentral activations in alpha and theta frequency bands were not influenced by robot guided mindfulness practice, however there was a significantly greater right sided activity in the occipital gamma band of Meditation group, which is attributed to increased sensory awareness and open monitoring. In addition, there was a significant main effect of Time on participants self reported affect, indicating an improved mood after interaction with the robot regardless of the interaction type. Our results suggest that EEG responses during robot-guided meditation hold promise in realtime detection and neurofeedback of mindful state to the user, however the experienced neurophysiological changes may differ based on the meditation practice and recruited tools. This study is the first to report EEG changes during mindfulness practice with a robot. We believe that our findings driven from an ecologically valid setting, can be used in development of future BCI systems that are integrated with social robots for health applications., Comment: accepted for conference RoMAN2020

Prison could be considered a prolonged stressful situation that can trigger not only a dysregulation of sleep patterns but can also bring out psychiatric illness, such as anxiety and depression symptoms. Our study is aimed at exploring sleep quality and sleep habits in an Italian prison ward with three different security levels, and to attempt to clarify how anxiety state and the total time spent in prison can moderate insomnia complaints. There were 129 participants divided into three groups who enrolled in this study: 50 were in the medium-security prison ward (Group 1), 58 were in the high-security prison ward (Group 2) and 21 were in the medium-security following a protocol of detention with reduced custodial measures (Group 3). All participants filled in a set of questionnaires that included the Beck Depression Inventory (BDI-2), the State-Trait Anxiety Inventory (STAI), the Pittsburgh Sleep Quality Index (PSQI), and the Insomnia Severity Index (ISI). Based on their responses, we observed that all participants showed poor sleep quality and insomnia, mild to moderate depressive symptoms that tended to a higher severity in Groups 1 and 3, and the presence of clinically significant anxiety symptoms, mainly in Groups 1 and 3. Our study shows that increased anxiety state-level and the presence of mood alteration corresponds to an increase in both poor sleep quality and, more specifically, insomnia complaints. Finally, we propose that TiP (total time in prison) could have an interesting and stabilizing paradox-function on anxiety state and insomnia.

International audience; Increasing evidence from animal and human studies suggests that inflammation may be involved in mood disorders. Sickness behavior and emotional changes induced by experimental inflammatory stimuli have been extensively studied in humans and rodents to better understand the mechanisms underlying inflammation-driven mood alterations. However, research in animals and humans have remained compartmentalized and a comprehensive comparison of inflammation-induced sickness and depressive-like behavior between rodents and humans is lacking. Thus, here, we highlight similarities and differences in the effects of bacterial lipopolysaccharide administration on the physiological (fever and cytokines), behavioral and emotional components of the sickness response in rodents and humans, and discuss the translational challenges involved. We also emphasize the differences between observable sickness behavior and subjective sickness reports, and advocate for the need to obtain both subjective reports and objective measurements of sickness behavior in humans. We aim to provide complementary insights for translational clinical and experimental research on inflammation-induced behavioral and emotional changes, and their relevance for mood disorders such as depression

The field related to mood disorders in Parkinson’s disease (PD) is fragmented. The aim of this cohort observational study was to evaluate whether the episodes of mood alteration could appear in different disease stages and to verify how nonmotor symptoms were led off into different stages. We enrolled 93 PD outpatients (three groups: drug naive—DN; not exhibiting motor fluctuations—n-MF; and exhibiting motor fluctuations—MF) and 50 healthy controls. Mood state was assessed through the Internal State Scale (ISS) while depressive symptoms were evaluated through the Beck Depression Inventory-II (BDI-II), nonmotor symptoms by means of the Non-Motor Symptoms Scale (NMSS), and the presence of impulse control disorders (ICDs) with the Questionnaire for Impulsive-Compulsive Disorders in Parkinson’s Disease (QUIP). Clinical and pharmacological data have also been recorded. No significant differences in mood state distribution between groups were observed. Nevertheless, as regards the mood state distribution within groups, in n-MF (47.6%) and MF patients (50%), (hypo)mania presence was significantly higher than other symptoms. In DN patients, hypomania showed a prevalence of 38.1% although it was not significant. At least one ICD was reported in 29.3% of n-MF and 50% of MF patients. In the MF group, a moderate positive correlation between ISS ACTivation subscale scores and the presence of ICDs and compulsive medication use emerged. Finally, MF patients reported higher BDI-II total scores than DN. Our results show that mood alterations in PD, considering both depressive symptoms and mood elevation, are related to the advanced stages of the disease as well as the presence of ICDs, and dopaminergic therapy would not always be able to restore a normal mood condition.

