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Sesso G, Brancati GE, Masi G. Comorbidities in Youth with Bipolar Disorder: Clinical Features and Pharmacological Management. Curr Neuropharmacol 2023; 21:911-934. [PMID: 35794777 PMCID: PMC10227908 DOI: 10.2174/1570159x20666220706104117] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 04/14/2022] [Accepted: 06/13/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Bipolar Disorder (BD) is a highly comorbid condition, and rates of cooccurring disorders are even higher in youth. Comorbid disorders strongly affect clinical presentation, natural course, prognosis, and treatment. METHODS This review focuses on the clinical and treatment implications of the comorbidity between BD and Attention-Deficit/Hyperactivity Disorder, disruptive behavior disorders (Oppositional Defiant Disorder and/or Conduct Disorder), alcohol and substance use disorders, Autism Spectrum Disorder, anxiety disorders, Obsessive-Compulsive Disorder, and eating disorders. RESULTS These associations define specific conditions which are not simply a sum of different clinical pictures, but occur as distinct and complex combinations with specific developmental pathways over time and selective therapeutic requirements. Pharmacological treatments can improve these clinical pictures by addressing the comorbid conditions, though the same treatments may also worsen BD by inducing manic or depressive switches. CONCLUSION The timely identification of BD comorbidities may have relevant clinical implications in terms of symptomatology, course, treatment and outcome. Specific studies addressing the pharmacological management of BD and comorbidities are still scarce, and information is particularly lacking in children and adolescents; for this reason, the present review also included studies conducted on adult samples. Developmentally-sensitive controlled clinical trials are thus warranted to improve the prognosis of these highly complex patients, requiring timely and finely personalized therapies.
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Affiliation(s)
- Gianluca Sesso
- IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiat., Calambrone (Pisa), Italy
| | | | - Gabriele Masi
- IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiat., Calambrone (Pisa), Italy
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Comparison of Emotional Dysregulation Features in Cyclothymia and Adult ADHD. ACTA ACUST UNITED AC 2021; 57:medicina57050489. [PMID: 34066126 PMCID: PMC8151096 DOI: 10.3390/medicina57050489] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 04/20/2021] [Accepted: 05/10/2021] [Indexed: 01/16/2023]
Abstract
Background and Objectives: Emotional dysregulation is central to the problem of the overlap between attention-deficit/hyperactivity disorder (ADHD) and cyclothymia. The aim of the study was to evaluate comorbidity rates between ADHD and cyclothymic disorder and to explore demographic and clinical differences among the groups, focusing on affective temperament and emotional dysregulation. Materials and Methods: One hundred sixty-five outpatients attending the Second Psychiatry Unit at the Santa Chiara University Hospital (Pisa) were consecutively recruited: 80 were diagnosed with ADHD, 60 with cyclothymic disorder, and 25 with both conditions. Temperament Evaluation of Memphis, Pisa, Paris, and San Diego (TEMPS-M) and the 40-item version of Reactivity, Intensity, Polarity, and Stability questionnaire (RI-PoSt-40) were administered. Results: Cyclothymic patients were more frequently female and older with respect to the ADHD groups. Both comorbid and non-comorbid ADHD patients showed significantly lower educational attainment and more frequently had substance use disorders. Panic disorder was common in non-comorbid cyclothymic patients, who showed significantly higher rates of familial panic disorder, major depressive disorder and suicide attempts in comparison with patients only diagnosed with ADHD. Cyclothymic patients without ADHD were also characterized by fewer hyperthymic temperamental traits, higher depressive and anxious dispositions, and a greater negative emotionality. No significant differences among groups were observed for cyclothymic temperament and overall negative emotional dysregulation, but comorbid patients with both conditions scored the highest in these subscales. This group also showed significantly higher affective instability with respect to ADHD patients without cyclothymia and was less frequently diagnosed with bipolar disorder type II than patients from both the other groups. Conclusions: ADHD and cyclothymia often co-occur and show similar levels of emotional dysregulation. However, cyclothymic patients may be more prone to negative emotionality in clinical settings. Subjects with “sunny” cyclothymic features might escape the attention of clinicians unless ADHD is present.
