Future Challenges for the Diagnosis and Management of Affective Disorders: From Preclinical Evidence to Clinical Trials

A special issue of Brain Sciences (ISSN 2076-3425). This special issue belongs to the section "Psychiatric Diseases".

Deadline for manuscript submissions: 30 August 2024 | Viewed by 6076

Special Issue Editors

Department of Clinical and Experimental Medicine, University of Foggia, 71121 Foggia, Italy
Interests: clinical psychiatry; mental illness; psychological assessment; clinical assessment; psychoeducation; child and adolescent psychiatry
Special Issues, Collections and Topics in MDPI journals
Department of Psychiatry, University of Campania Luigi Vanvitelli, 80138 Naples, Italy
Interests: bipolar disorder; major depression; perinatal mental health; family psychoeducation; coercive measures; psychiatric rehabilitation; diagnostic systems
Department of Psychiatry, University of Campania Luigi Vanvitelli, 80138 Naples, Italy
Interests: clinical psychiatry; epidemiology; social psychiatry; early intervention in mental health; promotion of mental health
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

The diagnosis and management of affective disorders have been influenced by new clinical and research evidence in recent decades. Alongside the monoamine hypothesis of mood disorders, new theories have been proposed including the role of glutamate, neuro-inflammation, genetic findings from large analyses consortia, etc. These biological achievements have led to new treatments based on physical therapies (e.g., magnetic stimulation) or pharmacological trials (e.g., esketmine). Moreover, the recent diagnostic classifications proposed by the DSM-5-TR and ICD-11 significantly modified criteria for mood disorders: e.g., the diagnosis of ‘mixed episode’ has been replaced by the clinical specifier of ‘mixed features’, the introduction of Complicated Grief as an independent disorder as well as the relevance of dimensions in psychopathology in the ICD-11.

These new trends and paradigms led to a broader clinical characterization of affective disorders including different factors related to patients (e.g., affective temperaments, chrono-types, seasonal patterns in mood disorders, mental pain, etc.), or to the therapeutic encounter and relationship (e.g., clinical decision making, psychoeducation, psychotherapies, etc.). Additionally, new biomarkers and biological tools, alongside the psychopathological rating scales, have been proposed for the diagnosis or phenotyping of affective disorders (e.g., interleukins, inflammation indices, neurotrophic factors, etc.). Particular attention has been paid to depression in special populations, such as the elderly or perinatal depression, focusing on the impact of illness on mothers’ health and newborn’s development. Not least, psychosocial interventions specifically conceived for mood disorders have been introduced alongside psycho-pharmacotherapies in order to increase the rate of recovery, patients’ empowerment, and improve the quality of life in the long-term outcome of illness as well as patients’ global functioning. All these themes will be addressed in the Special Issue named “Future Challenges for the Diagnosis and Management of Affective Disorders: from preclinical evidence to clinical trials”. Papers addressing biological aspects on affective disorders as well as those focused on novel diagnostic and therapeutic options are welcome.

Dr. Antonio Ventriglio
Dr. Mario Luciano
Prof. Dr. Andrea Fiorillo
Guest Editors

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Keywords

  • affective disorders
  • depression
  • bipolar disorders
  • mood disorders
  • biomarkers
  • psychosocial interventions
  • clinical characterization
  • perinatal depression
  • affective temperaments

Published Papers (6 papers)

