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Anorexia nervosa (AN) as a life-threatening eating disorder is linked to a high mortality risk with many deaths attributable to cardiovascular etiology. Cardiovascular complications in AN include structural as well as functional cardiac alterations, hemodynamic changes, and peripheral vascular abnormalities. Despite the fact that peripheral vascular abnormalities are not identified as a major AN complication, several manifestations of peripheral vascular dysregulation including Raynaud's phenomenon and endothelial dysfunction have been described and, therefore, warrant attention. This article briefly summarizes so far findings of microvascular alterations in AN patients and presents easily accessible and non-invasive procedures for a microvascular evaluation such as capillaroscopy and endothelium-related peripheral arterial tone (EndoPAT) which could be involved in the clinical diagnostic process for the earliest identification of an increased risk of later cardiovascular complications.

Background: Adolescent treatment resistant depression (TRD) is increasing in recent years. While ketamine showed rapid antidepressant effects in adult TRD studies, research on its effectiveness in adolescents is limited. Methods: This study examines the effects of intravenous ketamine vs. midazolam on depressive and anxiety symptomatology assessed by the Montgomery–Åsberg Depression Rating Scale (MADRS), Hamilton Anxiety Rating Scale (HAM-A), and Children's Depression Inventory (CDI) at two time points—2 h after initial infusion (T0+2h) and 24 h after the end of the treatment (Te+24h) in a sample of 55 adolescent TRD females (27 receiving ketamine, 28 midazolam). Results: At T0+2h, within-group comparisons revealed a significant reduction in MADRS and HAM-A scores compared to baseline in the ketamine and midazolam groups. At Te+24h, both groups demonstrated similar significant reductions in MADRS, HAM-A, and CDI scores compared to baseline. The MADRS assessment in the ketamine group showed 33% and 59% responders, and in the midazolam group, 14% and 46% responders at T0+2h and Te+24h, respectively. HAM-A evaluation in the ketamine group revealed 33% and 56% responders, and in the midazolam group, 11% and 39% responders at T0+2h and at Te+24h, respectively. CDI rating discovered 11% and 44% responders in the ketamine group and 4% and 21% responders in the midazolam group at T0+2h and Te+24h, respectively. Moreover, inner tension significantly decreased in ketamine compared to the midazolam group at Te+24h. Conclusions: Ketamine showed a reduction in depressive and anxiety symptoms during a short-term period with particular efficacy in alleviating inner tension over midazolam, suggesting its potential advantages in specific symptom relief in rarely studied adolescent TRD. [ABSTRACT FROM AUTHOR]

The coronavirus disease 2019 (COVID-19) pandemic had a significant impact on the somatic and psychological state of the population worldwide, leading to a wide range of health complications. Most of the studies on the COVID-19 pandemic have focused on the direct psychological and somatic aspects of the disease. However, the negative consequences of the indirect aspect of the pandemic (i.e., stay-at-home orders leading to social isolation) represent a major stressor on psychosomatic health and warrant greater interest. This study examines the COVID-19 pandemic as a significant stressor of the 21st century through the lens of the "allostatic" stress response concept and highlights the stress-related psychosomatic consequences of the COVID-19 pandemic. A better understanding of the pathomechanisms underlying indirect impacts of the pandemic on psychosomatic health can contribute to the implementation of personalized interventions for managing stress responses, thereby reducing the pandemic-linked stress burden and preventing stressassociated disease emergence. [ABSTRACT FROM AUTHOR]

Major depressive disorder is a severe mood disorder associated with a marked decrease in quality of life and social functioning, accompanied by a risk of suicidal behavior. Therefore, seeking out and adhering to effective treatment is of great personal and society-wide importance. Weight changes associated with antidepressant therapy are often cited as the reason for treatment withdrawal and thus are an important topic of interest. There indeed exists a significant mechanistic overlap between depression, antidepressant treatment, and the regulation of appetite and body weight. The suggested pathomechanisms include the abnormal functioning of the homeostatic (mostly humoral) and hedonic (mostly dopaminergic) circuits of appetite regulation, as well as causing neuromorphological and neurophysiological changes underlying the development of depressive disorder. However, this issue is still extensively discussed. This review aims to summarize mechanisms linked to depression and antidepressant therapy in the context of weight change. [ABSTRACT FROM AUTHOR]