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Gehlawat P, Mahal P, Gupta T. Atypical presentation of bipolar disorder in adolescent. ARCHIVES OF MENTAL HEALTH 2020. [DOI: 10.4103/amh.amh_40_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Eriksen S, Bjørkløf GH, Helvik AS, Larsen M, Engedal K. The validity of the hospital anxiety and depression scale and the geriatric depression scale-5 in home-dwelling old adults in Norway ✰. J Affect Disord 2019; 256:380-385. [PMID: 31212233 DOI: 10.1016/j.jad.2019.05.049] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 03/20/2019] [Accepted: 05/27/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Little is known about the validity of the Norwegian versions of the Geriatric Depression Scale-5 (GDS-5) and the Hospital Anxiety and Depression Scale-D (HADS-D). The aim of this study was therefor to validate the two assessment tools in a population of home-dwelling persons of 60 years of age and above. METHODS A sample of 194 home-dwelling old adults with and without depressive symptoms were recruited. The participants were examined for depressive symptoms (GDS-5, HADS-D) and cognitive impairment. Sociodemographic information was collected. The participants underwent a blinded diagnostic evaluation for a depressive episode according to the diagnostic criteria of ICD-10. RESULTS In all, 56 (28.9%) participants fulfilled criteria for a depressive episode according to ICD-10. The Receiver Operating Characteristics analyses of HAD-D and GDS-5 using the diagnostic criteria of ICD-10 for depression as gold standard was performed. For GDS-5 the Areal under the Curve was 0.81 and for HAD-D 0.75. The cut-off points of the measures that produced the highest accuracies were ≥2 for GDS-5 with a sensitivity of 73.2% and a specificity of 73.2% and ≥4 for HADS-D with a sensitivity of 70.3% and a specificity of 69.6%. LIMITATIONS A larger sample would have given the opportunity for analyzing home dwelling old adults with and without home health care separately. The participants were talked through the self-filling questionnaires. The procedure could have influenced the participants' answers. CONCLUSION GDS-5 and HADS-D are useful screening tools for old adults, but only fairly good to identify depression according to criteria of ICD-10.
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Affiliation(s)
- S Eriksen
- Norwegian National Advisory Unit on Ageing and Health, Postboks 2136, N-3103 Tønsberg, Norway.
| | - G H Bjørkløf
- Norwegian National Advisory Unit on Ageing and Health, Postboks 2136, N-3103 Tønsberg, Norway
| | - A-S Helvik
- Norwegian National Advisory Unit on Ageing and Health, Postboks 2136, N-3103 Tønsberg, Norway; Department of Public Health and General Practice, Norwegian University of Science and Technology, Postboks 8905, N-7491 Trondheim, Norway
| | - M Larsen
- Department of Geriatric Psychiatry, Diakonhjemmet, Oslo, Postboks 23, Vinderen, N-0319 Oslo, Norway
| | - K Engedal
- Norwegian National Advisory Unit on Ageing and Health, Postboks 2136, N-3103 Tønsberg, Norway
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Bjørkløf GH, Engedal K, Selbæk G, Maia DB, Borza T, Benth JŠ, Helvik AS. Can depression in psychogeriatric inpatients at one year follow-up be explained by locus of control and coping strategies? Aging Ment Health 2018; 22:379-388. [PMID: 28051894 DOI: 10.1080/13607863.2016.1262817] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Treatment of depression (in late life) is good. The short-term, but not long-term prognosis after treatment of depression in late life is good. To identify modifiable factors, we wanted to examine whether coping in terms of locus of control and coping strategies in depressed patients were associated with the prognosis of depression at follow-up, adjusted for sociodemographic information and health variables. METHOD In total, 122 patients (mean age 75.4 years; SD = 6.6) were followed up (median 13.7 months, Q1-Q3 386-441) with a diagnostic evaluation(ICD-10) for depression and assessment of depressive symptoms (MADRS). Coping was assessed using Locus of Control of behavior (LoC-scale) and Ways of Coping questionnaire (WoC-scale). RESULTS At follow-up, 37.7% were diagnosed with a depressive episode. A stronger external LoC and lower MMSE-NR score at baseline were in adjusted linear regression analysis significantly more associated to higher depressive symptom scores (MADRS). More use of problem-focused coping, a lower I-ADL functioning, but not emotion-focused coping at baseline were significantly associated with being depressed (ICD-10), at follow-up in adjusted logistic regression analysis. CONCLUSION LoC and coping strategies at baseline were associated with the prognosis of depression at follow-up, and may further be studied as indicators for choice of baseline intervention strategies.