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Research

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13 pages, 654 KiB  
Article
The Associations of Exposome Psychopathology: A Network Analysis in a Non-Clinical Sample
Brain Sci. 2024, 14(3), 242; https://doi.org/10.3390/brainsci14030242 - 29 Feb 2024
Viewed by 136
Abstract
Background: The intricate correlation between environmental exposures and mental health outcomes is increasingly acknowledged in psychiatric research. This study investigated the relationship between cumulative environmental risk factors, as represented by the exposome score (ES), and various domains of psychopathology within a non-clinical sample [...] Read more.
Background: The intricate correlation between environmental exposures and mental health outcomes is increasingly acknowledged in psychiatric research. This study investigated the relationship between cumulative environmental risk factors, as represented by the exposome score (ES), and various domains of psychopathology within a non-clinical sample using a network analysis. Methods: We recruited 1100 participants (aged 18–35 years, 51.4% females) via a computer-assisted web interview, assessing psychopathological symptoms using standardized questionnaires. Environmental exposures, including season of birth, obstetric complications, advanced paternal age, childhood trauma, cannabis use, and urban upbringing, were self-reported to calculate the ES. Results: A network analysis revealed significant associations of the ES with psychotic-like experiences (PLEs) (weight = 0.113), manic (weight = 0.072), and attention-deficit/hyperactivity disorder symptoms (weight = 0.062). These connections did not differ significantly with respect to their weights. Depressive symptoms had the highest centrality and predictability. The mean predictability across all nodes included in the network was 0.344. Conclusions: These findings underscore the transdiagnostic nature of environmental exposures, aligning with previous research indicating broad associations between the ES and various facets of psychopathology. Our results suggest that the ES may not specifically correlate with PLEs but may indicate the risk of a broader psychopathology. Full article
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13 pages, 616 KiB  
Article
What Came First, Mania or Depression? Polarity at Onset in Bipolar I and II: Temperament and Clinical Course
Brain Sci. 2024, 14(1), 17; https://doi.org/10.3390/brainsci14010017 - 23 Dec 2023
Viewed by 765
Abstract
(1) Background: Bipolar disorder (BD) is divided into type I (BD-I) and type II (BD-II). Polarity at onset (PO) is a proposal to specify the clinical course of BD, based on the type of the first episode at disorder onset—depressive (D-PO) or manic [...] Read more.
(1) Background: Bipolar disorder (BD) is divided into type I (BD-I) and type II (BD-II). Polarity at onset (PO) is a proposal to specify the clinical course of BD, based on the type of the first episode at disorder onset—depressive (D-PO) or manic (M-PO). At the same time, affective temperaments represent preexisting variants of the spectrum of affective disorders. Our objectives were to investigate the hypothesis that temperament may exert an influence on PO, and that this factor can serve as an indicator of the forthcoming course of the disorder, carrying significant therapeutic implications. (2) Methods: We included 191 patients with BD and examined clinical variables and temperament; the latter was assessed using the short version of the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego—Auto-questionnaire (TEMPS-A-39-SV). We tested the associations between these variables and PO using standard univariate/bivariate methods followed by multivariate logistic regression models. (3) Results: 52.9% of the sample had D-PO and 47.1% had M-PO. D-PO and M-PO patients scored higher for dysthymic and hyperthymic temperaments, respectively (p < 0.001). Also, they differed in BD subtypes, age at first affective episode, illness duration, number of depressive episodes, seasonality, suicide risk, substance use, lithium, and benzodiazepine use (p < 0.05). Only BD-II and age at first depressive episode were predictors of D-PO, whereas BD-I, age at first manic/hypomanic episode, and hyperthymic temperament were predictors of M-PO (p < 0.01). (4) Conclusions: Our findings point to the importance of carefully assessing temperament and PO in patients with BD, to better predict the clinical course and tailor therapeutic interventions to individual patients’ needs. Full article
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12 pages, 727 KiB  
Article
Elevated Plasma Levels of Mature Brain-Derived Neurotrophic Factor in Major Depressive Disorder Patients with Higher Suicidal Ideation
Brain Sci. 2023, 13(8), 1223; https://doi.org/10.3390/brainsci13081223 - 21 Aug 2023
Cited by 1 | Viewed by 1003
Abstract
Several pieces of evidence show that signaling via brain-derived neurotrophic factor (BDNF) and its receptor, tropomycin receptor kinase B (TrkB), as well as inflammation, play a crucial part in the pathophysiology of depression. The purpose of our study was to evaluate plasma levels [...] Read more.
Several pieces of evidence show that signaling via brain-derived neurotrophic factor (BDNF) and its receptor, tropomycin receptor kinase B (TrkB), as well as inflammation, play a crucial part in the pathophysiology of depression. The purpose of our study was to evaluate plasma levels of BDNF-TrkB signaling, which are inflammatory factors in major depressive disorder (MDD) patients, and assess their associations with clinical performance. This study recruited a total sample of 83 MDD patients and 93 healthy controls (CON). All the participants were tested with the Hamilton Depression Scale (HAMD), the Beck Scale for Suicide Ideation, and the NEO Five-Factor Inventory. The plasma level of selected BDNF-TrkB signaling components (mature BDNF (mBDNF), precursor BDNF (proBDNF), tyrosine kinase B (TrkB), and tissue plasminogen activator (tPA)) and selected inflammatory factors (interleukin-1β (IL-1β), interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α)) were measured using an enzyme-linked immunosorbent assay (ELISA). Further, we performed correlation analysis to indicate the relationship between the plasma levels of the factors and clinical characteristics. Results: (i) A higher level of mBDNF and lower openness were observed in MDD patients with higher suicidal ideation than patients with lower suicidal ideation. (ii) In MDD patients, mBDNF was positively correlated with the sum score of the Beck Scale for Suicide Ideation (BSS). (iii) The levels of mBDNF, tPA, IL-1 β and IL-6 were significantly higher in all MDD subjects compared to the healthy controls, while the levels of TrkB and proBDNF were lower in MDD subjects. Conclusion: Our study provides novel insights regarding the potential role of mBDNF in the neurobiology of the association between depression and suicidal ideation and, in particular, the relationship between BDNF-TrkB signaling, inflammatory factors, and clinical characteristics in MDD. Full article
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18 pages, 1322 KiB  
Article
Coping as a Mediator between Attachment and Depressive Symptomatology Either in Pregnancy or in the Early Postpartum Period: A Structural Equation Modelling Approach
Brain Sci. 2023, 13(7), 1002; https://doi.org/10.3390/brainsci13071002 - 28 Jun 2023
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Abstract
Peripartum depression (PPD) is a major complication of pregnancy, and numerous risk factors have been associated with its onset, including dysfunctional coping strategies and insecure attachment styles, both during pregnancy and postpartum. The aim of our study was to investigate the role of [...] Read more.
Peripartum depression (PPD) is a major complication of pregnancy, and numerous risk factors have been associated with its onset, including dysfunctional coping strategies and insecure attachment styles, both during pregnancy and postpartum. The aim of our study was to investigate the role of coping strategies in mediating the relationship between women’s attachment style and depressive symptomatology in pregnancy and one week after giving birth in a large sample of women (N = 1664). Our hypothesis was that the relationship between anxious and avoidant attachment and depressive symptomatology would be mediated by use of maladaptive coping strategies. The assessment instruments were Edinburgh Postnatal Depression Scale (EPDS), Brief Coping Orientation for Problem Experiences (COPE), and Experiences in Close Relationship Scale (ECR). The results indicated that the effect of insecure attachment styles (anxious and avoidant attachment) on antepartum depressive symptomatology was partially mediated by dysfunctional coping styles. Anxious attachment also has an indirect significant effect on postpartum depressive symptomatology through emotional coping; however, avoidant attachment does not seem to be significantly related to postpartum depressive symptoms. Our findings revealed that not only is it important to consider attachment in understanding peripartum depressive symptomatology, but also that coping plays an important role in these relationships. These findings would help a preventive coping-based intervention strategy to enhance the capacity of women with insecure attachment styles to use more adaptive coping during and after pregnancy. Full article
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Review