Ketamine is a potential rapid-onset antidepressant characterized by sympathomimetic effects. However, the question of ketamine's use in treating adolescents' major depressive disorder (MDD) is still discussed. Thus, we aimed to study the acute effect of ketamine infusion treatment on sympathetic regulation using electrodermal activity (EDA) in addition to an assessment of depressive symptomatology in MDD adolescents. Twenty hospitalized adolescent girls with MDD (average age: 15.0 ± 1.46 yrs.) were examined before and two hours after a single intravenous infusion of ketamine. EDA was continuously recorded for 6 min, and depressive symptoms were assessed before and two hours after ketamine administration. The evaluated parameters included skin conductance level (SCL), nonspecific electrodermal responses (NS-SCRs), MADRS (questions no. 1–10, total score), and CDI (items A–E, total score). EDA parameters showed no significant changes after the ketamine treatment, and depressive symptoms were significantly reduced after the ketamine infusion. The analysis revealed a significant negative correlation between index SCL and CDI-A, CDI-E, and the total CDI score and between index NS-SCRs and MADRS no. 4 before the ketamine treatment. In conclusion, ketamine improved depressive symptomatology without a significant effect on EDA, indicating its potential safety and efficiency as an acute antidepressant intervention in adolescent MDD. [ABSTRACT FROM AUTHOR]

Background: In the shadow of global pandemics of COVID-19, a new silent one concerning mental health is emerging. The complete understanding of the pathophysiology of mental diseases remains elusive, resulting in insufficient remission, frequent incidence of adverse drug reactions as well as resistance to treatment. While a vast number of affected individuals worldwide do not have access to effective mental disorder care, treatment resistance affects 20-60% patients.1 A personalized approach has been recently incorporated to the therapy also in psychiatry and one of the strategies is pharmacogenetic (PGx) testing, which has the potential to guide effective drug therapy and minimize side effects. Aims & Objectives: The objective of this study was to assess the viewpoints of Slovak psychiatrists regarding the integration of PGx testing in psychiatric clinical practice. Method: Questionnaires were distributed directly to attendees at two psychiatric conferences held in Slovakia in 2023. The questionnaires were designed to be anonymous and were structured based on research conducted by a collaborative team in Italy. They covered various aspects, including basic demographic information, prior experience with PGx testing, self-perceived competence in PGx, perceived utility, potential risks, and challenges, as well as the participants' willingness to expand their knowledge about the application of PGx in psychiatry. The questionnaire is currently available online and was shared within the Slovak psychiatric community. Results: Out of 60 directly approached conference participants we received 53 responses as 5 individuals declined to participate because of the questionnaire topic and 2 reported time constraints. Our respondents were from various age groups, the majority were females (66%) and had different backgrounds such as psychiatrists for adults (45.3%), pedopsychiatrists (15.1%), clinicians with expertise in both areas (3.8%), residents in a psychiatry program (20.7%) or pharmacists and researchers working in the field of psychiatry (15.1%). Only 4 participants (7.5%) had previous experience with PGx testing in psychiatric clinical practice and only 3 claimed its clinical benefit. The data indicated that 88.7% of participants believed it was their responsibility to provide PGx testing to their patients, but only 41.5% felt confident in their ability to do so. Based on the responses, 64.2% of attendees thought that PGx would be very or extremely useful in selection of medication, 62.3% in drug intolerance and adverse reactions, 56.6% in dosing adjustment, 66.0% in treatment resistant depression, 62.3% in treatment resistant schizophrenia, and 60.4% in resistant obsessivecompulsory disorder. The most significant concerns expressed were the absence of standards or guidelines (77.4%) and the cost of the tests (64.2%). Notably, 84.9% of the participants indicated their eagerness to acquire further knowledge about the integration of PGx in psychiatric clinical practice. Discussion & Conclusion: The results of this questionnaire found that most clinicians felt that they should possess the skills to apply PGx testing in psychiatric clinical practice and were enthusiastic about increasing their expertise. The primary concerns centered around the lack of well-defined guidelines and the financial considerations linked to the testing. The study was supported by grants VEGA-1/0145/22 and APVV-22-0342. [ABSTRACT FROM AUTHOR]

