Describe the history of psycho-oncology in Portugal. Research articles and theses related to Psycho-oncology in Portugal and do his description statistics.

Literature review of articles and theses on Psycho-oncology made in Portugal, using the following search engines: “Pubmed”, “Medline”, “ScieloPortugal” and scientific repositories of Portuguese universities.

Until 1997, psycho-oncology did not arouse the interest of researchers; however, since then, the Psycho-oncology has grown exponentially, with regard to the investigation. There was a period of increase in publications between 2005 and 2012 as well as, increase in the number of undergraduate theses, master's and doctorate. Disclosure of publications within the Psycho-oncology lies spread by various magazines in different specialties, demonstrating that this area arouses the interest not only of psychiatrists and psychologists, but also of other health professionals.

Despite growing research in Psycho-oncology and growing interest among clinicians and researchers, there is still some shortcomings, warning that the psychological support is also scarce in some Portuguese institutions.

The authors have not supplied their declaration of competing interest.

In Riga, Latvia, people who have been diagnosed with cancer at various stages, are not offered any group or individual psychological intervention. This applies for the immediate relatives as well.

The aim of the study was to collate a homogenous understanding of the resources and standards of extant practice in psychological needs of patients and their family diagnosed with cancer. Further aims include to identify any deficiencies in the service delivery and make appropriate recommendations.

The collective survey tool is devised to reflect the psychological needs of the aforementioned patients were devised by the authors, one a practicing psychiatrist in UK and the other with background in group work and support in Riga. The tool extended to ask coping skills, understanding, impact on relationship, work and general well-being of patients and carers and their family members alike. The collated survey was distributed and results collated.

The results of the survey indicate number of deficiencies in the organization and service delivery. There is also a huge lack of psychological support to family members who have been affected by a diagnosis of cancer or loss to cancer in the family. We also discuss means of improving service delivery in groups for this sample.

The authors have not supplied their declaration of competing interest.

Nowadays, it is well known that a cancer diagnosis has an important impact on the patient and his family. Given a stressful life event, such as cancer, the family is in crisis, so it is crucial how they facing the process. Two families with different adaptation process at the time of diagnosis are presented and the differences are analyzed.

Family 1: Woman, diagnosis of breast cancer. She lives with her husband and she has two children. Troubled family relationships before the diagnosis. Following the cancer diagnosis, family conflicts increase, both with their children and with her husband. The family is not able to adapt to the new situation and the patient perception is that her family do not care what is happening to her.

Family 2: Woman, diagnosis of breast cancer. She lives with her boyfriend, she has no children. She has a good relationship with her family before the diagnosis, without unresolved conflicts in the past. Since cancer diagnosis the whole family has turned to the patient, being more available for her needs, physically and emotionally. She is feeling supported by them and this is making the adaptation process and family adjustment easier, feeling the patient stronger to cope with illness.

In families with unresolved crisis before the disease, the psychological stress increases after diagnosis. The family finds it difficult to react and adapt to the changes caused by the disease and the relationships between its members deteriorate. Conversely, if the family dynamic is good, it is a positive factor in the recovery.

The authors have not supplied their declaration of competing interest.

For the most part, central nervous system (CNS) tumors present themselves with focal neurologic sing or manifestations resulting from increased intracranial pressure. However, in particular cases, these tumors may present exclusively psychiatric symptoms.

This communication explores importance of CNS tumors as differential diagnosis of various psychiatric disorders.

Highlight the need of acknowledging this important differential diagnosis (CNS tumors) in current psychiatry practice, while presenting a clinical case as an example of the subject.

It is exposed a bibliographic review of the topic, followed by the description of a clinical case regarding a patient with pituitary adenoma and simultaneous installation of psychotic symptoms namely delusional paranoid ideation.

The authors present a case report of a 66-year-old patient admitted compulsively in a Psychiatric ward in the context of behavioral changes associated with delusional ideation of paranoid content. Multidisciplinary assessed by specialties of Psychiatry, Neurology, Neurosurgery, Endocrinology and Psychology, concluded by the presence of nonfunctioning pituitary adenoma associated with cognitive major disturbance.

