Pediatric Neuroscience Pathways Fall 2012 - Cleveland Clinic

More documents

Recommendations

Info

depression is already the leading cause of disability as measured by the years lived with a disability, and among 15- to 44-year-olds, depression is the second cause of disability-adjusted life years. The point prevalence of depression is approximately 1 to 2.5 percent in school-age children and 2 to 8.3 percent in adolescents. Among adolescents, 14 to 25 percent experience at least one episode of depression before adulthood. the lifetime prevalence of depression in adolescents of 15 to 20 percent is similar to the lifetime prevalence found in adult populations with depression, suggesting that depression in adults often begins in adolescence. individuals born in the 20th century are at a greater risk of developing depression, and depressive disorders are manifesting at a younger age in children. Pediatric Psychiatry Biomarkers in Youth with Major Depressive Disorder Tatiana Falcone, MD depression has an enormous impact on individuals and society. about 121 million people worldwide suffer from depression, and fewer than 25 percent of those have access to effective treatments. With a lifetime prevalence of more than 15 percent in the year 2020, depression will be the second most disabling illness in the world as projected by the world health organization. Table 1. Two inflammatory markers in a group of 29 adolescents with mdd vs. 29 healthy controls marker f value P value IL-1α 0.71 0.40 IL-1β 0.18 0.67 IL-2 0.02 0.90 IL-4 0.89 0.35 IL-6 0.58 0.45 IL-8 12.38 0.0009 IL-10 1.44 0.23 IFN-γ 0.01 0.91 TNF-α 0.08 0.78 s100B 6.46 0.0139 To evaluate the role of inflammation in pediatric patients with mood disorders, a pilot study was conducted, and patients ages 12-18 were recruited; 29 adolescents with MDD and 29 healthy controls (matched by age, gender and ethnicity) were enrolled. Patients with MDD were diagnosed by two child psychiatrists and recruited in an outpatient child psychiatry clinic. Patients included in this study had scores on the Child Depression Inventory higher than 80. All patients or controls underwent serum evaluation of S100B and nine inflammatory cytokines (IL-1α, IL-1β, IL-2, IL-4, IL-6, IL-8, IL-10, IFN-γ and TNF-α). Depression in youth, on average, lasts 7 to 9 months and recurs in up to 70 percent. multiple negative sequelae are related to depression, including impairment in school performance and interpersonal relationships. suicidal ideation and attempts are frequent in adolescents. a survey of adolescents showed that 19 percent had seriously considered suicide in the past year, 15 percent had made a plan and 8 percent reported that they had made an attempt. Since 1950, the suicide rate among adolescents has quadrupled and represents 12 percent of the mortality rate for this age group. Suicide is now the third-leading cause of death among adolescents in the united states. The Link Between Inflammation and Depression adults with depression often have immunological alterations that can be detected in blood samples by clinical detection methods. a recent meta-analysis of more than 180 studies and more than 40 immune measures provides overwhelming evidence that immunological abnormalities are associated with mood disorders in adults. This evidence points to activation of the innate immune inflammatory response and alteration in the ability of the immune cells to express inflammatory cytokines. Inflammation is an important biological factor that might increase the risk of major depression. astrocytes and microglia are the major immunocompetent cells in the brain, and their activation points toward inflammation and immune reactions indicated by the release of cytokines and S100B, an astrocytic protein that has been measured in serum at increased levels in adults with severe mood disorders and depression. there is strong evidence linking major depressive disorder (mdd) with immunological abnormalities, inflammation and cytokine production. Likewise, strong evidence suggests that inflammation may contribute to the pathophysiology of MDD, and this is supported by multiple studies. Biomarkers have the potential to help us understand the development, diagnosis and prognosis of depression and to monitor treatment response. The episodic course of mood disorders, particularly in adolescents, makes biomarker validation a very important goal to further our understanding of the pathophysiology of this disease. Studying the association between serum markers of inflammation and symptoms of depression in youth with mood disorders is advantageous because studies of adults are constrained by years 28 Pediatric NeuroscieNce Pathways | 2012 – 2013