Introduction Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterised by behavioural disinhibition, deficient emotional self-regulation, inattention, and hyperactivity/ impulsivity. Autonomic nervous system (ANS) plays an important role in attention and [...], We aimed to evaluate complex cardiac sympathovagal control in attention deficit/hyperactivity disorder (ADHD) by using heart rate variability (HRV) nonlinear analysis--symbolic dynamics. We examined 29 boys with untreated ADHD and 25 healthy boys (age 8-13 years). ADHD symptoms were evaluated by ADHD-RS-IV scale. ECG was recorded in 3 positions: baseline supine position, orthostasis, and clinostasis. Symbolic dynamics indices were used for the assessment of complex cardiac sympathovagal regulation: normalised complexity index (NCI), normalised unpredictability index (NUPI), and pattern classification measures (0V%, 1V%, 2LV%, 2UV%). The results showed that HRV complexity was significantly reduced at rest (NUPI) and during standing position (NCI, NUPI) in ADHD group compared to controls. Cardiac-linked sympathetic index 0V% was significantly higher during all posture positions and cardiovagal index 2LV% was significantly lower to standing in boys suffering from ADHD. Importantly, ADHD symptom inattention positively correlated with 0V%, and negatively correlated with NCI, NUPI. Concluding, symbolic dynamics revealed impaired complex neurocardiac control characterised by potential cardiac beta-adrenergic overactivity and vagal deficiency at rest and to posture changes in boys suffering from ADHD that is correlated with inattention. We suggest that symbolic dynamics indices could represent promising cardiac biomarkers in ADHD. Key words: symbolic dynamics, heart rate variability, complexity, cardiac sympathovagal regulation, ADHD, orthostasis, inattention. Nous avions pour objectif d'etudier le controle sympathovagal cardiaque complexe dans le trouble du deficit de l'attention avec hyperactivite (TDAH) a l'aide de l'analyse non lineaire--dynamique symbolique--de la variabilite de frequence cardiaque (VFC). Nous avons examine 29 garcons presentant un TDAH non traite et 25 garcons en bonne sante (ages de 8 a 13 ans). Nous avons evalue le TDAH a l'aide de l'echelle ADHD-RS-IV et enregistre des ECG en 3 positions : position couchee initiale, orthostatisme et clinostatisme. Les indices de la dynamique symbolique suivants ont ete utilises pour evaluer la regulation sympathicovagale cardiaque complexe : indice de complexite normalise (ICN), indice d'imprevisibilite normalise (IIN) et mesures de classification des patrons de variations (0V%, 1V%, 2LV% (L pour << like >>) et 2UV% (U pour << unlike >>)). Les resultats ont montre que la complexite de la VFC etait nettement diminuee au repos (IIN) et en position debout (ICN et IIN) dans le groupe TDAH par rapport aux temoins. L'indice sympathique lie au creur 0V% etait nettement plus eleve dans toutes les postures et l'indice cardiovagal 2LV% etait nettement moins eleve chez les garcons atteints de TDAH. Fait important, l'inattention, symptome du TDAH, etait proportionnelle a l'indice 0V% et inversement proportionnelle aux ICN et IIN. En conclusion, la dynamique symbolique a revele la presence d'une atteinte de l'equilibre neurocardiaque complexe chez les garcons atteints de TDAH, caracterisee par une hyperactivite du systeme beta-adrenergique cardiaque et une insuffisance vagale--tant au repos et que lors de changements de posture--et qui est en correlation avec l'inattention. En somme, nous avan^ons l'hypothese selon laquelle les indices de la dynamique symbolique representeraient des biomarqueurs cardiaques prometteurs dans le contexte du TDAH. [Traduit par la Redaction] Mots-cles : dynamique symbolique, variabilite de la frequence cardiaque, complexite, regulation sympathovagale cardiaque, TDAH, orthostatisme, inattention.

