Jessica Eccles - Academia.edu (original) (raw)
Papers by Jessica Eccles
Frontiers in Psychiatry
ObjectivesAutism, attention deficit hyperactivity disorder (ADHD), and tic disorder (Tourette syn... more ObjectivesAutism, attention deficit hyperactivity disorder (ADHD), and tic disorder (Tourette syndrome; TS) are neurodevelopmental conditions that frequently co-occur and impact psychological, social, and emotional processes. Increased likelihood of chronic physical symptoms, including fatigue and pain, are also recognized. The expression of joint hypermobility, reflecting a constitutional variant in connective tissue, predicts susceptibility to psychological symptoms alongside recognized physical symptoms. Here, we tested for increased prevalence of joint hypermobility, autonomic dysfunction, and musculoskeletal symptoms in 109 adults with neurodevelopmental condition diagnoses.MethodsRates of generalized joint hypermobility (GJH, henceforth hypermobility) in adults with a formal diagnosis of neurodevelopmental conditions (henceforth neurodivergent group, n = 109) were compared to those in the general population in UK. Levels of orthostatic intolerance and musculoskeletal symptoms ...
Joint hypermobility is a common but often poorly recognised connective tissue condition. 1 Indivi... more Joint hypermobility is a common but often poorly recognised connective tissue condition. 1 Individuals with hypermobility are (up to 16 times) overrepresented among those with panic or anxiety disorders. 2 Hypermobility is also linked to stresssensitive psychosomatic disorders including irritable bowel syndrome, fibromyalgia and chronic fatigue and is associated with hypersensitivity to nociceptive stimuli. 1 Additionally, individuals with hypermobility often exhibit autonomic abnormalities, typically postural tachycardia syndrome, where there is enhanced cardiovascular reactivity and a phenomenological overlap with anxiety disorders. 3 Thus, direct and indirect evidence links hypermobility to anxiety and stress-sensitive medical disorders. Within a programme of research motivated to detail the theoretical contribution of central autonomic control to emotion regulation and psychiatric disorders, 4,5 we performed a voxelbased morphometry (VBM) study of brain magnetic resonance imaging (MRI) scans in participants with and without hypermobility, none of whom had an anxiety disorder.
Journal of Psychosomatic Research, 2015
Major depressive disorder (MDD) is a common consequence of interferon alpha (IFNα) treatment and ... more Major depressive disorder (MDD) is a common consequence of interferon alpha (IFNα) treatment and important supporting evidence of a role of inflammation in the aetiology of depression. This study aimed to expand the knowledge of baseline clinical vulnerability characteristics to IFNα induced MDD, particularly exploring sub-threshold depressive symptoms. A prospective cohort of chronic HCV patients undergoing treatment with pegylated-IFNα and ribavirin was studied. MDD was assessed using the Structured Clinical Interview for DSM-IV (SCID-I). Depressive symptoms and severity were assessed at baseline and monthly with the Hamilton Depression Rating Scale (HAMD). Subjects with MDD or taking antidepressant treatment at baseline were excluded. 278 patients were assessed for this cohort with a final study sample of 190. 94.2% had contracted HCV through intravenous drug use. During six months IFNα treatment, 53.2% of patients transitioned to DSM-IV threshold MDD. In the multivariate logistic analysis, independent factors significantly associated with development of MDD were younger age (OR 0.96, 95% CI 0.93-1.00, p=0.028), past history of MDD (OR 3.82, 95% CI 1.63-8.92, p=0.002), baseline HAMD items psychomotor retardation (OR 15.21, 95% CI 1.33-173.41, p=0.032) and somatic symptoms (general) (OR 2.96, 95% CI 1.44-6.08, p=0.003), and HCV genotype 2 (OR 2.27, 95% CI 1.07-4.78, p=0.032). During IFNα treatment, the rate of transition to MDD was high in this cohort. Psychomotor retardation and somatic symptoms may represent a greater inflamed state pre-treatment. This iatrogenic model of MDD may offer important insights into wider depression aetiology.