The tumors of the CNS can be associated with a whole variety of psychiatric symptoms such as psychosis, anxiety, depression or cognitive impairment, even in the absence of organic/neurological symptoms. Its role in the genesis of psychiatric symptomatology makes these neoplasias an important differential diagnosis, whose clinical approach should include different medical specialties integrated as a multidisciplinary team.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

Liaison psychiatry is based on a practice that lies on the interface between psychological, sociological and biological factors of illness. Cancer is a devastating disease. For many patients the occurrence of it is synonymous of chronic, severe or lethal outcome. It is important for health professionals to be aware of the psychological suffering of these patients and promote a proper use of specialized consultations in order to increase and improve adherence to treatment.

To make known the reality of referral to a Psycho-Oncology Liaison consult and its context in literature.

Data collection on applications for the 1st request to Psycho-Oncology liaison consults occurred between 2010–2012 in the variables, gender, age, reason for referral, psychiatric history, cancer diagnosis, knowledge of the referral and who does (patient/family/service) and psychiatric diagnosis. Statistical analysis with Microsoft Excel 2010®.

It was found that there were 83 applications during the three years, 24 men and 59 women. The most prevalent cancer diagnoses were breast cancer (29.89%) and colorectal carcinoma (19.28%). Most patients had knowledge of the request (75.9%). The reason was mostly for Anxiety and Depression (33.73%).

Cancer disease coupled with feelings of loss of autonomy, hopelessness and pain can lead the patient to develop psychopathology of anxious-depressive disorders. This condition may hamper the normal recovery of the patient. The promotion of mental well-being in cancer patients is critical to recovery and leads to a better adherence to treatment, inclusive can influence survival.

The authors have not supplied their declaration of competing interest.

The sedation could consist in a therapeutic strategy in advanced cancer conditions.

To study the drugs administered to patients under Palliative Care Sedation (PCS) audits effects on vital signs.

Our retrospective study included 101 oncological patients with mean age of 66.5 ± 13.4 years old and mean weight of 48.5 ± 3.36 kg, under PCS. The data were analysed applying the test of Wilcoxon.

The drugs administered to these patients under PCS were morphine 55 mg/kg/day associated to midazolam 52.5 mg/kg/day (Morph/Midazo) or the association of morphine 55 mg/kg/day, midazolam 52.5 mg/kg/day and neuroleptics such as chlorpromazine 54.5 mg/kg/day or haloperidol 13.25 mg/kg/day (Morph/Midazo/Neurol). The values of vital signs of these patients when the sedation was initiated were: systolic blood pressure 116.55 ± 16.98 mmHg, diastolic bloodpressure73.17 ± 10.55 mmHg, heart rate 83.41 ± 16.25bpm, respiratory rate 19.39 ± 3.97 rpm and body temperature 35.91 ± 0.57 °C. No significant differences between these groups were observed. Vital signs measures were collected 48 hours before the patient's death. Significant reduction in systolic blood pressure 77.5 mmHg, diastolic blood pressure 43.3 mmHg were observed in the group (Morph/Benzo/Neurol). The Wilcoxon test for independent samples to a significance level of 5% we obtain a P-value of 0.01. The sedation period was 2.56 ± 0.23 days.

Neuroleptic, a central nervous system (CNS) depressant drug, when associated to other two depressants (morphine/midazolam), conducted to the patient's vital signs reduction.

Considering the short period of time between the beginning of sedation and the patients’ death; and that palliative sedation should not include the hastening of patients’ death, we suggest a better drug association criteria.

The authors have not supplied their declaration of competing interest.

Emotionally unstable personality disorder (EUPD) is characterised by Pain Paradox. The response for acute, self-induced pain seems to be attenuated while chronic, endogenous pain is usually intolerable. Pain management of this group of patients poses many difficulties, including discrepancies between subjective and objective pain assessment, patients’ demands for strong analgesics and impact on relationship with other professionals.

The purpose of the study was to review pain management options for persons diagnosed with EUPD and complaining of chronic pain.

MEDLINE and PsycINFO databases were searched for all English-language articles containing the keywords “chronic pain”, “pain management”, “borderline personality disorder”, and “emotionally unstable personality disorder”.

Seventeen relevant papers were identified. Suggested first step in pain management was ongoing clarification with EUPD patients that analgesics are unlikely to fully treat their pain and support of non-pharmacological approaches to pain, including cognitive-behavioural strategies. Regarding pharmacology, liberal use of non-addicting analgesics was recommended with highly conservative use of opioid analgesics. Importance of evaluation and treatment of any underlying mood and/or anxiety syndromes was stressed as well as liaison with other professionals (e.g. psychologists, neurologists, orthopaedics, and physiotherapists).

