How Does Antiretroviral Treatment Attenuate the Stigma of HIV? Evidence From a Cohort Study in Rural Uganda.

How Does Antiretroviral Treatment Attenuate the Stigma of HIV? Evidence from a Cohort Study in Rural Uganda.

AIDS Behav. 2013 May 14;
Tsai AC, Bangsberg DR, Bwana M, Haberer JE, Frongillo EA, Muzoora C, Kumbakumba E, Hunt PW, Martin JN, Weiser SD

Program implementers and qualitative researchers have described how increasing availability of HIV antiretroviral therapy (ART) is associated with improvements in psychosocial health and internalized stigma. To determine whether, and through what channels, ART reduces internalized stigma, we analyzed data from 262 HIV-infected, treatment-naïve persons in rural Uganda followed from ART initiation over a median of 3.4 years. We fitted Poisson regression models with cluster-correlated robust estimates of variance, specifying internalized stigma as the dependent variable, adjusting for time on treatment as well as socio-demographic, clinical, and psychosocial variables. Over time on treatment, internalized stigma declined steadily, with the largest decline observed during the first 2 years of treatment. This trend remained statistically significant after multivariable adjustment (?(2) = 28.3; P = 0.03), and appeared to be driven by ART-induced improvements in HIV symptom burden, physical and psychological wellbeing, and depression symptom severity. HubMed – depression


Surgical Technique: Tscherne-Johnson Extensile Approach for Tibial Plateau Fractures.

Clin Orthop Relat Res. 2013 May 14;
Johnson EE, Timon S, Osuji C

BACKGROUND: The standard approach to lateral tibial plateau fractures involves elevation of the iliotibial band (IT) and anterior tibialis origin in continuity from Gerdy’s tubercle and metaphyseal flare. We describe an alternative approach to increase lateral plateau joint exposure and maintain iliotibial band insertion to Gerdy’s tubercle. DESCRIPTION OF TECHNIQUE: The approach entails a partial tenotomy of the anterior half of the IT band leaving the posterior IT band insertion attached to Gerdy’s tubercle. Fracture lines around Gerdy’s tubercle are completed or the tubercle was osteotomized and externally rotated and the joint overdistracted, allowing direct visualization of the joint depression. Joint elevation, grafting, and internal fixation are performed through this window. METHODS: We retrospectively reviewed 76 patients (two groups), Schatzker Types I to II and IV to VI fractures (66 patients), between 1989 and 2005, and 10 patients, with 10 bicondylar posterior plateau fractures, from 2002 to 2010. All patients were followed a minimum of 12 months (average, 3.9 years; range, 12 months to 10 years). Ten patients, with posterior plateau fractures, received anterolateral plateau intraarticular osteotomy for exposure of centroposterior and posterolateral articular depression. RESULTS: Average knee ROM was 2° of flexion (range, -3° to 5°) to greater than 120° of flexion (range, 100°-145°). In 66 patients, average articular depression improved from 7.4 mm to 1 mm (range, 0-5 mm) and, in 10 posterior fractures, from 18 mm to 1 mm (range, 0-4.5 mm). Infection occurred in one of the 76 patients; acute débridement and intravenous antibiotics resulted in control of the infection. CONCLUSIONS: This approach reliably increases direct visualization of the lateral plateau articular fractures and maintains IT band insertion. Articular osteotomy of the anterolateral plateau provides access to extensive posterior plateau fractures. LEVEL OF EVIDENCE: Level IV, retrospective study. See Guidelines for Authors for a complete description of levels of evidence. HubMed – depression


Adolescent self-control predicts joint trajectories of marijuana use and depressive mood into young adulthood among urban African Americans and Puerto Ricans.

J Behav Med. 2013 May 14;
Pahl K, Brook JS, Lee JY

Previous studies have identified an association between depressive mood and marijuana use. We examined adolescent self-control as a predictor of membership in joint developmental trajectories of depressive mood and marijuana use from adolescence to young adulthood. Urban African Americans and Puerto Ricans (N = 838) were sampled when participants were on average 14, 19, 24, and 29 years old. Using growth mixture modeling, four joint trajectory groups of depressive mood and marijuana use were established: low marijuana use/low depressive mood, low marijuana use/intermediate depressive mood, high marijuana use/low depressive mood, and high marijuana use/high depressive mood. Weighted logistic regression analysis showed that self-control at age 14 distinguished the high marijuana use/high depressive mood group and the low marijuana use/low depressive mood group from each of the other groups. Findings show that the co-occurrence of high levels of marijuana use and depressive mood from adolescence into young adulthood is predicted by low levels of self-control in adolescence. On the other hand, high selfcontrol is associated with low marijuana use and low levels of depression over time. Thus, while deficits in self-control in adolescence constitute a significant risk for maladjustment over time, high self-control exerts a protective factor with regard to marijuana use and depressive mood into young adulthood. HubMed – depression


Upregulation of mGlu2 receptors via NF-?B p65 acetylation is involved in the proneurogenic and antidepressant effects of acetyl-L-carnitine.