Background: Menopausal transition may occur between 45 and 55 years old and take 3–9 years. During this transition, the hormonal changes may contribute to the physical and psychological complaints in women. One of the psychological complaints is a sign of depression. However, not all of the women will experience those complaints. Objective: To assess the relationship between depression in menopause transition and other menopausal symptoms and factors contribute to depression among Indonesian people. Methods: Cross-sectional study on 133 female subjects between 45 and 55 years old. Depression measured using Beck Depression Inventory-II (BDI-II), and menopausal symptoms were collected using Menopause Rating Scale (MRS). The comparison and relation were assessed for every aspect regarding depression and menopausal symptoms. Results: Out of 133 subjects, depression was found in 17 subjects (12.8%). Somato-vegetative symptoms were complained by 50.4% and urogenital symptoms by 75.9% subjects. There was significant correlation between depression and somato-vegetative (p = 0.008) as well as urogenital complaints among women who underwent menopause transition (p = 0.016). These findings were consistent with previous studies. Conclusion: Depression on menopausal transition significantly correlated with somato-vegetative and urogenital symptoms among women. Future investigations should be conducted with a cohort design to observe mood alterations during the menopause transition.

The link between creativity, as the highest expression form of human achievement, and bipolar disorder came into focus of scientific investigations and research. Accomplished writers, composers and visual artists show a substantially higher rate of affective disorders, prodominantly bipolar mood disorders, comparing to the general population. Then again, patients afflicted with bipolar II subtype (hypomania and depression), as well as persons presenting the mildest form of bipolar mood swings (cyclothymia) possess higher creative skills. It evokes therefore that certain forms and mood states of bipolar disorder, notably hypomania might convey cognitive, emotional/affective, and motivational benefits to creativity. The aim of this paper is to display expression forms of creativity (writing, visual art, scientific work) as well as productivity (literary and scientific work output, number of artworks and exhibitions, awards) in the light of clinically diagnosed mood states at an eminent creative individual, treated for bipolar II disorder. Analysing the affective states, we found a striking relation between hypomanic episodes and visual artistic creativity and achievement, as well as scientific performance, whereas mild-moderate depressed mood promoted literary work. Severe depression and mixed states were not associated with creative activities, and intriguingly, long-term stabilised euthymic mood, exempted from marked affective lability, is disadvantageous regarding creativity. It seems, thereby, that mood functions as a sluice of creativity. Nevertheless, it is likely that there is a complex interaction between bipolar mood disorder spectrum and psychological factors promoting creativity, influenced also by individual variability due to medication, comorbid conditions, and course of disorder.

Introduction: Rheumatoid arthritis (RA) is a progressive and disabling autoimmune disease associated with mood disorders. However, little attention is paid to the potential effects on the emotional alterations. Objectives: To characterize and compare the mood state of patients with RA, based on the level of disease activity. Methods: 80 subjects were evaluated with RA, with 52.72 ± 15.14 years. The Disease Activity Score-28 (DAS-28) was used to assess the level of the disease activity. The evaluation of the Mood State was performed with the Brazilian Humor Scale (BRAMS). Results: Mood alterations were observed in the anger, tension and vigor domains, of which the group classified as having a high disease activity had the worst mood pictures. Conclusion: These data highlight the importance of a multidisciplinary treatment aiming to improve the mood and quality of life of these individuals, leading to a better therapeutic management of RA.

One of the most interesting but tenebrous parts of the bipolar disorder (BD) story is the switch between (hypo)mania and depression, which can give bipolar patients a thrilling, but somewhat perilous, ‘ride’. Numerous studies have pointed out that there are some recognizable differences (either state-dependent or state-independent) in several brain regions of people with BD, including components of the brain’s reward system. Understanding the underpinning mechanisms of high and low mood statuses in BD has potential, not only for the development of highly specific and selective pharmaceutical agents, but also for better treatment approaches and psychological interventions to manage BD and, thus, give patients a safer ride. Herein, we review evidence that supports involvement of the reward system in the pathophysiology of mood swings, with the main focus on the mesocorticolimbic dopaminergic neural circuitry. Principally using findings from neuroimaging studies, we aim to signpost readers as to how mood alterations may affect different areas of the reward system and how antipsychotic drugs can influence the activity of these brain areas. Finally, we critically evaluate the hypothesis that the mesocorticolimbic dopamine reward system may act as a functional rheostat for different mood states.