Patients with EUPD often report chronic pain, which can only be managed by close collaboration of professionals from different disciplines.

The authors have not supplied their declaration of competing interest.

About 15–20% of the population suffering from the chronic pain. Over time, chronic pain can result in different emotional problems, social isolation, sleep disturbances, which reduce the quality of life. Chronic pain syndrome (CPS) indicates persistent pain, subjective symptoms in excess of objective findings, associated dysfunctional pain behavious and self-limitation in activities of daily living. Duloxetine is a potent antidepressant approved by the Food and Drug Administration for the chronic musculoskeletal disorder, diabetic neuropathic pain, fibromyalgia, generallized anxiety disorder and major depressive disorder.

To determine the effect of duloxetine on the reduction of pain and psychosocial suffering.

The goal of the treatment should be to effectively reduce pain while improving function and reducing psychosocial suffering.

Thirty-six adult, nondepressed patients, already on tramadol therapy were included. Patients with VAS (visual analogue scale) ≥ 4were treated with duloxetine for 13 weeks. We measured pain intensity with the McGill Pain Questionnaire-Short Form (MPQ-SF) and compared VAS before starting the treatment with duloxetine and weekly for 13 weeks.

Pain response was defined as a 30%decrease in the MPQ-SF. A total of 62.5% of the sample met these criteria for response. Among them, 13.8% of patients were discontinued because of adverse effects. Duloxetine significantly improved functioning and the quality of life in patients with CPS.

Because of it is analgesic properties, duloxetine in the lower antidepressant doses (60 mg taken ones daily) combined with tramadol (another analgesic agent) can be useful in CPS for patients who do not respond satisfactory to monotherapy.

The authors have not supplied their declaration of competing interest.

Understanding of factors related to chronic pain in elderly is limited.

To estimate the prevalence of pain categories based on spreading of pain on the body and to investigate how such spreading is related to demographic variables, pain intensity, comorbidities and medication in an elderly general population in southeastern Sweden.

A total of 6611 adults aged ≥ 65 years participated (mean age = 76.2; SD = 7.4). Pain categories were assessed by a self-reported postal questionnaire covering 45 anatomical predefined pain regions along with demographics, pain intensity during previous seven days, comorbidities and medication. Poisson regression models with robust error variance were used for data analyzing.

The prevalence of pain spreading categories was: chronic local pain (CLP) 16%; chronic regional pain medium (CRP-Medium) 17%; chronic regional pain heavy (CRP-Heavy) 5% and chronic widespread pain (CWSP) 2%. Overall, increased prevalence for CRP-Heavy and CWSP in subjects 75–79 years old compared to those 65–69, 70–74, 80–84 and ≥ 85 years were revealed. In men, 75–79 years old, CRP-Heavy was more common than in the other pain categories. In women, 75–79 years old CWSP, was more common than in the other pain categories. Pain intensity was strongly associated with all pain categories (P < 0.001). CLP was associated with trauma, rheumatoid arthritis, cancer, prescribed and non-prescribed analgesics. CRP-Medium was associated with rheumatoid arthritis, CRP-Heavy with rheumatoid arthritis and lung diseases and CWSP with rheumatoid arthritis and prescribed analgesics (P < 0.001).

Our findings elucidate heterogeneity of pain in elderly which has to be further investigated.

The authors have not supplied their declaration of competing interest.

There is a lack of research on subtypes of chronic pain (CP) characteristics in the elderly.

To scrutinize major subgroups based on pain aspects and psychological factors on an elderly population.

To determine possible differences between the derived subgroups with respect to pain aspects and anxiety-depression symptoms, health aspects and health care costs.

A cross-sectional study was implemented. A large sample of 2300 individuals (M = 75.9 years, SD = 7.4) participated. Self-reported postal measurements regarding pain intensity, spreading of pain, anxiety and depression (General well-being schedule [GWBS]), and pain catastrophizing [PCS]) were used as classification variables. A two-step cluster analysis was employed. We further investigated whether the derived subgroups experienced different quality of life and general health. Calculations regarding health care costs were also performed.

Two major subgroups were identified: one low symptom severity subgroup (Cluster 1; n = 1326; 58%) and one high symptom severity subgroup (Cluster 2; n = 974; 42%). There were statistical significant differences on pain intensity, spreading of pain, anxiety, depression and pain catastrophizing between the two subgroups (P < 0.001). Significant lower levels for quality of life and general health (P < 0.001) were found for the high symptom severity subgroup. Health care costs in the high symptom severity subgroup were significantly higher than those of the low symptom severity subgroup (P < 0.001).