Journal of Neurology, Neurosurgery & Psychiatry, 2014
Frontiers in neuroscience, 2015
This review explores the proposal that vulnerability to psychological symptoms, particularly anxi... more This review explores the proposal that vulnerability to psychological symptoms, particularly anxiety, originates in constitutional differences in the control of bodily state, exemplified by a set of conditions that include Joint Hypermobility, Postural Tachycardia Syndrome and Vasovagal Syncope. Research is revealing how brain-body mechanisms underlie individual differences in psychophysiological reactivity that can be important for predicting, stratifying and treating individuals with anxiety disorders and related conditions. One common constitutional difference is Joint Hypermobility, in which there is an increased range of joint movement as a result of a variant of collagen. Joint hypermobility is over-represented in people with anxiety, mood and neurodevelopmental disorders. It is also linked to stress-sensitive medical conditions such as irritable bowel syndrome, chronic fatigue syndrome and fibromyalgia. Structural differences in "emotional" brain regions are reporte...
Frontiers in Psychology, 2014
Anxiety is associated with increased physiological reactivity and also increased &amp... more Anxiety is associated with increased physiological reactivity and also increased "interoceptive" sensitivity to such changes in internal bodily arousal. Joint hypermobility, an expression of a common variation in the connective tissue protein collagen, is increasingly recognized as a risk factor to anxiety and related disorders. This study explored the link between anxiety, interoceptive sensitivity and hypermobility in a sub-clinical population using neuroimaging and psychophysiological evaluation. Thirty-six healthy volunteers undertook interoceptive sensitivity tests, a clinical examination for hypermobility and completed validated questionnaire measures of state anxiety and body awareness tendency. Nineteen participants also performed an emotional processing paradigm during functional neuroimaging. We confirmed a significant relationship between state anxiety score and joint hypermobility. Interoceptive sensitivity mediated the relationship between state anxiety and hypermobility. Hypermobile, compared to non-hypermobile, participants displayed heightened neural reactivity to sad and angry scenes within brain regions implicated in anxious feeling states, notably insular cortex. Our findings highlight the dependence of anxiety state on bodily context, and increase our understanding of the mechanisms through which vulnerability to anxiety disorders arises in people bearing a common variant of collagen.
ACM SIGGRAPH 2014 Posters on - SIGGRAPH '14, 2014
2014 6th International Conference on Games and Virtual Worlds for Serious Applications (VS-GAMES), 2014
Handbook of Clinical Neurology, 2013
The Lancet, 2013
Background A subgroup of patients present to dermatological services with unexplained skin sensat... more Background A subgroup of patients present to dermatological services with unexplained skin sensations, usually ascribing them to infestation; however, no medical cause can be found. This condition is referred to as delusional infestation, a rare and diffi cult to treat disorder with considerable impact on psychosocial functioning. The neurobiological mechanisms underlying this condition are unclear. We undertook the fi rst functional MRI (fMRI) study in this group of patients.