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Affiliation(s)
- Guro Hanevold Bjørkløf
- a Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust , Tønsberg , Norway.,b Department for Mental Health Research and Development, Division for Mental Health and Addiction , Vestre Viken Hospital Trust , Lier , Norway.,c Institute of Health and Society, Faculty of Medicine , University of Oslo , Oslo , Norway
| | - Knut Engedal
- a Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust , Tønsberg , Norway
| | - Geir Selbæk
- a Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust , Tønsberg , Norway.,d Centre for Old Age Psychiatric Research Innlandet Hospital Trust , Ottestad , Norway.,e National School of Public Health, Fundação Oswaldo Cruz , Rio , Brazil
| | - Deborah Bezerra Maia
- f Department of Public Health and General Practice, Faculty of Medicine , Norwegian University of Science and Technology (NTNU)
| | - Tom Borza
- d Centre for Old Age Psychiatric Research Innlandet Hospital Trust , Ottestad , Norway
| | - Jūratė Šaltytė Benth
- g St Olav's University Hospital , Trondheim , Norway.,h Institute of Clinical Medicine, Campus Ahus, University of Oslo , Norway
| | - Anne-Sofie Helvik
- a Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust , Tønsberg , Norway.,i HØKH, Research Centre , Akershus University Hospital , Norway
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[Differences in Subjective Experience Between Unipolar and Bipolar Depression]. ACTA ACUST UNITED AC 2016; 45:162-9. [PMID: 27569010 DOI: 10.1016/j.rcp.2015.09.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2015] [Revised: 08/09/2015] [Accepted: 09/25/2015] [Indexed: 11/22/2022]
Abstract
INTRODUCTION It is important to make distinction between bipolar and unipolar depression because treatment and prognosis are different. Since the diagnosis of the two conditions is purely clinical, find symptomatic differences is useful. OBJECTIVES Find differences in subjective experience (first person) between unipolar and bipolar depression. METHODS Phenomenological-oriented qualitative exploratory study of 12 patients (7 with bipolar depression and 5 with unipolar depression, 3 men and 9 women). We used a semi-structured interview based on Examination of Anomalous Self-Experience (EASE). RESULTS The predominant mood in bipolar depression is emotional dampening, in unipolar is sadness. The bodily experience in bipolar is of a heavy, tired body; an element that inserts between the desires of acting and performing actions and becomes an obstacle to the movement. In unipolar is of a body that feels more comfortable with the stillness than activity, like laziness of everyday life. Cognition and the stream of consciousness: in bipolar depression, compared with unipolar, thinking is slower, as if to overcome obstacles in their course. There are more difficult to understand what is heard or read. Future perspective: in bipolar depression, hopelessness is stronger and broader than in unipolar, as if the very possibility of hope was lost. CONCLUSIONS Qualitative differences in predominant mood, bodily experience, cognition and future perspective were found between bipolar and unipolar depression.
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Bjørkløf GH, Engedal K, Selbæk G, Maia DB, Coutinho ESF, Helvik AS. Locus of control and coping strategies in older persons with and without depression. Aging Ment Health 2016; 20:831-9. [PMID: 25955293 DOI: 10.1080/13607863.2015.1040722] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To compare locus of control and coping strategies in older persons with and without depression. METHOD This cross-sectional study included 144 depressed in-patients from seven psychogeriatric hospital units, and 106 community-dwelling older persons without depression. All participants were 60 years and older. Locus of control was assessed by a 17-items self-report questionnaire with six response categories. Coping strategies were assessed by a 26-items self-report questionnaire with five response categories. For analytical purposes, age (<75 years vs. ≥75 years), level of education (<10 years vs. ≥10 years) and general medical health (poor vs. not poor) were categorized. RESULTS In linear regression analysis, controlling for demographics, health, and social variables, the depressed in-patients showed a higher external locus of control orientation and a less frequent use of problem-focused coping strategies compared with the non-depressed group. No differences in use of emotion-focused strategies were found between the two groups. CONCLUSION Compared with the non-depressed old persons, the depressed hospitalized older persons were characterized by perceptions of less personal control, and less use of problem-focused strategies, what also might have brought positive alterations into their situation.