Neuropsychopharmacology. 2013 May 14;
Cuccurazzu B, Bortolotto V, Maddalena Valente M, Ubezio F, Koverech A, Luigi Canonico P, Grilli M

Acetyl-L-carnitine (ALC) is a naturally occurring molecule with an important role in cellular bioenergetics and as donor of acetyl groups to proteins, including NF-?B p65. In humans, exogenously administered ALC has been shown to be effective in mood disturbances, with a good tolerability profile. No current information is available on the antidepressant effect of ALC in animal models of depression and on the putative mechanism involved in such effect. Here we report that ALC is a proneurogenic molecule, whose effect on neuronal differentiation of adult hippocampal neural progenitors is independent of its neuroprotective activity. The in vitro proneurogenic effects of ALC appear to be mediated by activation of the NF-?B pathway, and in particular by p65 acetylation, and subsequent NF-?B-mediated upregulation of metabotropic glutamate receptor 2 (mGlu2) expression. When tested in vivo, chronic ALC treatment could revert depressive-like behaviour caused by unpredictable chronic mild stress, a rodent model of depression with high face validity and predictivity, and its behavioural effect correlated with upregulated expression of mGlu2 receptor in hippocampi of stressed mice. Moreover chronic, but not acute or subchronic, drug treatment significantly increased adult born neurons in hippocampi of stressed and unstressed mice. We now propose that this mechanism could be potentially involved in the antidepressant effect of ALC in humans. These results are potentially relevant from a clinical perspective since for its high tolerability profile ALC may be ideally employed in patient subpopulations which are sensitive to side-effects associated with classical antidepressants.Neuropsychopharmacology accepted article preview online, 14 May 2013; doi:10.1038/npp.2013.121. HubMed – depression


P-glycoprotein Inhibition Increases the Brain Distribution and Antidepressant-like Activity of Escitalopram in Rodents.

Neuropsychopharmacology. 2013 May 14;
O’Brien FE, O’Connor RM, Clarke G, Dinan TG, Griffin BT, Cryan JF

Despite the clinical prevalence of the antidepressant escitalopram, over 30% of escitalopram-treated patients fail to respond to treatment. Recent gene association studies have highlighted a potential link between the drug efflux transporter P-glycoprotein (P-gp) and response to escitalopram. The present studies investigated pharmacokinetic and pharmacodynamic interactions between P-gp and escitalopram. In vitro bidirectional transport studies revealed that escitalopram is a transported substrate of human P-gp. Microdialysis-based pharmacokinetic studies demonstrated that administration of a P-gp inhibitor resulted in increased brain levels of escitalopram without altering plasma escitalopram levels in the rat, thereby showing that P-gp restricts escitalopram transport across the blood-brain barrier (BBB) in vivo. The tail suspension test (TST) was carried out to elucidate the pharmacodynamic impact of P-gp inhibition on escitalopram effect in a mouse model of antidepressant activity. Pre-treatment with a P-gp inhibitor enhanced the response to escitalopram in the TST. Taken together, these data indicate that P-gp may restrict the BBB transport of escitalopram in humans, potentially resulting in sub-therapeutic brain concentrations in certain patients. Moreover, by verifying that increasing escitalopram delivery to the brain by P-gp inhibition results in enhanced antidepressant-like activity, we suggest that adjunctive treatment with a P-gp inhibitor may represent a beneficial approach to augment escitalopram therapy in depression.Neuropsychopharmacology accepted article preview online, 14 May 2013; doi:10.1038/npp.2013.120. HubMed – depression



The Road Back Dramatic Film on Teen Anxiety/Depression (Low-res) – Acadia Hospital, Project AWARE and Maine teens present a powerful short film created to educate people about youth anxiety and depression. The is a low resol…