Psychosocial functioning in relation to symptomatic remission: A longitudinal study of first episode schizophrenia

OBJECTIVES

The aims of the study were: (1) to evaluate longitudinally symptomatic remission in first-episode (FE) schizophrenia, (2) to describe symptoms, social functioning and quality of life (Qol) in relation to remission status, and (3) to determine the long-term outcome of schizophrenia and its early predictors.

METHODS

Sixty-four patients were assessed 1 month after a first hospitalization (T1), 12 months (T2), 4-6 years (T3), and 7-11 years (T4) after T1. The patients were allocated to three remission groups according to their remission status over the whole observation period, e.g. stable remission (SR), unstable remission (UR) and non-remission (NR). The PANSS, Social Functioning Scale and WHOQoL were used to evaluate the patients' psychosocial functioning levels, symptomatic and functional remissions and satisfying QoL. A good outcome was defined as meeting, simultaneously, the criteria of symptomatic and functional remissions and satisfying QoL at T4, while failure to meet all of these criteria was defined as a poor outcome.

RESULTS

Among them, 17.2% patients were in stable remission, 57.8% in unstable remission and 25.0% were unremitted at all time points. The SR group had lower levels of psychopathological symptoms and reported better social functioning and QoL than the NR group. During the follow-up, the symptoms increased, social functioning slightly improved and QoL did not change. At T4, 53% of the sample had a poor outcome, which was independently predicted by the longer duration of untreated psychosis and a lack of satisfying QoL at T1.

CONCLUSIONS

Our results demonstrate that: (1) the long-term course in schizophrenia is heterogeneous and that three illness trajectories exist, (2) social functioning and QoL are only partially connected with symptomatic remission (3), the risk of a poor outcome may potentially be reduced by appropriate interventions at an early stage of the illness.

Cognitive functions and mood during chronic thyrotropin-suppressive therapy with L-thyroxine in patients with differentiated thyroid carcinoma

BACKGROUND

Subclinical thyroid dysfunctions may cause cognitive deficits and mood disorders. Chronic TSH-suppressive therapy with L-T(4) causing subclinical hyperthyroidism has been widely used in treatment of patients with thyroid differentiated carcinoma. The impact of this therapy on cognitive functions and mood have not been systematically studied. The aim of this study was to asses executive functions, working memory, attention, and depression in patients with subclinical hyperthyroidism in the course of TSH-suppressive therapy.

METHODS

Thirty-one patients with subclinical hyperthyroidism in the course of suppressive treatment with L-T(4) following the total thyroidectomy and radioiodine ablative therapy were included in the study. Cognitive functioning in patients and control group were investigated using the battery of neuropsychological tests [Wisconsin Card Sorting Test (WCST), The Oral Word Association Test (OWAT), Trail Making Test, The Stroop Color-Word Interference test and Digit span]. Psychometric evaluation was performed using 17-items the Hamilton Depression Rating Scale (HDRS) and Beck Depression Inventory (BDI).

RESULTS

The performance on tests assessed executive functions, psychomotor speed, and attention was significantly lower in patients group. There was no differences in results of Stroop test and Digit Span forward and backwards between both groups. The intensity of depressive symptoms negatively correlated with a number of completed categories on WCST and results of OWAT. Cognitive deficits were still observed when patients with concomitant general medical conditions and depression were excluded from the analysis.

CONCLUSION

Our findings provide evidence of neuropsychological impairment in patients with differentiated thyroid carcinoma treated with chronic TSH-suppressive therapy.

Trajectories of change in depression severity during treatment with antidepressants

BACKGROUND

Response and remission defined by cut-off values on the last observed depression severity score are commonly used as outcome criteria in clinical trials, but ignore the time course of symptomatic change and may lead to inefficient analyses. We explore alternative categorization of outcome by naturally occurring trajectories of symptom change.

METHOD

Growth mixture models were applied to repeated measurements of depression severity in 807 participants with major depression treated for 12 weeks with escitalopram or nortriptyline in the part-randomized Genome-based Therapeutic Drugs for Depression study. Latent trajectory classes were validated as outcomes in drug efficacy comparison and pharmacogenetic analyses.

RESULTS

The final two-piece growth mixture model categorized participants into a majority (75%) following a gradual improvement trajectory and the remainder following a trajectory with rapid initial improvement. The rapid improvement trajectory was over-represented among nortriptyline-treated participants and showed an antidepressant-specific pattern of pharmacogenetic associations. In contrast, conventional response and remission favoured escitalopram and produced chance results in pharmacogenetic analyses. Controlling for drop-out reduced drug differences on response and remission but did not affect latent trajectory results.

CONCLUSIONS

Latent trajectory mixture models capture heterogeneity in the development of clinical response after the initiation of antidepressants and provide an outcome that is distinct from traditional endpoint measures. It differentiates between antidepressants with different modes of action and is robust against bias due to differential discontinuation.

[The effect of antidepressants on regional cerebral blood flow measured with 99m Tc HMPAO SPECT in depressive patients]

The results of investigations of regional cerebral blood flow using 99mTc HMPAO SPECT in 19 depressed patients before treatment and after 6 weeks of pharmacotherapy are presented.