Our findings exhibit the necessity for subgroup-specific treatment services for improving pain management and reducing health care costs in the elderly.

The authors have not supplied their declaration of competing interest.

Ziconotide is a new class of non-opioid analgesic that selectively blocks the neuron-specific (N-type), voltage-gated calcium channels, preventing the release of substance P and calcitonin gene-related peptide.

A literature search was conducted in September 2015 using Pubmed and Scopus databases. No articles speaking about the direct correlation between ziconotide and amnesia were found.

A 56-year-old female patient, in treatment with ziconotide for chronic phantom pain syndrome, reported amnesia and dysgeusia symptoms. No psychiatric pathologies were diagnosed except for the high anxiety state correlated to the amnesia for recent events. The ziconotide treatment was reduced from 2,4 μg/day to 1,5 μg/day. Clonazepam was prescribed to treat the anxiety state. The subject clinical conditions did not require hospitalization.

It is recommended that patients in treatment with ziconotide be monitored for changes in mood, suicidality ideation, thoughts or consciousness. Ziconotide could have serious neurological or psychiatric signs/symptoms (Table 1). Amnesia is a rare side effect of intrathecal administration of ziconotide. Severe psychiatric adverse effects may require ziconotide discontinuation, treatment with psychotropic agents and/or acute hospitalization.

The authors have not supplied their declaration of competing interest.

Maxillofacial surgeons and dentists often (up to 10%) deal with the phenomenon of atypical facial pain (AFP) – painful condition of maxillofacial area without clear organic pathology. Psychiatric studies of this disorder are almost lacking.

The aim of this study was to define psychopathological disorders in patients with AFP and to set up psychopharmacological treatment strategies.

The study used clinical psychopathological and psychometric (Pain measurement scales: Brief Pain Inventory, VAS, Pain Catastrophizing Scale) methods. We included patients with AFP examined in the clinic in December 2014 - September 2015.

Study sample consists of 54 patients with AFP: 45 women (83.3%), 9 men (16.7%), 18-70 years old (39.5 ± 14.7 years). In 67.8% of patients (33 women, 4 men), AFP was associated with affective disorders; among them, recurrent major depressive disorder was verified in 9.2% (4 women, 1 men), single depressive episode – in 33.6% (15 women, 3 man), bipolar II depression – in 3.6% (2 women), cyclothymic disorder – in 7.1% (4 women), dysthymia – in 14.3% (8 women). In 10.8% of patients (6 women), AFP was considered as a symptom of somatoform pain disorder. In 21.4% (6 women, 5 men), AFP was related with schizotypal personality disorder. Psychopharmacological agents used were SSRIs (fluvoxamine, escitalopram), SNRIs (venlafaxine, duloxetine), agomelatine and antipsychotics (quetiapine, amisulpride, alimemazine). The pain subsides in 87,04% of patients and the severity of pain decreased in 12.96% of patients.

Patients with AFP should be examined by psychiatrist in order to determine psychopathological disorders and to elaborate psychopharmacological treatment strategies.

The authors have not supplied their declaration of competing interest.

It is known for a fact that a number of psychological factors may affect heart pain perception in patients with coronary artery disease (CAD). However, psychosemantics of pain in CAD patients was hardly ever explored.

To study the features of pain psychosemantics in CAD patients.

There were applied McGill Pain Questionnaire (Melzack, 1975); the psychosemantic technique “Classification of sensations” (Tkhostov, Efremova, 1989); the 20-item Toronto Alexithymia Scale (Bagby, Taylor, Parker, 1994); and State-Trait Anxiety Inventory (Spielberger et al., 1983). Fifty-four CAD patients took part in the study, the mean age was 55.9 ± 7.6 years. CAD duration was 5.8 ± 2.6 years.

CAD patients with the high level of trait anxiety (28%) choose greater variety of descriptors for pain definition, revealing an impaired ability to differentiate between emotional states and physical sensations. They show higher scale values for McGill Pain Questionnaire. Patients with high indices of alexithymia (31%) require significantly fewer words for description of painful and dangerous perceptions within the “Classification of sensations”. This may testify to a certain bafflement in verbal description of the pain. With that, intensity of alexithymia does not correlate significantly with the high level of state and trait anxiety (P > 0.05). The method of “Classification of sensations” revealed that patients with trait anxiety, as well as those with alexithymia, define the pain with significantly more numerous metaphorical and affective descriptors (Pervichko, Zinchenko, 2013).