Objectives: This prospective, observational, non-randomized study aimed to describe the relationship between treatment regimen prescribed and the quality of life (QoL) of ADHD patients in countries of Central and Eastern Europe (CEE) and Eastern Asia over 12 months. Methods: 977 Male and female patients aged 6-17 years seeking treatment for symptoms of ADHD were assessed using the Child and Adolescent Symptom Inventory-4 Parent Checklists, and the Clinical Global Impressions-ADHD-Severity scale. QoL was assessed using the Child Health and Illness Profile-Child Edition parent report form. Patients were grouped according to whether they were prescribed psycho- and/or pharmacotherapy (treatment) or not (no/"other" treatment). Results: No statistically significant differences were observed between cohorts (treatment vs. no/"other" treatment) in terms of change in QoL, although there was improvement over 12 months, with a greater improvement experienced by patients in the treatment cohort in both study regions (CEE and Eastern Asia). Psychoeducation/counselling and methylphenidate were the predominant ADHD treatments prescribed. Conclusions: Although both treatment and no/"other" treatment cohorts showed improvements in mean QoL over 12 months, the difference was small and not statistically significant. A major limitation was the higher than anticipated number of patients switching treatments, predominantly from the no/"other" treatment cohort. (Contains 5 figures and 5 tables.)

Autism spectrum disorder (ASD) is a neurodevelopmental disease characterized by emotional and social deficits, which can be associated with sympathetic dysregulation. Thus, we aimed to analyze the electrodermal activity (EDA) using time, and novel spectral and nonlinear indices in ASD. The cohort consisted of 45 ASD boys and 45 age-matched controls. EDA was continuously recorded at rest. The EDA indices were evaluated by time-, spectral-, and nonlinear-domain analysis. Our results revealed increased non-specific skin conductance responses, spectral parameters in high and very-high frequency bands, approximate and symbolic information entropy indicating sympathetic overactivity in ASD vs. controls (p < 0.05, for all). Surprisingly, the nonlinear index from detrended fluctuation analysis a1 was lower in ASD vs. controls (p = 0.024) providing thus distinct information about qualitative features of complex sympathetic regulation. Concluding, the complex time, spectral, and nonlinear EDA indices revealed discrete abnormalities in sympathetic cholinergic regulation as one of the potential pathomechanisms contributing to cardiovascular complications in ASD. [ABSTRACT FROM AUTHOR]

Mental disorders affect 10-20 % of the young population in the world. Major depressive disorder (MDD) is a common mental disease with a multifactorial and not clearly explained pathophysiology. Many cases remain undetected and untreated, which influences patients’ physical and mental health and their quality of life also in adulthood. The aim of our pilot study was to assess the prediction value of selected potential biomarkers, including blood cell counts, blood cell ratios, and parameters like peroxiredoxin 1 (PRDX1), tenascin C (TNC) and type IV collagen (COL4) between depressive pediatric patients and healthy peers and to evaluate a short effect of antidepressant treatment. In this study, 27 young depressive patients and 26 non-depressed age-matched controls were included. Blood analyses and immunological assays using commercial kits were performed. Platelet count was the only blood parameter for which the case/control status was statistically significant (p=0.01) in a regression model controlling for the age and gender differences. The results from ELISA analyses showed that the case/control status is a significant predictor of the parameters PRDX1 (p=0.05) and COL4 (p=0.009) in respective regression model considering the age and gender differences between MDD patients and controls. A major finding of this study is that values of platelet count, monocyte to lymphocyte ratio, white blood cell, and monocyte counts were assessed by the Random Forest machine learning algorithm as relevant predictors for discrimination between MDD patients and healthy controls with a power of prediction AUC=0.749. [ABSTRACT FROM AUTHOR]

