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Danute Balkeliene d,e Algirdas Utkus d,e and Edgaras Dlugauskas a,e Background The cytochrome P-450 2C19 (CYP2C19) enzyme is involved in the metabolism of numerous antidepressants. It also metabolises some endogenous substrates, which could also confer to vulnerability. We aimed to establish whether the severity of depression and treatment response are associated with the genetically predicted CYP2C19 phenotype. MethodsWe assessed the CYP2C19 genotypepredicted metabolic phenotypes (normal, intermediate or ultrarapid, there were no poor metabolisers) in patients with moderate or severe depression. We used the selfrated Beck Depression Inventory-II (BDI-II) scale and the clinician-rated Montgomery-Åsberg Depression Rating Scale (MADRS) at baseline, after 2 and 4 weeks of an empirical treatment trial. Patients and clinicians were blind to the genetic testing results. ResultsSeventy-six patients participated in the present study. At baseline, impaired CYP2C19 metabolisers, compared to normal metabolisers, had higher BDI-II (P = 0.046; η p 2 = 0.08) but not MADRS score. Intermediate metabolisers more often had a diagnosis of severe depression than normal metabolisers (P = 0.003). After 4 weeks of empirical treatment, intermediate metabolisers had significantly higher MADRS and BDI-II scores than normal metabolisers (P = 0.006; η p 2 = 0.131 and P = 0.030; η p 2 = 0.091). These differences were independent of the use of CYP2C19-metabolised medications in the treatment trial, as well as the treatment discrepancy status.Conclusions Intermediate CYP2C19 polymorphismpredicted activity was associated with more severe depression after an empirical treatment trial. The lack of association between the prescription of CYP2C19metabolised drugs and treatment response calls for a further look into the role of endogenous substrates of CYP2C19.

Background: In Huntington’s disease psychiatric symptoms may manifest prior to motor dysfunction. Such symptoms negatively impact people’s quality of life and can worsen the course of the primary disease. The aim of the present study was to assess and compare depression, anxiety and hopelessness rates in individuals with and without an abnormal expansion of CAG repeats in the huntingtin (HTT) gene and healthy controls.Materials and methods: Study involved 31 individuals referred for genetic testing for Huntington’s disease and a control group of 41. Depressive and anxiety symptoms were assessed using Beck Hopelessness Scale (BHS) and Hospital Anxiety and Depression Scale (HADS). Results between groups were compared using the Mann–Whitney U test. Two-sided Bonferroni corrected p-value was set at ≤0.017.Results: Individuals with HTT gene mutation (“gene mutation positive”, GMP) (N=20) scored higher on the HADS depression subscale (5.90 ± 4.52 vs 1.36 ± 1.91; p ≤ 0.017) than those without HTT gene mutation (“gene mutation negative”, GMN) (N=11). GMP and control groups scored higher than the GMN group on the BHS (5.65 ± 3.91 vs 2.09 ± 1.64 and 5.27 ± 4.11 vs 2.09 ± 1.64, respectively; p ≤ 0.017). No differences in anxiety levels were found.Conclusions: Depressive symptoms and hopelessness were more prevalent in individuals with HTT gene mutation than in individuals who were tested but had no said mutation. Such results emphasise the importance of timely diagnosis and treatment of psychiatric comorbidities in individuals affected by Huntington’s disease.