Exercise training is associated with elevations in mood in patients with various chronic illnesses and disabilities. However, little is known regarding the effect of exercise training on short and long-term mood changes in those with traumatic brain injury (TBI). The purpose of this study was to examine the time course of mood alterations in response to a vigorous, 12-week aerobic exercise training regimen in ambulatory individuals with chronic TBI (>6 months postinjury). Short and long-term mood changes were measured using the Profile of Mood States-Short Form, before and after specific aerobic exercise bouts performed during the 12-week training regimen. Ten subjects with nonpenetrating TBI (6.6 ± 6.8 years after injury) completed the training regimen. A significant improvement in overall mood was observed following 12 weeks of aerobic exercise training (P = .04), with moderate to large effect sizes observed for short-term mood improvements following individual bouts of exercise. Specific improvements in long-term mood state and short-term mood responses following individual exercise sessions were observed in these individuals with TBI. The largest improvement in overall mood was observed at 12 weeks of exercise training, with improvements emerging as early as 4 weeks into the training regimen.

Mutations in the astrocyte-enriched enzyme aldehyde dehydrogenase 7a1 (ALDH7A1) cause a neonatal epilepsy accompanied by treatment-resistant, inter-ictal neuropsychiatric symptoms. Nevertheless, the mechanistic impact of ALDH7A1 dysfunction in the brain remains elusive. We generated ALDH7A1 knockout mice and report that constitutive global ALDH7A1 depletion increases chemoconvulsant sensitivity and altered mood-associated behaviors. However, contrary to our expectation, astrocyte-specific ALDH7A1 depletion only affects mood-associated behaviors. Accordingly, in astrocyte-specific ALDH7A1 knockout mice, we show enhanced redox-sensitive microdomain Ca2+signaling in astrocytes and both elevated synaptic inhibitory tone and increased dendritic spine density in prelimbic pyramidal neurons. Sulforaphane (SFN), an indirect antioxidant and dietary supplement, has been explored as a possible treatment to ameliorate neuropsychiatric manifestations in autism and schizophrenia, at least at the clinical levels, but its mechanism in the brain is unclear. Here we show that SFN rescues both the physiological and behavioral changes by targeting astrocytic redox imbalance in ALDH7A1 knockout mice, implicating astrocyte redox changes in creating cortical excitatory-inhibitory imbalance and mood alteration.

Lithium is a unique drug. In more than 60 years of observation, it showed its multiple important clinical properties in treating mania, stabilizing mood alterations, preventing suicide and protecting from neurodegeneration. It was also the most extensively studied drug in psychiatry. Nevertheless, it is generally underprescribed. Specifically, lithium is virtually not considered in the treatment of patients affected by mixed affective states. Lithium is not suggested for the acute treatment of mixed affective states and is considered to be less effective than other mood stabilizers in the long-term management of these patients. The main reason why lithium has no indication for mixed states is the “lack of evidence.” Actually, there are several reasons to consider lithium as an effective treatment in patients with mixed affective states.

The mercury-related central nervous system disorders have been extensively studied on animal models and human beings. However, clinical evidences of which neurological changes are in fact associated with mercury exposure remains controversial. This systematic review (Prospero registration under the number CRD42016041760) aimed to elucidate the association of methylmercury (MeHg) exposure with neurological alteration in populations living in MeHg-endemic risk area. A systematic search was performed according to the Preferred Reporting Items for Systematic Review and Meta-Analysis criteria using available databases PubMed, LILACS, Scopus, Web of Science, The Cochrane Library, OpenGrey and Google Scholar. A search of the following terms: "methylmercury compounds", "organomercury compounds", "neurologic manifestations", "memory disorders", "neurobehavioral manifestations" and "communication disorders" were performed in a systematic way. Studies focusing on MeHg exposure and subsequent neurological alteration on humans (>13 years) were included. Evaluation of methodological quality and risk of bias as well as the level of evidence was performed. Our results have identified 470 studies and six articles were eligible for systematic review inclusion criteria. The studies suggested alterations related to the psychosensory, motor and coordination system, as well as motor speech, hearing, visual impairment, mood alterations and loss of intelligent quotient. Of all the six studies, two presented a high risk of bias, with methodological problems related to the confounding factors and all studies presented evidence level ranged from very low to low. In this way our results revealed that a definitive demonstration of an association of MeHg and neurological alterations in human beings is still a pending subject. Future studies in this topic should take into consideration more confident and reliable methods to answer this question.