Received results prove an important role of psychological factors in etiology of chest pain in CAD patients with the high level of trait anxiety and alexithymia, which supports the urgency of psychotherapy for them.

References not available.

The authors have not supplied their declaration of competing interest.

Magnesium is an endogenous voltage-dependent NMDA receptor channel blocker and ketamine is a non-competitive NMDA receptor antagonist. Magnesium may potentiate the effect of ketamine in analgesia and anaesthesia, but may also interact in an opposing manner. This study aimed at evaluating type of the interaction between magnesium sulphate and ketamine administered systemically in rats with an acute nociceptive pain (tail-immersion test).

Analgesic activity was assessed by tail-immersion test in male Wistar rats (200-250 g). The distal 5 cm of the tail was immersed in a warm water bath (55 ± 0.5 °C) and the time for tail-withdrawal was measured as response latency.

Magnesium sulphate (2.5–30 mg/kg, s.c.) and ketamine (2.5-30 mg/kg, i.p.) administered alone did not produce any effect. However, significant antinociception (synergistic interaction) was revealed at the following doses of ketamine: magnesium sulphate of 5:5 mg/kg, 2.5:5 mg/kg and 10:5 mg/kg. The effect was not dose-dependent, and a greater response was obtained when ketamine was administered before magnesium sulphate.

This study revealed that (1) magnesium sulphate and ketamine given alone were not effective against acute nociceptive pain in rats, but (2) a combination of both drugs resulted in synergistically inhibited nociception, (3) which occurred only at selected low doses and proportions of the medications in a combination and (4) suggested the importance of the order of drug administration.

The authors have not supplied their declaration of competing interest.

To assess effect of pelvic tilt by birth ball, sacrum-perinea heat therapy and combination use of them on active phase of physiologic labor.

In this randomized control trial, 120 primiparous volunteer with age 18-35 years, gestational age of 38–40 weeks, in one of hospitals of Iran university of medical sciences were randomly selected and divided in four groups: Pelvic tilt by using birth ball, sacrum perinea heat therapy, combined use of two mentioned methods and control group. Tools had 3 main parts of personal characteristic, client examination form and pain visual analogue scale (VAS). All ethical points were considered.

Equality of four groups had been checked before intervention. Lowest pain score first belong to pelvic tilt by birth ball then combined group and finally in heat therapy, which all were significantly less than control group. Significant decrease of pain had been seen in birth ball group and combined group during after 30 minutes intervention, but in the heat therapy group, it was seen after 60 minutes intervention (P-value < 0.05).

All three interventions of this study had significant effect and decreased labor pain during active phase, but highest decrease was in pelvic tilt by birth ball group and its effect started after 30 minutes intervention. It is suggested that that Obstetrics and Midwives consider these safe methods for labor pain management.

The authors have not supplied their declaration of competing interest.

Hofstede's model of cultural dimensions has become the most widely accepted and most frequently cited model for cross-cultural research. His cultural dimensions included power distance index (PDI), individualism vs. collectivism (IDV), masculinity vs. femininity (MAS), uncertainty avoidance index (UAI), and long-term vs. short-term orientation (LTO).

The objective of this study is to explore gender related differences in the Hofstede's five dimensions of national culture for work-related values among a sample from Kuwait.

The participants were 540 first year secondary school Kuwaiti teachers (270 males: mean age = 28.95 ± 2.47; 270 females: mean age = 28.20 ± 2.04). The Arabic version of the Values Survey Module, VSM 08 was administered to participants. Data analysis include independent sample t-test was used to examine gender differences in Hofstede's five dimensions of national culture.

Internal consistency was satisfactory for the Power Distance, Individualism vs. Collectivism, Masculinity vs. Femininity, Uncertainty Avoidance, and Long-term vs. Short-term Orientation subscales respectively (Cronbach's alpha = 0.82, 0.84, 0.90, 0.74, 0.87) for males and (Cronbach's alpha = 0.77, 0.90, 0.83, 0.80, 0.88) for females. The results revealed significant gender differences where the males obtained a higher score than females on individualism (t = 2.95, P < 0.002), and masculinity (t = 2.77, P < 0.005), while females obtained a higher score than males on power distance (t = 4.48, P < 0.000), and long-term orientation (t = 4.13, P < 0.000).