Journal of the International AIDS Society, 2012
Effective clearance rates of HCV with interferon alpha plus ribavirin treatment are reported to b... more Effective clearance rates of HCV with interferon alpha plus ribavirin treatment are reported to be reduced in the co-infected HIV/ HCV population when compared to the HCV monoinfected population . Neuropsychiatric adverse events are associated with hepatitis C treatment and interferon alpha-induced major depressive disorder is commonly reported . This study examined the rate and predictors of depression during interferon alpha plus ribavirin treatment in a Brighton, UK cohort of HCV-infected patients including a subsample with HIV coinfection. Depressive disorder was explored at baseline and monthly up to 6 months using the Structured Clinical Interview for DSMIV and the Hamilton Rating Scale for depression. Six month treatment response was determined using viral load assay (clearance achieved if HCV RNA B400 IU/mL). A cohort of 237 HCV patients consented to participate in the study, including 38 coinfected with HIV. The HCV monoinfected group had a mean age of 45.60 years (SD08.93) and 64.3% were male. The HIV/HCV coinfected group had a mean age of 41.34 (SD09.8) and 94.7% were male. The most common mode of HCV transmission was intravenous drug use in both groups. Notably, clearance rates at 6 months were equivalent in both groups: 88.3% in the HCV group vs 86.5% in the coinfected group. Baseline DSMIV depressive disorder rates and mean HAMD scores were not significantly different between groups. For Hamilton depression scores over time, a significant multivariate effect was found [Wilks' Lambda 0.33, F (6, 203) 067.73, pB.001, h p 2 0.67] with the co-infected group having lower scores. For the whole sample, post-hoc comparisons revealed that all depression scores after week 8 were significantly different from baseline scores and scores at week 4. Multiple regression analysis revealed DSMIV depressive disorder at week 4 was significantly predicted by baseline DSMIV depression (b0.30), past psychiatric history (b0.25), and not being coinfected (b0(.16). Age and gender had no significant effect. Only baseline depression predicted depression at later time points. Lower rates of depression in this coinfected group may relate to antiretroviral treatment effects. Limitations of our study include a small coinfected sample size and the absence of immunological data over the time course.
Journal of Neurology, Neurosurgery & Psychiatry, 2013
ABSTRACT A sub-group of patients present to dermatological services with unexplained skin sensati... more ABSTRACT A sub-group of patients present to dermatological services with unexplained skin sensations that characteristically evoked a subjective sense of infestation. The consequent psychological and behavioural impacts of these experiences are considerable and difficult to manage therapeutically. Underlying neurobiological mechanisms are unclear. We therefore undertook the first functional MRI study to test the hypothesis that such patients will differ from controls in central neural processing of affective and infestation-related stimuli. Participants: Five patients presenting with medically unexplained skin sensations were recruited from the specialist psychodermatology service at The Royal London Hospital, mean age 52.8 years, 4 female, 1 male. Five healthy controls were matched for age and gender. Image acquisition: Whole brain MRI data was acquired on a 1.5 T scanner. Task: In a randomized event- related design participants were shown 6 classes of images - insects on skin; insects on leaf; other objects on skin; other objects on leaf; neutral images; disgusting and fearful images. Analysis: Functional images were analyzed using SPM8. A full factorial model was used to analyze the results with two factors - group and stimulus type. Across all conditions patients showed greater activity in the right parahippocampus. Insect versus non insect images evoked greater activation within occipital regions. The main effect of presentation of skin rather than leaf stimuli was to activate inferior parietal lobule and the patients showed enhanced activity within this area. Formal testing of differential responses of patients v. controls to images of insects on skin (three way interaction) revealed differences in the engagement of dorsal anterior cingulate and right lateral prefrontal cortices. Patients also showed greater activity in bilateral temporal lobes when viewing disgusting/fearful images compared to neutral images. We confirm that regional neural activity differs between patients with abnormal skin sensations and controls to condition-relevant and affective visual stimuli. These data provide insight into central mechanisms that potentially represent novel treatment targets.
The British Journal of Psychiatry, 2012
Joint hypermobility is a common but often poorly recognised connective tissue condition. 1 Indivi... more Joint hypermobility is a common but often poorly recognised connective tissue condition. 1 Individuals with hypermobility are (up to 16 times) overrepresented among those with panic or anxiety disorders. 2 Hypermobility is also linked to stresssensitive psychosomatic disorders including irritable bowel syndrome, fibromyalgia and chronic fatigue and is associated with hypersensitivity to nociceptive stimuli. 1 Additionally, individuals with hypermobility often exhibit autonomic abnormalities, typically postural tachycardia syndrome, where there is enhanced cardiovascular reactivity and a phenomenological overlap with anxiety disorders. 3 Thus, direct and indirect evidence links hypermobility to anxiety and stress-sensitive medical disorders. Within a programme of research motivated to detail the theoretical contribution of central autonomic control to emotion regulation and psychiatric disorders, 4,5 we performed a voxelbased morphometry (VBM) study of brain magnetic resonance imaging (MRI) scans in participants with and without hypermobility, none of whom had an anxiety disorder.