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Affiliation(s)
- Guro Hanevold Bjørkløf
- a Ageing and Health, Norwegian Centre for Research, Education and Service Development , Vestfold Hospital Trust , Tønsberg , Norway.,b Department for Mental Health Research and Development, Division for Mental health and Addiction , Vestre Viken Hospital Trust , Lier , Norway.,c Faculty of Medicine , University of Oslo , Oslo , Norway
| | - Knut Engedal
- a Ageing and Health, Norwegian Centre for Research, Education and Service Development , Vestfold Hospital Trust , Tønsberg , Norway
| | - Geir Selbæk
- a Ageing and Health, Norwegian Centre for Research, Education and Service Development , Vestfold Hospital Trust , Tønsberg , Norway.,d Research Center of Old Age Psychiatry , Innlandet Hospital Trust , Ottestad , Norway.,e Akershus University Hospital , Lørenskog , Norway
| | - Deborah Bezerra Maia
- f National School of Public Health, Fundação Oswaldo Cruz (ENSP-FIOCRUZ) , Rio , Brazil
| | | | - Anne-Sofie Helvik
- a Ageing and Health, Norwegian Centre for Research, Education and Service Development , Vestfold Hospital Trust , Tønsberg , Norway.,g Department of Public Health and General Practice, Faculty of Medicine , Norwegian University of Science and Technology (NTNU) , Trondheim , Norway.,h St Olav's University Hospital , Trondheim , Norway
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Helvik AS, Corazzini K, Selbæk G, Bjørkløf GH, Laks J, Šaltytė Benth J, Østbye T, Engedal K. Health-related quality of life in older depressed psychogeriatric patients: one year follow-up. BMC Geriatr 2016; 16:131. [PMID: 27388445 PMCID: PMC4936227 DOI: 10.1186/s12877-016-0310-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Accepted: 06/17/2016] [Indexed: 11/16/2022] Open
Abstract
Background Knowledge about long-term change in health related quality of life (HQoL) among older adults after hospitalization for treatment of depression has clinical relevance. The aim was firstly to describe the change of HQoL one year after admission for treatment of depression, secondly to explore if improved HQoL was associated with remission of depression at follow-up and lastly to study how HQoL in patients with remission from depression were compared to a reference group of older persons without depression. Method This study had the one year follow-up information of 108 older patients (≥60 years), all hospitalized for depression at baseline, and a reference sample of 106 community-living older adults (≥60 years) without depression. HQoL was measured using the EuroQol Group’s EQ-5D Index and a visual analog scale (EQ-VAS). Depression and remission were diagnosed according to ICD-10. Socio-demographic variables (age, gender, and education), depressive symptom score (Montgomery-Aasberg Depression Rating Scale), cognitive functioning (Mini Mental State Examination scale), instrumental activities of daily living (the Lawton and Brody’s Instrumental Activities of Daily Living Scale), and poor general physical health (General Medical Health Rating) were included as covariates. Results HQoL had improved at follow-up for the total group of depressed patients, as indicated by better scores on the EQ-5D Index and EQ-VAS. In the multivariate linear regression model, improved EQ-5D Index and EQ-VAS was significantly better in those with remission of depression and those with better baseline physical health. In adjusted analyses, the HQoL in patients with remission from depression at follow-up did not differ from the HQoL in a reference group without depression. Conclusion Older hospital patients with depression who experienced remission one year after admission gained HQoL and their HQoL was comparable with the HQoL in a reference group of older adults without depression when adjusting for differences in socio-demographics and health conditions.
