Migraine in bipolar disorder and schizophrenia: The hidden pain

OBJECTIVE

This study examined the prevalence of comorbid migraine in patients with bipolar disorder and those with schizophrenia and also examined the association between migraine comorbidity and disease characteristics in both disorders.

METHODS

In this cross-sectional study, 150 patients with bipolar disorder and 150 with schizophrenia were evaluated for migraine diagnosis using the International Classification of Headache Disorders (3rd ed). Patients were selected from psychiatry outpatient clinics at Kasr Al Ainy hospitals, Cairo University.  The Young Mania Rating Scale (YMRS) and the Hamilton Depression Rating Scale (HDRS) were administered to the bipolar group, whereas the Positive and Negative Syndrome Scale (PANSS) was administered to the schizophrenia group. Both groups were evaluated by the Clinical Global Impressions (CGI) scale.

RESULTS

The diagnosis of migraine was made in 34 (22.7%) of the bipolar group and 24 (16.0%) of the schizophrenia group. Patients with schizophrenia showed a significantly higher frequency and intensity of migraine attacks on the Migraine Disability Assessment scale than did the bipolar group (p < 0.001). In the bipolar group, there was no significant difference between patients with and without migraine on the YMRS, HDRS, and CGI. Among patients with schizophrenia, the duration of the migraine attacks was positively correlated with CGI scores (r = 0.40, p = 0.02).

CONCLUSION

Migraine was found to be a significant comorbidity in patients with bipolar disorder and schizophrenia. However, the intensity and frequency of migraine attacks were higher in the schizophrenia than in the bipolar group.

Clinical implication of children's depression rating scale-revised score: Linking the children's depression rating scale-revised score and clinical global impression using patients data from clinical trials

Background and Aims

The Children's Depression Rating Scale-Revised (CDRS-R) score has been widely used to assess the severity of major depression in children and adolescents; however, the clinical implications of changes in the CDRS-R score remain unclear. We evaluated these clinical implications by assessing the relationship between changes in the CDRS-R score and changes in the Clinical Global Impression of Improvement (CGI-I), in clinical research on major depression.

Methods

We used data from four clinical trials involving two antidepressants and evaluated the relationship between CDRS-R score changes and the CGI-I score using the equipercentile linking method.

Results

CDRS-R score changes corresponding to a minimally improved (score of 3) CGI-I score was approximately 14 points.

Conclusion

Our findings from the linking analyses are useful for interpreting the clinical implications of changes in the CDRS-R score.

Linking the Clinical Dementia Rating Scale-Sum of Boxes, the Clinician's Interview-Based Impression Plus Caregiver Input, and the Clinical Global Impression Scale: Evidence based on Individual Participant Data from Five Randomized Clinical Trials of Donepezil

BACKGROUND

In patients with Alzheimer's disease, global assessment scales, such as the Clinical Dementia Rating-Sum of Boxes (CDR-SB), the Clinician's Interview-Based Impression Plus Caregiver Input (CIBI plus), and the Clinical Global Impression (CGI) are commonly used.

OBJECTIVE

To clinically understand and interpret the associations between these scales, we examined the linkages for the total and change scores of CDR-SB, CIBI plus, and CGI.

METHODS

Individual participant data (N = 2,198) from five pivotal randomized placebo-controlled trials of donepezil were included. Data were collected at baseline and scheduled visits for up to 6 months. Spearman's correlation coefficients ρ were examined between corresponding total and change scores of simultaneous CDR-SB, CIBI plus, and CGI ratings. To link between the simultaneous ratings, equipercentile linking was used.

RESULTS

We found strong evidence that the Spearman's correlation coefficients between the CDR-SB and CGI, and CDR-SB and CIBI plus total scores were at least adequately correlated (ρ= 0.50 to 0.71, with p < 0.01). The correlation coefficients between the change scores of CDR-SB and CGI were deemed adequate for weeks 6 to 24 (ρ= 0.44 to 0.65); the remaining correlations were smaller in magnitude (ρ= 0.09 to 0.35). Overall, the linkages were in-line with expectations, e.g., CDR-SB range score of 3-4 (= very mild dementia) was linked to a CGI score of 3 (= mildly ill), and an increase of CDR-SB of 1 was linked to a change of 5 (= minimal worsening) in both CGI and CIBI plus.

CONCLUSION

The study findings can be useful for clinicians wishing to compare scores of different scales across patients. They can also help researchers understand results of studies using different scales and can facilitate meta-analyses, to increase statistical power.

Approaches to denote treatment outcome: Clinical significance and clinical global impression compared

OBJECTIVES

The authors of a previous study proposed a statistically based approach to denote treatment outcome, translating pretest and posttest scores into clinically relevant categories, such as recovery and reliable improvement. We assessed the convergent validity of the Jacobson-Truax (JT) approach, using T-score based cutoff values, with ratings by an independent evaluator.

METHODS

Pretest and retest scores on the Brief Symptom Inventory (BSI) and clinical global impression improvement (CGI-I) ratings were collected repeatedly through routine outcome monitoring from 5,900 outpatients with common mental disorders. Data were collected in everyday practice in a large mental health care provider.

RESULTS

Continuous pretest-to-retest BSI change scores had a stronger association with CGI-I than the categorical variable based on JT. However, JT categorization and improvement according to CGI converged substantially with association indices (Somers' D) ranging from D = .50 to .56. Discordance was predominantly due to a more positive outcome according to JT than on CGI-I ratings.

CONCLUSION

Converting continuous outcome variables into clinically meaningful categories comes at the price of somewhat diminished concurrent validity with CGI-I. Nevertheless, support was found for the proposed threshold values for reliable change and recovery, and the outcome denoted in these terms corresponded with CGI improvement for most patients.

Successful treatment with interleukin-17A antagonists of generalized pustular psoriasis in patients without IL36RN mutations

Generalized pustular psoriasis (GPP) is a potentially life-threatening disease that can be attributed to mutations in IL36RN in a subgroup of patients. In small trials, interleukin (IL)-17A and IL-17RA antagonists have been shown to be effective in patients with generalized pustular psoriasis in Japan. We identified seven patients who received the IL-17A antagonists secukinumab (six cases) or ixekizumab (one case) in two dermatological centers. All patients showed a good or excellent clinical response. Anti-IL-17A therapy was well tolerated and ongoing in all patients after an average therapy duration of 12.9 months. Analysis of IL36RN mutation status was performed in six patients, one patient carried a heterozygous mutation, while the other five patients did not show a mutation in IL36RN. This is the first report of a successful treatment of GPP patients without IL36RN mutations responding to anti-IL-17A therapy.