Pediatric Psychiatry of chronic symptoms and multiple medical comorbidities that can affect the levels of certain biomarkers. In addition, early interventions are important to prevent progression to full-blown disease. there are important immunological differences in patients with mood disorders. cytokines may prove to be important biomarkers in the course of pediatric patients with mood disorders. Further studies are needed. Tatiana Falcone, MD, is a staff physician in Cleveland Clinic’s Neurological Institute who focuses on child and adolescent psychiatry. Her specialty interests include anxiety and mood disorders, consultation-liaison psychiatry, emergency psychiatry, psycho-oncology, psychosis, schizophrenia, epilepsy and psychiatric issues in epilepsy. She can be contacted at 216.444.7459 or falcont1@ccf.org. suggested readiNg Segerstrom SC, Miller GE. Psychological stress and the human immune system: A meta-analytic study of 30 years of inquiry. Psychol Bull. 2004 Jul;130(4):601-630. Falcone T, Fazio V, Lee C, Simon B, Franco K, Marchi N, Janigro D. serum s100B: a potential biomarker for suicidality in adolescents? PLoS ONE. 2010;5(6):e11089. Gabbay V, Klein RG, Guttman LE, Babb JS, Alonso CM, Nishawala M, Katz Y, Gaite MR, Gonzalez CJ. A preliminary study of cytokines in suicidal and nonsuicidal adolescents with major depression. J Child Adolesc Psychopharmacol. 2009 Aug;19(4):423-430. Steiner J, Bielau H, Brisch R, Danos P, Ullrich O, Mawrin C, Bernstein HG, Bogerts B. Immunological aspects in the neurobiology of suicide: elevated microglial density in schizophrenia and depression is associated with suicide. J Psychiatr Res. 2008 Jan;42(2):151-157. figure 1. Biomarker levels in a group of adolescents with mdd (n = 29) and healthy age-matched controls (n = 29) Levels of both markers are significantly increased in adolescents with MDD compared with healthy controls (P = .0139 for S100B; P = .0009 for IL-8). In contrast with adults, IL-8 is elevated in depressed youth while IL-1β is not. VISIT CLEVELANDCLINICCHILDRENS.ORG | 866.588.2264 29 s100B il-8 1.0 0.8 0.6 0.4 0.2 0.0 70 60 50 40 30 20 10 0 levels of s100B Control Patients depression levels of il-8 Control Patients depression
Page 1 and 2: Pediatric Neuroscience Pathways 201
Page 3 and 4: Welcome from the Editors cleveland
Page 5 and 6: anticipated applications of dti and
Page 7 and 8: cover story | diagNostic radiology
Page 9 and 10: suggested readiNg Wyllie E, Lachhwa
Page 11 and 12: figure 2. interictal eeg FP1-F7 F7-
Page 13 and 14: Health Survey. CSHCN have greater d
Page 15 and 16: Pediatric ePilePsy The first issue
Page 17 and 18: Pediatric ePilePsy reference-free,
Page 19 and 20: Pediatric ePilePsy aNd Neurosurgery
Page 21 and 22: establishment of Pediatric deep Bra
Page 23 and 24: Pediatric Neurosurgery figure 1. Bv
Page 25 and 26: table 1: arteriopathies in pediatri
Page 27 and 28: foremost among them are its diagnos
Page 29: Pediatric sleeP disorders Obstructi
Page 33 and 34: develoPmeNtal aNd rehaBilitatioN Pe
Page 35 and 36: table 2 school days missed (week pr
Page 37 and 38: figure 1. sKamP ratings by extended
Page 39 and 40: Pediatric Neurosurgery Epilepsy Sur
Page 41 and 42: Pediatric Neuropsychology Pediatric
Page 43 and 44: sandra sommers, Phd Consulting Staf
Page 45 and 46: Pediatric Neuroscience Pathways is
Page 47: clevelaNd cliNic | Pedicatric Neuro

Pediatric Neuroscience Pathways Fall 2012 - Cleveland Clinic

Create successful ePaper yourself

Delete template?

Save as template?