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Affiliation(s)
- Anne-Sofie Helvik
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway. .,St. Olav's University Hospital, Trondheim, Norway. .,Norwegian National Advisory Unit on Aging and Health, Vestfold Health Trust, Tønsberg, Norway.
| | | | - Geir Selbæk
- Norwegian National Advisory Unit on Aging and Health, Vestfold Health Trust, Tønsberg, Norway.,Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, Ottestad, Norway.,Faculty of Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Guro Hanevold Bjørkløf
- Norwegian National Advisory Unit on Aging and Health, Vestfold Health Trust, Tønsberg, Norway
| | - Jerson Laks
- Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.,Post Graduation Program in Translational Medicine, Universidade do Grande Rio (Unigranrio), Rio de Janeiro, Brazil
| | - Jūratė Šaltytė Benth
- Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, Ottestad, Norway.,Institute of Clinical Medicine, Ahus Campus, University of Oslo, Oslo, Norway.,Research Centre, HØKH, Akershus University Hospital, Lørenskog, Norway
| | | | - Knut Engedal
- Norwegian National Advisory Unit on Aging and Health, Vestfold Health Trust, Tønsberg, Norway
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Helvik AS, Bjørkløf GH, Corazzini K, Selbæk G, Laks J, Østbye T, Engedal K. Are coping strategies and locus of control orientation associated with health-related quality of life in older adults with and without depression? Arch Gerontol Geriatr 2016; 64:130-7. [DOI: 10.1016/j.archger.2016.01.014] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 01/15/2016] [Accepted: 01/26/2016] [Indexed: 11/26/2022]
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Lövdahl H, Bøen E, Malt EA, Malt UF. Somatic and cognitive symptoms as indicators of potential endophenotypes in bipolar spectrum disorders: an exploratory and proof-of-concept study comparing bipolar II disorder with recurrent brief depression and healthy controls. J Affect Disord 2014; 166:59-70. [PMID: 25012411 DOI: 10.1016/j.jad.2014.04.056] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2013] [Revised: 04/21/2014] [Accepted: 04/24/2014] [Indexed: 12/17/2022]
Abstract
BACKGROUND We examined whether somatic symptoms reported by patients with bipolar spectrum disorder (BSD), in this study defined as bipolar II (BD-2) or recurrent brief depression with (RBD-H) or without (RBD-O) a history of hypomanic symptoms might point to the possible underlying disease markers (endophenotypes). We hypothesized that somatic symptoms that are possible indirect indicators of endophenotypes should be more prevalent among patients than among healthy controls; should not correlate with neuroticism; should not correlate with the severity of current mental status (e.g., anxiety, depression); and should not correlate with the use of psychotropic drugs including antiepileptics or be explained by co-morbid medical diseases. METHODS Sixty-one patients (BD-2: n=21; RBD-H: n=19; RBD-O: n=21) were compared with 21 healthy controls. Assessments included a 123-item somatic symptom checklist; assessments for neuroticism, anxiety and depression. Candidate somatic symptoms were selected using a 4-step inclusion/exclusion procedure. RESULTS Seven symptoms survived in all three groups: general (fatigue, feeling exhausted); sensory (leaden sensation in legs, pain in the body, impaired sense of smell); cognitive (loss of memory) and autonomic (excessive perspiration). In addition 15 symptoms survived in one or two groups (examples: impaired hearing, hypersensitivity to sound, inability to find words). LIMITATIONS Possible selection bias and small sample size precludes firm conclusions with regards to specific symptoms. CONCLUSION Our approach identified symptoms for which an association with BSDs has been suggested previously, as well as symptoms not commonly associated with BSDs. The findings support the feasibility and validity of using assessment of somatic symptoms as an approach to identify potential endophenotypes in BSDs.
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Affiliation(s)
- H Lövdahl
- Department of Psychosomatic Medicine, Division of Surgery & Neuroscience, Oslo University Hospital-Rikshospitalet, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Clinical Psychiatry, Sørlandet Hospital, Arendal, Norway.
