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IntroductionMetabolic syndrome (MetS) is defined by metabolic and cardio-vascular impairments and is frequently associated with anxiety and depressive disorders. Both MetS and anxiety-depressive syndromes feature similar systemic inflammatory alterations. Inflammation of the large bowel is also a key factor for the development of colorectal cancer (CRC).ObjectiveTo measure the prevalence of MetS and symptoms of anxiety and depression among patients undergoing colonoscopy.MethodsCross-sectional study. Patients undergoing colonoscopy aged 40 or more, with negative history for neoplasia or inflammatory bowel disease, were enrolled. Data collected: colonoscopy outcome, presence/absence of MetS (IDF and ATP III criteria), presence/absence of depressive and anxiety symptoms assessed with HADS.ResultsThe sample was made up of 53 patients (female 24, 45.3%). Mean age was 60.66 ± 9.08. At least one adenoma was found to 23 patients (43.3%). Prevalence of MetS ranged from 34% to 36% (ATP III and IDF criteria, respectively). Prevalence of depressive and anxiety symptoms was 20% and 33%, respectively.ConclusionPrevalence of MetS, anxiety and depressive symptoms among patients undergoing colonoscopy was higher than in the general population.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Burn-Out (BO) is commonly described as a growing situation of work stress and conceptualized as a combination of emotional exhaustion, depersonalization/cynicism and reduced personal efficacy. Some professionals are exposed to a higher risk, depending on their specific work mansions (most typically the so called helping professions) and on personal and contextual conditions. Evidence from scientific literature has confirmed that being younger and working in the field of mental health are very significant risk factors for BO. Furthermore, BO is an essential target for preventive strategies: prevention of BO, rather than treatment of potential psychopathological consequences, has been proved to be more effective and cost-effective, though unfortunately very often disregarded or left to individual initiatives.Physical activity, diet, and other features of a healthy life-style are core targets of interventions aimed at prevention of BO. Increasing evidence is collected on the effectiveness of mindfulness-based techniques and yoga. Supervision, and more specifically Balint-inspired models of group case discussions. Scientific and professional associationism is also effective as a strategy to avoid isolation. Finally, interventions aimed at improving work organization, targeting logistic aspects (eg. Time schedules), infrastructures (eg. Parking places) or dynamics and human interactions, are also essential and effective.Disclosure of interestThe authors have not supplied their declaration of competing interest.

IntroductionAnxiety disorders and Cardiovascular (CV) diseases, among the most common disorders in Western World, are often comorbid. A chronic systemic inflammatory state might be a shared underlining pathophysiological mechanism.AimsTo investigate the association between anxiety symptoms, CV risks factors and inflammatory markers in an outpatient sample.MethodsCross-sectional study. Inclusion criteria: outpatients aged ≥40 years, attending colonoscopy after positive faecal occult blood test, negative medical history for cancer. Collected data: blood pressure, glycaemia, lipid profile, waist circumference, BMI, PCR (C Reactive Protein), LPS (bacterial Lipopolysaccharide). Psychometric tests: HADS, TCI, IMSA, SF36. Statistical analysis performed with STATA13.ResultsFifty four patients enrolled (27 males, 27 females). Sixteen patients (30.19%) were positive for anxiety symptoms. Thirty-three patients (61.11%) had hypertension, 14 (25.93%) hyperglycaemia and 64.81% were overweight, with frank obesity (BMI≥ 30) in 11 subjects (20.37%). Anxiety symptoms were associated with low hematic HDL values (OR = 0.01; P = 0.01) and high concentration of triglycerides (OR = 0.023; P = 0.02) at the multiple regression model. At the univariate logistic analysis, anxiety was associated with LPS (OR = 1.06; P = 0.04).ConclusionsFurther evidence over the epidemiological link between common mental disorders and CV diseases was collected, with possible hints on pathophysiology and causative mechanisms related to inflammation. The importance of screening for anxiety and depression in medical populations is confirmed. Suggestions on future availability of screening tools based on inflammatory-related indicators should be the focus of future research.Disclosure of interestThe authors have not supplied their declaration of competing interest.

IntroductionSeveral studies have shown an association between the Short-Form 36 (SF36) scores and anxiety-depressive symptoms, suggesting that depression in particular could reduce Quality of Life (QoL) to the same, and even greater, extent than chronic non-communicable diseases, such as diabetes and hypertension.AimsTo explore the relationship among QoL and anxiety, depressive and anxiety-depressive symptoms in an outpatient sample.MethodsCross-sectional study. Inclusion criteria: outpatients aged ≥40 years, without history for cancer, attending colonoscopy after positive faecal occult blood test. Collected data: blood pressure, blood glucose, lipid profile. Psychometric test: Hospital Anxiety and Depression Scale (HADS). QoL was assessed with SF36. Statistics performed with STATA13.Results54 patients enrolled (27 females). Sixteen patients (30.2%) were positive for anxiety symptoms, ten (18.9%) for depressive symptoms and five (9.4%) for anxiety-depressive symptoms. The perceived QoL was precarious in twelve subjects (22.2%): eight (15.9%) had low score (≤ 42) at “Mental Component Summary” (MCS) subscale, three (5.7%) at the “Mental Health” item and one patient (1.9%) at the “Vitality” one. At the multiple regression analysis, depressive (OR = 28.63; P = 0.01) and anxiety-depressive symptoms (OR = 11.16; P = 0.02) were associated with MCS.ConclusionsThe association emerging from the present study between depressive/anxiety symptoms and the MCS component of SF36 is consistent with available literature. Study design and small sample size do not allow to generalize results, that need further studies to be confirmed.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Introduction Eating Disorders (ED), including obesity, with and without Metabolic Syndrome (MetS), are associated with anxiety and depression. Increased levels of cytokines and their consequences on the pathway of kynurenine (KYN), the main metabolite of tryptophan, have been proposed to account for these associations. Aim To review the evidences suggesting biochemical connections between the Depression and Anxiety Spectrum (DAS), MetS and ED, respectively, focusing on the role of the KYN pathway. Methods Three PubMed searches of the literature conducted in October 2013 (key words:‘kynurenine’ ‘eating disorders’; ‘kynurenine’ ‘waist circumference’; ‘kynurenine’‘obesity’‘metabolic syndrome’) provided 2, 3 and 7 references, respectively. Results The metabolism of L-tryptophan through the KYN pathway depends on the following three factors: 1) NUTRITION; in underweight ED LKYN metabolites (quinolinic acid, kynurenic acid, 5-hydroxyindoleacetic acid) are significantly reduced until the restoration of normal body weight. In overweight and obesity with and without MetS, increased KYN levels and KYN/tryptophan ratio are found, with abdominal fat content as strongest factor for an increase of the KYN/TRP ratio. 2) AGE; KYN/TRP ratios are markedly increased vs. decreased in overweight and obese adults vs. juveniles, respectively. 3) INFLAMMATION; IFN-gamma induces the indoleamine 2,3- dioxygenase (IDO)-catalyzed synthesis of KYN, whose derivatives increase in diabetes (xanturenic acid), psychosis (kynurenic acid), and depression (quinolinic acid). Conclusions The KYN pathway may link DAS, MetS and ED explaining the frequent association of DAS to so many different disorders. Further studies are needed in order to understand these complex connections.