[The analysis of diagnoses and pharmacological treatment of patients on disability pension due to depression]

The aim of the study was to assess the diagnoses and pharmacological treatment in 80 patients with symptoms of depression in reference to the psychiatric examination due to disability pension proceedings. Diagnoses were often not in accordance with the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10). Twenty two per cent of outpatients were treated using benzodiazepines only. In the group of antidepressants, mianserin, fluoxetine and doxepine were used most often (in 12%, 12% and 11% of outpatients respectively). Inpatients were usually treated with doxepine (24%) and mianserin (18%). As many as 15% of patients received benzodiazapines as the only drug during the hospitalisation. In contrast to the newer generation of drugs (moclobemide, fluoxetine), tricyclic antidepressants were usually used in low, not therapeutic doses. Further studies on the quality of treatment of depression in Poland, based on the more representative groups are necessary.

[Regional cerebral blood flow in depression]

In the review article, the results of studies on regional cerebral blood flow (rCBF) in major depression are presented. Most studies have reported global and regional deficits in cerebral blood flow in major depression as compared to healthy controls. Longitudinal studies show that after recovery from depression an increase of CBF has been observed. The influence of different biological treatment methods on rCBF is also discussed. Findings regarding lateral asymmetries of cerebral function in patients with major depression are inconclusive but the deficit of rCBF is often more pronounced in the left hemisphere. The nature of regional brain flow abnormalities in depression is unclear. Structural changes of the brain and biochemical abnormalities are under consideration.

[The assessment of regional cerebral blood flow using HMPAO-SPECT during depressive episode and in remission]

Twenty patients who met the DSM-IV criteria for major depressive disorder were investigated at rest using Single Photon Emission Computed Tomography (SPECT). Participation in the study required a minimum score of 18 points on the 17-item Hamilton Rating Scale. All patients were drug free for at least one week before the SPECT scan. Assessments were made twice during depression and after recovery. Regional tracer uptake was measured by a semiquantitative method. The reference region was delineated on the cerebellum. In remission a significant increase of 99m Tc-uptake in almost all regions of interest was observed what may point on the improvement of regional blood flow after recovery from depression. For most regions except right frontal and left parietooccipital there were no significant differences of tracer uptake between patients with bipolar and unipolar depression. The negative correlation between regional cerebral blood flow and Hamilton score was found in temporal areas and left temporo-parietal region. We did not find the influence of age on regional cerebral blood flow. In conclusion, during depression global reduction of brain metabolism was observed, which may point on the role of subcortical nuclei with diffuse cortical projection in pathogenesis of depression.

[Usefulness of Widlöcher scale in assessment of psychomotor activity disorders in endogenous depression]

A group of 50 patients with a diagnosis of affective disease was examined. Dependence between the intensification of depression psychomotor activity measured according to Widlöcher scale was established. Neurophysiological factors (such as thinking productivity, letter drafting, tapping test, simple reaction time) correlated with the intensification of psychomotor activation disorders.

[Studies of neurophysiological reactivity and level of activation of the central nervous system in endogenous depression and circulatory system disturbances]

The aim of the study was to assess the neurophysiological factors of simple and complex reactivity of central nervous system in a group of 30 patients treated with endogenous depression and showing circulatory system disturbances, and in a group of 30 patients showing no such somatic problems. The findings showed that the simple and complex reactivity testing can be considered an important and sensitive indicator of the endogenous depression intensity, characteristic of additional circulatory system disturbances and "organic" basis of depression. Any improvement in the circulatory system disturbances and anti-atherosclerotic effect in elderly people should be taken into account.

[Lipid metabolism in depressive syndromes with the symptoms of disorders of the cardiovascular and cerebrovascular systems during pharmacological treatment]

Rheoencephalographic research had been performed in 30 subjects (mean age = = 57) suffering from both endogenous depression and cardiovascular disorder showing the disturbance of lipid metabolism. The result of the reg assessment confirmed our previous observations pointing to existence of the cerebral blood flow disturbances in these patients: shorter time of the propagation of the wave (Ra) suggesting higher tonus of the precerebral arteries, shorter time of the period (b) pointing to an acceleration of the heart rhythm and the lower value of the ratio Hmax/hd pointing to the higher tonus of the intracerebral arteries. The rheoencephalographic indices correlated with the lipid metabolism parameters, especially with total lipids, HDL and LDL-cholesterol fractions. The results point to the need for simultaneous using both antidepressant and prophylactic anti-atherosclerotic therapy in these patients.

[Evaluation of clinical and neurophysiological markers of depressive disorder with symptoms of peripheral and brain circulation disturbance]

The evaluation of neurophysiological markers during imipramine treatment of 60 patients with endogenous depression was made. These markers were evaluated in 2 groups of patients: with cardio-vascular, and with brain circulation disturbances; both groups equal 30 subjects. During thymoleptic treatment of patients with circulation disturbances, elevated level of anxiety and statistically significant lower simple and complex reactivity of central nervous system were found. Such reactivity did not improve during the treatment in this group of patients. The lack of improvement of above mentioned parameters under imipramine may be the factor that elucidates the pathomechanism of chronic course of depression in old age. The improvement of circulation conditions, along with the thymoleptic therapy, should have the crucial importance for the therapeutic effect.