| | - E Bøen
- Department of Psychosomatic Medicine, Division of Surgery & Neuroscience, Oslo University Hospital-Rikshospitalet, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Normood (Norwegian Research Network on Mood Disorders), Norway
| | - E A Malt
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Adult Habilitation, Akershus University Hospital and Institute of Clinical Medicine, Campus Akershus University Hospital, University of Oslo, Norway
| | - U F Malt
- Department of Psychosomatic Medicine, Division of Surgery & Neuroscience, Oslo University Hospital-Rikshospitalet, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Normood (Norwegian Research Network on Mood Disorders), Norway
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Korsnes MS, Lövdahl H, Andersson S, Björnerud A, Due-Tönnesen P, Endestad T, Malt UF. Working memory in recurrent brief depression: an fMRI pilot study. J Affect Disord 2013; 149:383-92. [PMID: 23510545 DOI: 10.1016/j.jad.2013.02.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Revised: 02/12/2013] [Accepted: 02/12/2013] [Indexed: 01/17/2023]
Abstract
BACKGROUND We examined women with recurrent brief depression (RBD) with and without episodes of hypomania with an n-back working memory paradigm to assess how working memory load affects the neurological network corresponding to working memory for these groups. METHOD Participants (n=33) were medication-free and mostly euthymic while performing a 1-back and a 2-back task in the fMRI scanner. Differential activation results between the tasks were assessed globally and within seven predefined regions of interest associated with working memory activation. The patient groups were compared with healthy women and matched for age, handedness, and length of education. RESULTS Poor task modulation was observed in both RBD groups in the prefrontal cortex (BA9) in the 1-back task and activation during the 2-back task, particularly in a subgroup with a history of brief hypomanic episodes (RBD-H) compared with the subgroup without such episodes (RBD-O). Task modulation in the right parahippocampal gyrus (BA27) distinguished the RBD-O group, and task modulation in the right insula clearly distinguished the RBD-H group. LIMITATIONS Small sample size and recruitment of most patients through media that may induce a selection bias towards better-functioning subjects. CONCLUSION The observed lack of deactivation within the right insula has also been reported in patients with bipolar I disorders. Activation differences in BA9 and the parahippocampal region between RBD patients with and without a history of hypomania suggest different functional hypersensitivity of early limbic regions and ability to sustain attention and working memory, respectively, possibly identifying functional differences between the two subgroups.
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Carta MG, Angst J, Moro MF, Mura G, Hardoy MC, Balestrieri C, Chessa L, Serra G, Lai ME, Farci P. Association of chronic hepatitis C with recurrent brief depression. J Affect Disord 2012; 141:361-6. [PMID: 22609196 DOI: 10.1016/j.jad.2012.03.020] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2012] [Revised: 03/12/2012] [Accepted: 03/12/2012] [Indexed: 12/21/2022]
Abstract
BACKGROUND Depressive syndromes, including recurrent brief depression (RBD), have frequently been observed in association with chronic diseases characterized by immune activation, such as autoimmune thyroiditis or celiac disease. However, the association of RBD with chronic hepatitis C (CHC), a disease with an increased incidence of major depressive disorders, is unknown. CASES 135 (83 males, 52 females) consecutive treatment-naïve patients with CHC. EXCLUSION CRITERIA previous treatment with IFN-alpha, co-infection with hepatitis C virus (HCV) and hepatitis B virus, infection with human immunodeficiency virus (HIV), drug or alcohol abuse, or malignancy. CONTROLS 540 (332 males, 208 females) subjects without evidence of hepatitis, randomly extracted from the database of a previous epidemiological study. The psychiatric diagnosis was based on the Composite International Diagnostic Interview Simplified (CIDI-S), containing a specific section on RBD. RESULTS A significantly higher rate of RBD was observed among both male and female patients with CHC (n=21, 15.5%) as compared to controls (n=34, 6.3%) (OR=2.6, CI 95% from 1.37 to 4.93). CONCLUSION The present study provides the first evidence of an association between CHC and RBD, independent of treatment with IFN-alpha and not influenced by substance or alcohol abuse. The results are similar to those found in other conditions with immune activation. RBD may be another expression of mood disorders in such conditions.
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Affiliation(s)
- Mauro G Carta
- Department of Public Health, University of Cagliari, Italy.