BMJ, 2011
ABSTRACT Ross and Grahame highlighted that hypermobility is just one visible feature of joint hyp... more ABSTRACT Ross and Grahame highlighted that hypermobility is just one visible feature of joint hypermobility syndrome.1 The breadth of physical complications, including dysautonomia, premature osteoarthritis, and intestinal dysmotility, suggests a broader multi-system phenotype. Joint hypermobility is also commonly associated with psychiatric …
European Neuropsychopharmacology, 2012
Depressive disorder is a common consequence of interferon α treatment. An understanding of the ae... more Depressive disorder is a common consequence of interferon α treatment. An understanding of the aetiological processes involved is evolving. HPA axis abnormalities are clearly described in community depressive disorder and represent vulnerability to depression development. We explored whether pre-treatment HPA axis abnormalities influence depression emergence during interferon α treatment. We examined waking HPA axis response via salivary cortisol sampling in 44 non-depressed, chronic hepatitis C infected patients due to commence standard interferon α treatment. Hamilton depression scales and the structured clinical interview for DSM-IV major depressive disorder status were administered monthly during treatment. Major depressive disorder developed in 26 of 44 subjects during interferon-α treatment. The pre-treatment waking cortisol response over 1h was significantly greater in the subsequent switch to depression group (F=4.23, p=0.046). The waking cortisol response pre-treatment with interferon α appears greater in those subsequently switching to depressive disorder during treatment. This waking response may join other vulnerability factors for depression emergence in this group. This model could prove a valuable tool in understanding non-iatrogenic depressive disorder in the general population and notably the role of cytokines.
Frontiers in Psychiatry
ObjectivesAutism, attention deficit hyperactivity disorder (ADHD), and tic disorder (Tourette syn... more ObjectivesAutism, attention deficit hyperactivity disorder (ADHD), and tic disorder (Tourette syndrome; TS) are neurodevelopmental conditions that frequently co-occur and impact psychological, social, and emotional processes. Increased likelihood of chronic physical symptoms, including fatigue and pain, are also recognized. The expression of joint hypermobility, reflecting a constitutional variant in connective tissue, predicts susceptibility to psychological symptoms alongside recognized physical symptoms. Here, we tested for increased prevalence of joint hypermobility, autonomic dysfunction, and musculoskeletal symptoms in 109 adults with neurodevelopmental condition diagnoses.MethodsRates of generalized joint hypermobility (GJH, henceforth hypermobility) in adults with a formal diagnosis of neurodevelopmental conditions (henceforth neurodivergent group, n = 109) were compared to those in the general population in UK. Levels of orthostatic intolerance and musculoskeletal symptoms ...
Joint hypermobility is a common but often poorly recognised connective tissue condition. 1 Indivi... more Joint hypermobility is a common but often poorly recognised connective tissue condition. 1 Individuals with hypermobility are (up to 16 times) overrepresented among those with panic or anxiety disorders. 2 Hypermobility is also linked to stresssensitive psychosomatic disorders including irritable bowel syndrome, fibromyalgia and chronic fatigue and is associated with hypersensitivity to nociceptive stimuli. 1 Additionally, individuals with hypermobility often exhibit autonomic abnormalities, typically postural tachycardia syndrome, where there is enhanced cardiovascular reactivity and a phenomenological overlap with anxiety disorders. 3 Thus, direct and indirect evidence links hypermobility to anxiety and stress-sensitive medical disorders. Within a programme of research motivated to detail the theoretical contribution of central autonomic control to emotion regulation and psychiatric disorders, 4,5 we performed a voxelbased morphometry (VBM) study of brain magnetic resonance imaging (MRI) scans in participants with and without hypermobility, none of whom had an anxiety disorder.