Mood state alterations are often accompanied by disruptions of daily rhythms of physiology. Circadian rhythms of physiology are controlled by a central clock harbored in the suprachiasmatic nucleus (SCN), which is functionally dependent on the rhythmic expression of several clock genes. The molecular clockwork has been identified in other extra-SCN brain regions, some of which are implicated in the regulation of motivational and emotional states, although their specific circadian role is not fully known. In mood disorders, alterations of the molecular clock have been reported. Thus, functional expression of circadian genes in the brain is compromised in mood diseases. In the present review, we describe the current evidence that implicates the clock gene alterations as an important factor in the development of mood-related disorders. Furthermore, we describe the possible role of other brain clocks, beyond the SCN, in the circadian control of mood. The comprehension of the circadian neural and genetic mechanisms underlying mood alterations might guide towards the identification of optimal drug and non-drug therapies for the cure of depression and other mood disorders.

Es objeto de este estudio determinar la prevalencia de sintomatología de dependencia al ejercicio físico en universitarios y su relación con variables como la dedicación a la práctica deportiva, ansiedad rasgo, estado de ánimo, calidad del sueño y adherencia a una dieta baja en grasa. Se evaluaron a 240 deportistas (edad: M = 21.1, dt = 4.2). Los resultados mostraron como un 6% presentaron riesgo de dependencia al ejercicio físico. Son más los casos entre las mujeres, menores de 20 años, los que practican más sesiones semanales de entrenamiento y son más experimentados. El riesgo de dependencia al ejercicio físico aparece relacionado con una mayor frecuencia de las sesiones semanales de entrenamiento, alteraciones en el estado de ánimo, problemas de sueño, propensión ansiosa y la menor adherencia a una dieta baja en grasas. Estos resultados muestran indicadores psicológicos y signos del trastorno de dependencia al ejercicio físico evaluables por un psicólogo deportivo para su detección temprana o intervención.

Patients with brain tumor encounter a wide spectrum of tumor and treatment-related complications during their disease course. Tumors may serve as seizure substrates, are associated with a hypercoagulable state that results in thromboembolic complications, and may influence mood and cognition. Antitumor and supportive therapies may also have deleterious effects. Herein, we discuss major aspects of supportive care for patients with brain tumors, with attention to benefit and complications derived from the management of seizures, brain edema, venous thromboembolism, fatigue, mood alterations, and cognitive dysfunction.

Addiction to pornography thrives in the consumer’s compulsive need for novelty because it is more exciting than satisfying, images quickly become threadbare in their power to arouse and stimulate. Sex addiction, like addiction to gambling, is a process addiction, arising out of self-generated chemicals and hormones that behave like powerful drugs. For the susceptible person, the effect of compulsively using internet pornography has been compared to those that crack cocaine has on the nervous system of cocaine users, causing an acceleration of addiction. When a person watches pornography, he or she builds sexual excitement, raising and maintaining tension by producing dopamine, and when orgasm is reached, endorphins are released bringing relaxation and relief, so that a self-contained method of mood alteration has been learnt. Young people presenting in therapy for sexual compulsion might not have suffered early relational trauma or come from sexually abusive homes like the “classic” sex addict; their addiction to pornography may have had an opportunistic element.

The definition of migraine is mainly descriptive: there is no diagnostic test and no useful biomarker. Migraine attacks are invisible but can present with an encyclopedia of neurological symptoms. Pain is commonly assumed to be the essence of migraine, yet there is no structural lesion correlated to it. It can range from no pain at all to excruciating misery. Still, even in its most disabling form, the pain is only one symptom among many others. Migraine is often accompanied by nausea and hypersensitivity to light and sound. Other symptoms may include speech deficits, mood alterations, neck stiffness, and inability to concentrate. Even this brief excerpt of possible clinical presentations points to the involvement of numerous different brain regions during an attack. Migraine can be seen as a temporary, self-limiting shutdown of the brain’s operating system followed by a restart. Almost any function of the brain can be affected which presents a considerable variability in clinical symptoms from one individual to the next and from one attack to another within the same patient.