It is assumed that the Attention Deficit Hyperactivity Disorder is associated with the central autonomic dysregulation, however, the studies are rare. Analysis of pupillary light reflex represents a non-invasive tool to provide information related to the central autonomic regulation; thus, we aimed to evaluate potential disturbances in the central autonomic integrity using pupillary light reflex examination in Attention Deficit Hyperactivity Disorder. We have examined 20 children with Attention Deficit Hyperactivity Disorder (10 boys, 13.0±2.3 years) and 20 age/gender-matched healthy subjects. Pupillary light reflex was examined at rest for both eyes using Pupillometer PLR-2000 (NeurOptics, USA). Evaluated parameters were: diameter of the pupil before the application of light stimulus and after illumination at the peak of the constriction, the percentual change of the pupil diameter during constriction, average constriction velocity, maximum constriction velocity and average dilation velocity. We found significantly lower percentual change of the pupil diameter during constriction for both eyes in Attention Deficit Hyperactivity Disorder group compared to controls (right eye: -25.81±1.23 % vs. -30.32±1.31 %, p<0.05, left eye: -25.44±1.65 % vs. -30.35±0.98 %, p˂0.05). The average constriction velocity and maximum constriction velocity were significantly shortened in left eye in Attention Deficit Hyperactivity Disorder group compared to controls (p˂0.05). Our findings revealed altered pupillary light reflex indicating abnormal centrally-mediated autonomic regulation characterized by parasympathetic underactivity associated with relative sympathetic predominance in children suffering from Attention Deficit Hyperactivity Disorder. [ABSTRACT FROM AUTHOR]

Introduction: Behavioral disorders are one of the most comorbid diseases in the patients with attention deficit/hyperactivity disorder (ADHD). The milder forms of behavioral disorders mainly from the group of oppositional defiant disorders with typical negativistic, hostile and defiant symptomatology significantly affecting the social, academic or occupational functioning are more manifested in these patients. Serious behavioral disorders with antisocial and aggressive symptoms are less explicit among the hyperactive children. Objective: To evaluate the association between behavioral symptomatology with prevalence of ADHD and oppositional defiant with patients and hyperactivity/impulsivity as well as their attentional deficits prior to initiation of therapy and during the treatment with methylphenidate. Material and method: 35 children with ADHD and behavioral problems have been enrolled to the 4 weeks lasting clinical study with intermediate-acting methylphenidate. Patients do not meet all diagnostic criteria for ODD (oppositional defiant disorder) or CD (conduct disorder) according to DSM-IV TR. ADHD symptomatology including hyperactivity/impulsivity and attentional deficit were evaluated using the ADHD RS IV questionnaire and behavioral problems using the factor 1 of Conners questionnaire for parents (F1-CPQ) in three time periods, before setting the therapy and after the second and fourth week of treatment. The results were statistically analyzed by the Student's t-test, the Wilcoxon test and the Pearson and Spearman coefficient. Results: In the study group of patients there was a significant decrease in behavioral symptomatology during the first two and also the second two weeks of treatment with methylphenidate. Milder behavioral symptomatology significantly correlated with inattention and with hyperactivity/impulsivity before initiating therapy too, while after the second and fourth week of treatment with methylphenidate significantly correlated only with inattention. Conclusion: Despite the general paradigm linking behavioral disorders in ADHD patients predominantly with hyperactivity and impulsivity, our results suggest their close relationship with an attention deficit. [ABSTRACT FROM AUTHOR]