Journal of Psychosomatic Research, 2015
Major depressive disorder (MDD) is a common consequence of interferon alpha (IFNα) treatment and ... more Major depressive disorder (MDD) is a common consequence of interferon alpha (IFNα) treatment and important supporting evidence of a role of inflammation in the aetiology of depression. This study aimed to expand the knowledge of baseline clinical vulnerability characteristics to IFNα induced MDD, particularly exploring sub-threshold depressive symptoms. A prospective cohort of chronic HCV patients undergoing treatment with pegylated-IFNα and ribavirin was studied. MDD was assessed using the Structured Clinical Interview for DSM-IV (SCID-I). Depressive symptoms and severity were assessed at baseline and monthly with the Hamilton Depression Rating Scale (HAMD). Subjects with MDD or taking antidepressant treatment at baseline were excluded. 278 patients were assessed for this cohort with a final study sample of 190. 94.2% had contracted HCV through intravenous drug use. During six months IFNα treatment, 53.2% of patients transitioned to DSM-IV threshold MDD. In the multivariate logistic analysis, independent factors significantly associated with development of MDD were younger age (OR 0.96, 95% CI 0.93-1.00, p=0.028), past history of MDD (OR 3.82, 95% CI 1.63-8.92, p=0.002), baseline HAMD items psychomotor retardation (OR 15.21, 95% CI 1.33-173.41, p=0.032) and somatic symptoms (general) (OR 2.96, 95% CI 1.44-6.08, p=0.003), and HCV genotype 2 (OR 2.27, 95% CI 1.07-4.78, p=0.032). During IFNα treatment, the rate of transition to MDD was high in this cohort. Psychomotor retardation and somatic symptoms may represent a greater inflamed state pre-treatment. This iatrogenic model of MDD may offer important insights into wider depression aetiology.
Journal of Neurology, Neurosurgery & Psychiatry, 2014
Frontiers in neuroscience, 2015
This review explores the proposal that vulnerability to psychological symptoms, particularly anxi... more This review explores the proposal that vulnerability to psychological symptoms, particularly anxiety, originates in constitutional differences in the control of bodily state, exemplified by a set of conditions that include Joint Hypermobility, Postural Tachycardia Syndrome and Vasovagal Syncope. Research is revealing how brain-body mechanisms underlie individual differences in psychophysiological reactivity that can be important for predicting, stratifying and treating individuals with anxiety disorders and related conditions. One common constitutional difference is Joint Hypermobility, in which there is an increased range of joint movement as a result of a variant of collagen. Joint hypermobility is over-represented in people with anxiety, mood and neurodevelopmental disorders. It is also linked to stress-sensitive medical conditions such as irritable bowel syndrome, chronic fatigue syndrome and fibromyalgia. Structural differences in "emotional" brain regions are reporte...
Frontiers in Psychology, 2014
Anxiety is associated with increased physiological reactivity and also increased &amp... more Anxiety is associated with increased physiological reactivity and also increased "interoceptive" sensitivity to such changes in internal bodily arousal. Joint hypermobility, an expression of a common variation in the connective tissue protein collagen, is increasingly recognized as a risk factor to anxiety and related disorders. This study explored the link between anxiety, interoceptive sensitivity and hypermobility in a sub-clinical population using neuroimaging and psychophysiological evaluation. Thirty-six healthy volunteers undertook interoceptive sensitivity tests, a clinical examination for hypermobility and completed validated questionnaire measures of state anxiety and body awareness tendency. Nineteen participants also performed an emotional processing paradigm during functional neuroimaging. We confirmed a significant relationship between state anxiety score and joint hypermobility. Interoceptive sensitivity mediated the relationship between state anxiety and hypermobility. Hypermobile, compared to non-hypermobile, participants displayed heightened neural reactivity to sad and angry scenes within brain regions implicated in anxious feeling states, notably insular cortex. Our findings highlight the dependence of anxiety state on bodily context, and increase our understanding of the mechanisms through which vulnerability to anxiety disorders arises in people bearing a common variant of collagen.