International audience; Dirks et al. 1 's recent study provides greater insight into the neu-ropsychiatric symptoms experienced by HCV-infected patients and questions how these symptoms are associated with HCV clearance. The authors show that in HCV-infected patients with mild liver disease , none of the following outcomes depend on HCV clearance: cognitive function, mood alteration, health-related quality of life (HRQL) and fatigue (FIS scores). However, these results may not be generalizable to HIV-HCV co-infected patients and cirrhotic patients , who were excluded from the study and who are generally more concerned by fatigue and neuropsychiatric symptoms. This restriction avoids possible interferences of specific clinical conditions with neuropsychiatric symptoms but reduces external validity. The HIV-HCV co-infected population includes a non-negligible proportion of individuals with a history of injection of opioids. Exposure to opioids tends to amplify neuropsychiatric and painful symptoms. Cirrhotic patients also have more numerous and more acute symptoms related to their disease, treatment experience and poor quality of life. The results from two studies we conducted in these specific patient subpopulations 2,3 were similar to those of Dirks et al. 1 The first of these studies was based on data collected on HIV-HCV-co-infected patients in the French cohort ANRS CO13-HEPAVIH. In that study, changes in FIS scores before/ after pegylated interferon (PegIFN)-based treatment were not significantly associated with HCV clearance. 2 Moreover, functional fatigue-related limitations persisted two years in median after the end of treatment. It is interesting to note that the characteristics of the 107 patients analysed in that study were quite different from those in Dirks et al's study. More specifically, time since HCV diagnosis was shorter in the former (10 years in median vs 26 years) and the percentage of HCV-cleared patients higher (53% vs 23%). Our second study analysed HRQL in 47 HCV-infected patients with compensated cirrhosis who switched from PegIFN-based to PegIFN-free therapy. Results showed no major improvement in physical HRQL after the end of therapy, despite HCV clearance and improved physical and mental HRQL being observed during PegIFN-free treatment. 3 However, just as for Dirks et al.'s study, 1 our results were obtained in patients treated with PegIFN-based therapies and may not be repeatable in the era of direct-acting antivirals (DAA). Data from DAA clinical trials show major improvements in patient-reported outcomes (including better HRQL, less fatigue and fewer symptoms) for HCV-treated patients. 4 However, real-world, long-term, post-HCV clearance changes in patient-reported outcomes of DAA-treated patients still require further evaluation. 5 ORCID F. Marcellin http://orcid.org/0000-0001-8853-3829 D. Salmon-Ceron http://orcid.org/0000-0002-6817-8951 M. P. Carrieri

Mental contamination, an internal sense of dirtiness that originates in the absence of physical contact with a stimulus, has been implicated in the exacerbation of posttraumatic stress (PTS) symptoms following sexual trauma. In addition, evidence suggests that associations between PTS-related risk factors and PTS symptoms may depend on the degree to which one can tolerate experiencing negative emotions. To better understand the association between mental contamination and PTS symptoms, we examined main and interactive effects of mental contamination and tolerance of negative emotions in relation to PTS symptoms, including specific symptom clusters, in a community sample of women who experienced sexual trauma (N = 101). Tolerance of negative emotions moderated the association between mental contamination and PTS symptoms (total symptom severity, intrusion cluster, and cognitive/mood alterations cluster). These results indicate that difficulties tolerating negative emotions may be a necessary condition for mental contamination to relate to PTS symptoms following sexual trauma.