These findings suggest that the gender differences exist for cultural dimensions, and provide insight on leadership characteristics.

The authors have not supplied their declaration of competing interest.

Recent studies suggest that Borderline Personality Disorder (BPD) could be regarded as an affective disorder within the Bipolar Affective Disorder (BP) spectrum. This is supported by evidence suggesting a clinical/neurobiological overlap between these two disorders. The Temperament and Character Inventory Revised (TCI-R) may help differentiate between the two disorders and orientate the clinical approach, considering the evidence of the medium-term temporal stability of TCI-R in a clinical population.

We present a clinical case diagnosed with BD which underwent testing using TCI-R. TCI-R orientated towards a secondary diagnosis of BPD and the case further received a course of Dialectical Behavior Therapy (DBT) which led to clinical improvement. We therefore study the usefulness of TCI-R in this clinical setting.

To study whether TCI-R may help differentiate between BD and BPD in mood stabilized patients.

Our patient is a 52-year-old married male diagnosed with BD. Considering his clinical features of impulsivity/instability of behaviors and pathological interpersonal relationships, patient was started on individual DBT (fortnightly, 4 months). Psychotropic treatment (paroxetine 30 mg/day, lithium 1000 mg/day, aripiprazole 15 mg/day) was not modified.

TCI-R scores: harm avoidance (100%), novelty seeking (53%), reward dependence (20%), persistence (18%), self-directedness (1%), cooperativeness (2%) and self-transcendence (48%). After 4 months of therapy, the patient improved in distress tolerance, acceptance, behavioral activation and assertiveness.

TCI-R is an inventory for personality traits in which character scores differ markedly between PD and non-PD patients. It is a useful tool in BPD patients orientating the clinician in the differential diagnosis and the treatment approach.

The authors have not supplied their declaration of competing interest.

According to Millon, personality is a “complex pattern of psychological factors, which are mostly unconscious and express themselves automatically in almost every functional dimension of the subject”. It has been described how personality traits can modify the expression of other mental diseases, leading to confusion in diagnosis and treatment of the patient.

Systematic review of the literature in English (PubMed) and clinical history of the patient. Keywords: “recurrent depression disorder”; “schizoid personality”.

To highlight the importance of making an accurate and detailed diagnostic formulation, in patients with both mental and personality disorders.

Sixty-seven-year-old woman, with many psychiatric hospitalizations, secondary to a recurrent depression disorder with psychotic symptoms and schizoid personality disorder. Both psychiatric monitoring and pharmacological treatment have been erratic. Initially, depressive episodes were considered as symptoms of her personality disorder. However, over the years, it was possible to make a more accurate diagnosis and a better treatment adjustment. In this case, lack of adherence is probably due to multiple factors, but no awareness of illness and personality disorder itself are the most important ones. This fact makes the patient less concerned about her personal care, leading to irregular treatment.

People with schizoid, schizotypal or paranoid personality traits usually have a worse outcome, and they interfere with the functionality of the patient. This explains the importance of making an accurate and detailed diagnostic formulation, in order to benefit the course of the underlying mental disorders.

The authors have not supplied their declaration of competing interest.

There is growing evidence of the importance of nutrition in mental disorders. Gut microbiota, influenced by environmental factors such as diet and stress, has been proposed as one of the players on a dynamic called gut-brain axis, which is thought to have an influence on behaviour and mental health.

To summarize recent evidence on the topic, and its potential role in psychiatric interventions.

The authors review updated literature collected from online scientific databases.

The development of the brain itself has been shown to be influenced by the gut microbiome. Research demonstrates that the composition of the microbiota has influence on behaviour through neuroendocrine and other neuroactive messengers production by the bacteria within the gut lumen. Studies in germ-free animals, animals exposed to bacterial infections, probiotic suplements or antibiotic drugs suggest a role for the gut microbiota in the regulation of anxiety, mood, cognition and pain. The gut microbiome has been implicated in brain disorders including anxiety and depression, multiple sclerosis, Alzheimer's disease, Parkinson's disease, and autism.

The treatment of mental disorders is usually based on pharmacological and psychotherapeutic interventions, and little attention is given to dietary interventions. The emerging field of research focused on the human microbiome suggests an important role for the gut microbiota in influencing brain development, behaviour and mood in humans, and points new strategies for developing novel therapeutics for mental disorders.

The authors have not supplied their declaration of competing interest.