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17 pages, 544 KiB  
Review
Can Brain-Derived Neurotrophic Factor Be Considered a Biomarker for Bipolar Disorder? An Analysis of the Current Evidence
Brain Sci. 2023, 13(8), 1221; https://doi.org/10.3390/brainsci13081221 - 20 Aug 2023
Cited by 1 | Viewed by 837
Abstract
Brain-derived neurotrophic factor (BDNF) plays a key role in brain development, contributing to neuronal survival and neuroplasticity. Previous works have found that BDNF is involved in several neurological or psychiatric diseases. In this review, we aimed to collect all available data on BDNF [...] Read more.
Brain-derived neurotrophic factor (BDNF) plays a key role in brain development, contributing to neuronal survival and neuroplasticity. Previous works have found that BDNF is involved in several neurological or psychiatric diseases. In this review, we aimed to collect all available data on BDNF and bipolar disorder (BD) and assess if BDNF could be considered a biomarker for BD. We searched the most relevant medical databases and included studies reporting original data on BDNF circulating levels or Val66Met polymorphism. Only articles including a direct comparison with healthy controls (HC) and patients diagnosed with BD according to international classification systems were included. Of the 2430 identified articles, 29 were included in the present review. Results of the present review show a reduction in BDNF circulating levels during acute phases of BD compared to HC, which increase after effective therapy of the disorders. The Val66Met polymorphism was related to features usually associated with worse outcomes. High heterogeneity has been observed regarding sample size, clinical differences of included patients, and data analysis approaches, reducing comparisons among studies. Although more studies are needed, BDNF seems to be a promising biomarker for BD. Full article
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Other

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15 pages, 286 KiB  
Study Protocol
The Efficacy of Psychoeducational Family Intervention for Major Depression: Study Protocol of a Randomized Controlled Trial
Brain Sci. 2023, 13(8), 1199; https://doi.org/10.3390/brainsci13081199 - 13 Aug 2023
Cited by 1 | Viewed by 1157
Abstract
This study aims to assess the efficacy of a psychoeducational family intervention (PFI) to reduce the severity of depressive symptoms and to improve psychosocial functioning and to increase social contacts in a sample of patients with major depressive disorder (MDD). The degree to [...] Read more.
This study aims to assess the efficacy of a psychoeducational family intervention (PFI) to reduce the severity of depressive symptoms and to improve psychosocial functioning and to increase social contacts in a sample of patients with major depressive disorder (MDD). The degree to which PFI will reduce patients’ relapses, hospitalizations, and self-stigmatization and will improve their quality of life will also be assessed. Other secondary outcomes include the improvement of relatives’ coping strategies, family burden, expressed emotions and quality of life. This non-profit, unfunded, national, multicentric randomized controlled trial with blinded outcome assessments will be carried out in 24 Italian university outpatient units. Families will be assessed at baseline and at 6, 12, and 24 months post-randomization. Our working hypothesis is that the PFIs will reduce the patients’ severity of depressive symptoms, their relapses, and their hospitalizations, and that they will improve their psychosocial functioning and quality of life. We expect these results to be maintained after 12 and 24 months, albeit with a reduction in magnitude. The sample will consist of 384 patients randomized at a 1:1 ratio and stratified according to center, age, gender, and educational level. Full article
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