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Altamura AC, Buoli M, Dell'osso B, Albano A, Serati M, Colombo F, Pozzoli S, Angst J. The impact of brief depressive episodes on the outcome of bipolar disorder and major depressive disorder: a 1-year prospective study. J Affect Disord 2011; 134:133-7. [PMID: 21737143 DOI: 10.1016/j.jad.2011.06.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2011] [Revised: 06/15/2011] [Accepted: 06/15/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND Brief depressive episodes (BDEs) cause psychosocial impairment and increased risk of suicide, worsening the outcome and long-term course of affective disorders. The aim of this naturalistic observational study was to assess the frequency of BDEs and very brief depressive episodes (VBDEs) and their impact on clinical outcome in a sample of patients with major depressive disorder (MDD) and bipolar disorder (BD). METHOD Seventy patients with a diagnosis of MDD or BD were followed up and monthly visited for a period of 12 months, assessing the eventual occurrence of BDEs and/or VBDEs. Clinical and demographic variables of the total sample and of the groups divided according to the presence of BDEs or VBDEs were collected and compared by one-way ANOVAs. Hamilton Depression Rating Scale 21 items (HDRS), Young Mania Rating Scale (YMRS), Clinical Global Impression (severity of illness) (CGIs) and the Short Form Health Survey (SF-36-item 1) were administered at baseline and logistic regression was performed to evaluate whether baseline scores were predictive of the onset of BDEs or VBDEs. RESULTS BDEs (88.6% of the total sample), VBDEs (44.3% of the total sample) and BDEs+VBDEs (40.0% of the total sample) were found to occur frequently across the sample. BDE patients showed more death thoughts during major depressive episodes (χ(2) = 4.14, df = 1, p = 0.04, Phi = 0.24) compared to patients without BDEs. Indeed VBDE patients showed a higher rate of hospitalization (χ(2) = 5.71, df = 1, p = 0.031, phi = 0.29), a more frequent prescription of a combined treatment (χ(2) = 13.07, df = 7, p = 0.03, phi = 0.43) and higher scores at SF-36 item 1 (F = 6.65, p = 0.01) compared to patients without VBDEs. Finally, higher SF-36 item 1 scores were found to be predictive of VBDEs (odds ratio = 2.81, p = 0.03). DISCUSSION Major depressives, either unipolar or bipolar, with BDEs or VBDEs showed a worse outcome, represented by a more severe psychopathology and higher rates of hospitalization. VBDEs were predicted by a negative subjective general health perception. Studies with larger samples and longer follow-up are warranted to confirm the results of the present study.
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Affiliation(s)
- A Carlo Altamura
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, via Francesco Sforza 35, 20122 Milano, Italy
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Kosmadakis C, Stoléru S, Allilaire JF. Une approche de la phénoménologie de la dépression par l’Entretien Semi-structuré Multiregistres. ANNALES MEDICO-PSYCHOLOGIQUES 2011. [DOI: 10.1016/j.amp.2010.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Présentation de l’Entretien Semi-structuré Multiregistres. ANNALES MEDICO-PSYCHOLOGIQUES 2011. [DOI: 10.1016/j.amp.2010.03.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Lövdahl H, Bøen E, Falkum E, Hynnekleiv T, Malt UF. Temperament and character in patients with bipolar II disorder and recurrent brief depression. Compr Psychiatry 2010; 51:607-17. [PMID: 20965308 DOI: 10.1016/j.comppsych.2010.03.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2009] [Revised: 02/24/2010] [Accepted: 03/07/2010] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES We compared the temperament and character profiles of 21 patients with bipolar II disorder, 40 patients with recurrent brief depression (RBD; at least monthly depressive episodes meeting the diagnostic criteria for major depressive episode except for duration that is less than 2 weeks, typically 2-3 days, without fixed relation to menstrual cycle) of which 21 had no history of hypomania and 19 had experienced hypomanic episodes, and 21 age- and sex-matched controls. METHODS Assessments included the Montgomery-Åsberg Depression Rating Scale, Hypomania Checklist, and Temperament and Character Inventory-125. Patients with cluster A and B personality disorders were excluded. RESULTS Bipolar II and RBD patients had higher harm avoidance (HA) and lower self-directedness (SD) compared with controls. Excluding panic disorder comorbidity effaced this difference in HA and SD (bipolar II only) and harm avoidance. No other differences were found. CONCLUSIONS In this first study comparing personality profiles of patients with bipolar II vs RBD, when controlling for confounders, neither bipolar II nor RBD patients differed significantly from healthy controls. The lower SD scores among RBD patients may reflect sampling bias (a higher rate of Axis 2 cluster C disorders).