ACM SIGGRAPH 2014 Posters on - SIGGRAPH '14, 2014
2014 6th International Conference on Games and Virtual Worlds for Serious Applications (VS-GAMES), 2014
Handbook of Clinical Neurology, 2013
The Lancet, 2013
Background A subgroup of patients present to dermatological services with unexplained skin sensat... more Background A subgroup of patients present to dermatological services with unexplained skin sensations, usually ascribing them to infestation; however, no medical cause can be found. This condition is referred to as delusional infestation, a rare and diffi cult to treat disorder with considerable impact on psychosocial functioning. The neurobiological mechanisms underlying this condition are unclear. We undertook the fi rst functional MRI (fMRI) study in this group of patients.
Journal of the International AIDS Society, 2012
Effective clearance rates of HCV with interferon alpha plus ribavirin treatment are reported to b... more Effective clearance rates of HCV with interferon alpha plus ribavirin treatment are reported to be reduced in the co-infected HIV/ HCV population when compared to the HCV monoinfected population . Neuropsychiatric adverse events are associated with hepatitis C treatment and interferon alpha-induced major depressive disorder is commonly reported . This study examined the rate and predictors of depression during interferon alpha plus ribavirin treatment in a Brighton, UK cohort of HCV-infected patients including a subsample with HIV coinfection. Depressive disorder was explored at baseline and monthly up to 6 months using the Structured Clinical Interview for DSMIV and the Hamilton Rating Scale for depression. Six month treatment response was determined using viral load assay (clearance achieved if HCV RNA B400 IU/mL). A cohort of 237 HCV patients consented to participate in the study, including 38 coinfected with HIV. The HCV monoinfected group had a mean age of 45.60 years (SD08.93) and 64.3% were male. The HIV/HCV coinfected group had a mean age of 41.34 (SD09.8) and 94.7% were male. The most common mode of HCV transmission was intravenous drug use in both groups. Notably, clearance rates at 6 months were equivalent in both groups: 88.3% in the HCV group vs 86.5% in the coinfected group. Baseline DSMIV depressive disorder rates and mean HAMD scores were not significantly different between groups. For Hamilton depression scores over time, a significant multivariate effect was found [Wilks' Lambda 0.33, F (6, 203) 067.73, pB.001, h p 2 0.67] with the co-infected group having lower scores. For the whole sample, post-hoc comparisons revealed that all depression scores after week 8 were significantly different from baseline scores and scores at week 4. Multiple regression analysis revealed DSMIV depressive disorder at week 4 was significantly predicted by baseline DSMIV depression (b0.30), past psychiatric history (b0.25), and not being coinfected (b0(.16). Age and gender had no significant effect. Only baseline depression predicted depression at later time points. Lower rates of depression in this coinfected group may relate to antiretroviral treatment effects. Limitations of our study include a small coinfected sample size and the absence of immunological data over the time course.