OBJECTIVE: Aim of this study was to evaluate the effects of an emerging rehabilitative tool (“Power-AFA” - software) in the recovery of a patient with chronic non-fluent aphasia. MATERIAL AND METHODS: A 56-year-old woman, affected by post-stroke severe expressive aphasia, underwent two different intensive rehabilitation trainings, including either standard language rehabilitation alone or a proper PC based speech training in addition to conventional treatment. We evaluated her cognitive and psychological profile in two separate sessions, before and after the two different trainings, by using a proper psychometric battery, to assess cognitive status, language abilities, and to estimate the presence of mood alterations and coping strategies. The overall PC-program was articulated in 6 sessions/weekly for 3 months. RESULTS: Only at the end of the PC-training, we observed an important improvement in peculiar cognitive domains (attention and memory functions), in denomination, in verbal understanding ability, in written, in communication skills as well as an optimization of the mood and coping styles. CONCLUSIONS: Computer-based cognitive and language rehabilitation, using proper and dedicated software, may be a valuable tool in improving either communication or cognitive skills in patient affected by aphasia, even in the chronic state.

Cognitive impairment, as well as mood and anxiety disorders, occur frequently in patients following stroke. Aim of this study was to evaluate the effects of a combined rehabilitative treatment using conventional relaxation and respiratory techniques, in a specific rehabilitative virtual environment (by using Bts-Nirvana). A 58-year-old woman, affected by hemorrhagic stroke, underwent two different rehabilitation trainings, including either standard relaxation techniques alone in a common clinical setting or the same psychological approach in a semi-immersive virtual environment with an augmented sensorial (audio-video) and motor feedback (sensory motor-interaction). We evaluated the patient's cognitive and psychological profile before and after the two different trainings, by using a specific psychometric battery, aimed to assess cognitive status, attention processes and to estimate the presence of mood alterations, anxiety and coping strategies. Only at the end of the combined approach, we observed a significant improvement in attention and memory functions, with a nearly complete relief of anxiety symptoms and an improvement in coping strategies. Relaxation and respiratory techniques in a semi-immersive virtual reality environment, using Bts-Nirvana, may be a promising tool in improving attention process, coping strategies, and anxiety in individuals with neurological disorders, including stroke.

Impairment of cognitive function, mood alterations and fatigue are the most commonly reported symptoms in cancer patients and represent a major cause of impaired quality of life. Notably, the high prevalence of such symptoms has been observed not only in brain tumor patients treated with radiation and chemotherapy, but also in patients treated for tumors outside of the central nervous system, such as in patients with breast cancer, lung cancer, lymphoma and leukemia. While it has been difficult to identify the etiology of chronic fatigue, cognitive impairment, and mood alterations in most cancer patients, recent discoveries from preclinical and translational studies have started to shed light on possible underlying mechanisms. This chapter will review the current spectrum and pattern of neurocognitive and neuropsychiatric syndromes and fatigue encountered in cancer patients. Potential mechanisms will be discussed and available treatment options highlighted.

Chronic pain is often associated with sleep disruption, fatigue, cognitive deficits and mood alterations. In particular a bidirectional relationship exists between pain and mood disorders, for example chronic pain and depression. When these morbidities co-occur, the patient’s quality of life can significantly decrease. Different pharmacological solutions have been proposed to target both symptom atologies but misuse, addiction and side effects may limit their adoption. Non-pharmacological interventions like psychotherapy and physical activity have been shown to yield promising results in the management of both chronic pain and mood disorders. In the last twenty years multisensory feedback approaches based on body representation have also been shown to be a valid method to treat different forms of chronic pain. However, comorbid mood disorders have not been taken in consideration by this latter approach. The advances in the treatment of chronic pain with comorbid depression may benefit from future studies using multisensory feedback approaches based on body representation

Sleep is divided into four stages and cortisol increases in the blood from low values in the evening during Stage 3 sleep which is entered quite quickly after falling asleep. It is not clear if sleep determines cortisol appearance, as cortisol is more attuned to the light/dark cycle than sleep itself. It has been suggested taking hydrocortisone late in the evening causes problems in trying to fall asleep. Often adults are advised to take the last dose of hydrocortisone at 18:00 (6 p.m.) but this leads to long periods of time without cortisol overnight. Careful sleep studies have shown the time sleep starts, quality and duration of sleep, is not affected by the timing of hydrocortisone dosing. Cortisol levels are increased but the circadian rhythm is maintained in people with depression. Whether the altered amount of cortisol in these situations leads to the depression or is a secondary effect of whatever causes the problem in the first place, is not clear. Although mood changes can be associated with any of the glucocorticoids, both prednisolone and dexamethasone appear to have higher rates of mood changes associated with their use.