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Affiliation(s)
- H Lövdahl
- Division of Clinical Neurosciences, Department of Neuropsychiatry and Psychosomatic Medicine, Oslo University Hospital-Rikshospitalet, Oslo, Norway.
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17
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Neuropsychological function in unmedicated recurrent brief depression. J Affect Disord 2010; 125:155-64. [PMID: 20085849 DOI: 10.1016/j.jad.2009.12.023] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2009] [Revised: 12/30/2009] [Accepted: 12/30/2009] [Indexed: 12/13/2022]
Abstract
BACKGROUND Recurrent brief depression (RBD) is a mood disorder characterized by mild to severe depressive episodes lasting less than 2 weeks and occurring approximately once a month with complete recovery between episodes. The aim of this study was to describe neuropsychological impairments associated with RBD, relating cognitive performance to clinical features and comorbidity. METHODS Forty-six ICD-10 defined RBD patients (mean age 33.8) and 24 matched controls were assessed on working memory/attention tasks, executive functions, verbal/visual memory, and psychomotor speed. RESULTS Patients were significantly impaired across all domains of cognition except for verbal learning and non-semantic verbal fluency. Neuropsychological performance was not related to depression severity, duration of depressive episodes, interval duration, psychiatric or somatic comorbidity, or attributable to a general reduction in processing speed or effort. Patients reporting previous major depressive episodes were impaired on one measure of psychomotor speed. Previous episodes of hypomania were not related to neuropsychological performance. LIMITATIONS The relatively high number of self-referrals, high female-to-male ratio in the patient sample, and the relatively high level of education and intellectual capacity among participants may limit the possibility to generalize our results to the RBD population in general. CONCLUSIONS Unmedicated RBD patients demonstrate significant neuropsychological impairment that also may persist into euthymic states. Examining cognitive functions might be equally important in RBD as in major depression with consequences for functional diagnostics and treatment strategies.
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Helvik AS, Skancke RH, Selbaek G. Screening for depression in elderly medical inpatients from rural area of Norway: prevalence and associated factors. Int J Geriatr Psychiatry 2010; 25:150-9. [PMID: 19551706 DOI: 10.1002/gps.2312] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
AIM The present investigation screened for depression in order to assess the prevalence of depression and to study the associated factors with depression in elderly medically hospitalised patients from a rural area in Norway. METHODS A cross-sectional study evaluated 484 (243 women) elderly medical inpatients with age range 65-101 (mean 80.7) years between September 2006 and August 2008 and used the Hospital Anxiety and Depression scale (HAD), Montgomery and Asberg Depression Rating Scale, the Mini-Mental State Examination, Lawton and Brody's scale for self-maintaining and instrumental activities of daily living. RESULTS The prevalence of current depression, depression score > or =8 at HAD, was for the total sample 10% of whom 78% was previously not diagnosed as having depression. The odds for depression were decreased for women aged 80 years or more while for men at the same age strata it was increased threefold. Age adjusted logistic regression analyses demonstrated an increased odds for depression for those who were in need of nursing assistance before hospitalisation, had lower level of physical functioning, had clinical anxiety symptoms and had higher number of medicaments at inclusion time. CONCLUSION The prevalence of depression in medical hospitalised elderly from rural areas was lower than in most other hospital studies. However, most patients with depression were not previously recognised as being depressed.
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Affiliation(s)
- Anne-Sofie Helvik
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
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Bhattacharyya R, Sanyal D, Chakraborty S, Bhattacharyya S. A case of corpus callosum agenesis presenting with recurrent brief depression. Indian J Psychol Med 2009; 31:92-5. [PMID: 21938102 PMCID: PMC3168092 DOI: 10.4103/0253-7176.63580] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Agenesis of corpus callosum can have various neuropsychiatric manifestations. Following case report highlights the case of a young man presenting with features of recurrent brief depressive disorder, each lasting for about 3 to 7 days, for over a year. He had history of occasional headache and episodes of swooning attack in between, usually precipitated by emotional events. His neuroimaging revealed agenesis of corpus callosum. He was experiencing swooning attacks as he became aware that some 'unusual' findings were present in his reports. Recurrent brief depression can be a manifestation of this congenital anomaly, and conversion disorder can be present as comorbid diagnosis perhaps due to ignorance and fear of this apparently innocuous congenital malformation.
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