Journal of Neurology, Neurosurgery & Psychiatry, 2013
ABSTRACT A sub-group of patients present to dermatological services with unexplained skin sensati... more ABSTRACT A sub-group of patients present to dermatological services with unexplained skin sensations that characteristically evoked a subjective sense of infestation. The consequent psychological and behavioural impacts of these experiences are considerable and difficult to manage therapeutically. Underlying neurobiological mechanisms are unclear. We therefore undertook the first functional MRI study to test the hypothesis that such patients will differ from controls in central neural processing of affective and infestation-related stimuli. Participants: Five patients presenting with medically unexplained skin sensations were recruited from the specialist psychodermatology service at The Royal London Hospital, mean age 52.8 years, 4 female, 1 male. Five healthy controls were matched for age and gender. Image acquisition: Whole brain MRI data was acquired on a 1.5 T scanner. Task: In a randomized event- related design participants were shown 6 classes of images - insects on skin; insects on leaf; other objects on skin; other objects on leaf; neutral images; disgusting and fearful images. Analysis: Functional images were analyzed using SPM8. A full factorial model was used to analyze the results with two factors - group and stimulus type. Across all conditions patients showed greater activity in the right parahippocampus. Insect versus non insect images evoked greater activation within occipital regions. The main effect of presentation of skin rather than leaf stimuli was to activate inferior parietal lobule and the patients showed enhanced activity within this area. Formal testing of differential responses of patients v. controls to images of insects on skin (three way interaction) revealed differences in the engagement of dorsal anterior cingulate and right lateral prefrontal cortices. Patients also showed greater activity in bilateral temporal lobes when viewing disgusting/fearful images compared to neutral images. We confirm that regional neural activity differs between patients with abnormal skin sensations and controls to condition-relevant and affective visual stimuli. These data provide insight into central mechanisms that potentially represent novel treatment targets.
The British Journal of Psychiatry, 2012
Joint hypermobility is a common but often poorly recognised connective tissue condition. 1 Indivi... more Joint hypermobility is a common but often poorly recognised connective tissue condition. 1 Individuals with hypermobility are (up to 16 times) overrepresented among those with panic or anxiety disorders. 2 Hypermobility is also linked to stresssensitive psychosomatic disorders including irritable bowel syndrome, fibromyalgia and chronic fatigue and is associated with hypersensitivity to nociceptive stimuli. 1 Additionally, individuals with hypermobility often exhibit autonomic abnormalities, typically postural tachycardia syndrome, where there is enhanced cardiovascular reactivity and a phenomenological overlap with anxiety disorders. 3 Thus, direct and indirect evidence links hypermobility to anxiety and stress-sensitive medical disorders. Within a programme of research motivated to detail the theoretical contribution of central autonomic control to emotion regulation and psychiatric disorders, 4,5 we performed a voxelbased morphometry (VBM) study of brain magnetic resonance imaging (MRI) scans in participants with and without hypermobility, none of whom had an anxiety disorder.
BMJ, 2011
ABSTRACT Ross and Grahame highlighted that hypermobility is just one visible feature of joint hyp... more ABSTRACT Ross and Grahame highlighted that hypermobility is just one visible feature of joint hypermobility syndrome.1 The breadth of physical complications, including dysautonomia, premature osteoarthritis, and intestinal dysmotility, suggests a broader multi-system phenotype. Joint hypermobility is also commonly associated with psychiatric …
European Neuropsychopharmacology, 2012
Depressive disorder is a common consequence of interferon α treatment. An understanding of the ae... more Depressive disorder is a common consequence of interferon α treatment. An understanding of the aetiological processes involved is evolving. HPA axis abnormalities are clearly described in community depressive disorder and represent vulnerability to depression development. We explored whether pre-treatment HPA axis abnormalities influence depression emergence during interferon α treatment. We examined waking HPA axis response via salivary cortisol sampling in 44 non-depressed, chronic hepatitis C infected patients due to commence standard interferon α treatment. Hamilton depression scales and the structured clinical interview for DSM-IV major depressive disorder status were administered monthly during treatment. Major depressive disorder developed in 26 of 44 subjects during interferon-α treatment. The pre-treatment waking cortisol response over 1h was significantly greater in the subsequent switch to depression group (F=4.23, p=0.046). The waking cortisol response pre-treatment with interferon α appears greater in those subsequently switching to depressive disorder during treatment. This waking response may join other vulnerability factors for depression emergence in this group. This model could prove a valuable tool in understanding non-iatrogenic depressive disorder in the general population and notably the role of cytokines.