Reikšminiai žodžiai: depresija, lėtinė inkstų liga. Depresija yra viena dažniausių psichiatrinių ligų tarp pacientų, sergančių lėtine inkstų liga (LIL). Pastebėta, kad sergančiųjų LIL depresijos simptomai yra susiję su prastesne gyvenimo kokybe, ilgesne hospitalizacijos trukme, greitesne dializės terapijos pradžia bei padidėjusia mirties rizika. Norint išanalizuoti depresijos simptomų pasireiškimą, Vilniaus universiteto ligoninės Santariškių klinikos (VUL SK) Nefrologijos centre atliktas skerspjūvio tyrimas. Įtraukti 132 pacientai, sergantys 3–5 stadijos LIL. Tiriamieji įvertinti pagal Hamiltono depresijos skalę (HAM-D), surinkti duomenys apie LIL stadiją ir etiologiją, vedybinę padėtį, darbo pobūdį, išsilavinimą, žalingus įpročius, fizinį aktyvumą, streso įveikos strategiją, demografiniai duomenys. Statistinė duomenų analizė atlikta „Microsoft Excel“. 70 (53 proc.) apklaustų pacientų surinko lengvą depresiją atspindinčius balus. Moterys (p = 0,0001), ≥ 80 m. (p = 0,03), ūkininkai (p = 0,009), taikantys į jausmus orientuotą įveikos strategiją (p = 0,04), surinko daugiau HAM-D balų, o susituokusieji (p = 0,015), sergantys IgA nefropatija (p = 0,49), užimantys aukštas pareigas darbe (p = 0,0003) – mažiau. Dėl dažnai pasireiškiančių depresijos simptomų sergantiesiems lėtine inkstų liga rekomenduojame rutinišką depresijos simptomų ištyrimą ir ankstyvą gydymą.

Since the times of S. Freud the art illustrating greek mitology closely relates to psychoanalysis. Freud used myth of Sophocles to illustrate the Oedipus complex, staging ancient symbolism in a modern context. The Sphinx symbolises the revengeful, destructive side of prototypical female. By killing his father, Oedipus aquires his own self, in that way approaching his first woman in life – the Sphinx. By taking a shape of female the Sphinx in art lost its significance as a protector against evil and became a symbol of threat. A woman able to kill/castrate. On his way to Thebes Oedipus encounters the Sphinx who would stop all travelers to ask them a riddle. Oedipus was the first to answer correctly (outran his own father). The artist G. Moreau reflected the symbolic meaning of the duel between Oedipus and Sphinx. But the real riddle is the Sphinx herself, the riddle of the complexity of being Female-Woman-Mother. Her actions stand for a distorted maternalistic urge to treat 'approaching wayfarers' as children, to exercise control and to deal out ruthless punishment. She is the destructive phallic mother. The portrayal of neurotic motherhood continues when the Sphinx, apparently narcissistically wounded by Oedipus' success, throws herself over a cliff. By killing his father and loosing 'the fear of castration' Oedipus has no fear of the Sphinx and symbolically answers her riddle. That is the way of getting closer to his next woman – his mother.

IntroductionPrevious studies suggest that one of the possible depression pathophysiological pathways is autoimmune inflammation increasing inflammatory mediators’ levels and thus affecting mood.ObjectivesTo compare depression and anxiety symptoms among inflammatory bowel disease patients receiving TNF-α inhibitors and those receiving treatment as usual (TAU).MethodsInstruments: Ulcerative colitis activity index, Crohn’s disease activity index, the subscale of neurovegetative symptoms of the Beck depression inventory, Hospital anxiety and depression scale. Active ulcerative colitis or Chron‘s disease patients not using antidepressants were included in the study and divided into an experimental group (receiving TNF-α inhibitors) and control group (receiving TAU).Results46 patients’ data were analyzed. Between the experimental group and the control group, the disease activity index was not significantly different (Chron’s disease 3.54 ±4.20; ulcerative colitis 5.70 ±5.00; p > 0.05) as well as the mean scores of the neurovegetative depression symptoms subscale of the Beck depression inventory (2.52 experimental ±3.91 control; p > 0.05). The mean score of the hospital anxiety and depression scale were significantly different between both groups (5.22 ±8.13; p < 0.05). The mean anxiety subscale scores’ p=0,06, which shows trend for significance. The mean depressive subscale score was significantly different in the control group (1.43 ±2.65; p < 0.05).ConclusionsPatients treated with biological therapy experienced fewer depression symptoms than patients showing similar disease activity, but receiving TAU.

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