bluuebunny/crossref_metadata_2025 huggingface dataset:
Identification of Relevant Problems of Individuals with Bipolar Disorder: A Worldwide Expert Survey
Authors: Ávila C. , Cieza A. , Chatterji S. , Cabello M. , Vieta E. , Ayuso-Mateos J.L.
Published: March 2009

Aims:

We aimed to explore the expert perspective on relevant issues of individuals with bipolar disorder. The specific aims are to identify problems in functioning important to individuals with BD and to quantify these using the ICF.

Method:

An online survey on functioning in BD was conduced. For each ICF domain one question was presented. Recruited participants were psychiatrists, general physicians, psychologists, nurses and social workers worldwide. Answers were linked to the ICF according to predefined rules (Cieza, 2001). Data analyses include frequencies of ICF categories named by experts.

Results:

Health professionals from all WHO-world regions and from different professional backgrounds accepted our invitation to participate. The Americas was the highest represented region (36%) and a significant part of the professionals involved were psychiatrists. From all the concepts contained in the answers, body functions categories with highest frequency of appearance were emotional functions (3,5%), mentioned by 62% of the experts and sleep functions (2,4%) mentioned by 58%. The body structure brain corresponds to 2% of the total categories obtained and was included by 56% of the experts. Maintaining one's health was the most mentioned activity and participation (2,8%), referred by 36% of the participants and important environmental factors include health services (4,8%) and immediate family(3,8%), which appeared in 82% of the questionnaires.

Conclusion:

The present study is an important step in applying of the ICF to BD. It also shows an important level of agreement between experts around the world regarding central issues of the disorder.

Funded by MURINET-MRTN-CT-2006-035794
Quality of Life in Patients with Schizophrenia and Bipolar Disorder: Comparison of Self-report and Proxy Assessment
Authors: Kim E.-J. , Kim S.-J. , Cho H.-S.
Published: March 2009

Aims:

There is little data to indicate whether or not patients with chronic mental illness can provide self-report QOL data or if informant reports can substitute the patients’ ratings. We evaluated patient-proxy agreement in patients with schizophrenia and bipolar disorder and compared levels of agreement according to the relationship between patient-proxies.

Method:

WHOQOL-BREF and SF-36, two of the most popular quality of life instrument were administered to 82 schizophrenia-proxy and 50 bipolar disorder patient-proxy pairs.

Results:

Proxies of schizophrenia patients rated patients’ QOL lower than the patients themselves. Agreement between patients and proxies on the four main domains of QOL was moderate to good. Moreover, the agreement between patients’ and proxies’ ratings was higher when the proxy was a mother or spouse compared to father.

Conclusion:

These findings suggest that proxy rating of QOL can be used as a reasonable estimate of the patients’ rating of QOL in schizophrenia and bipolar patients, at least in Korea. Knowing which domains of QoL are affected in specific psychiatric disorders can help clinicians focus on particular QoL domains during the diagnostic process and to define adequate treatment goals. Therefore, the assessment of QoL may be an important part of the diagnostic process because it can give insight into the areas of functioning in which a patient is suffering the most.
Self-esteem and Affective Temperament of Nurses in Psychiatric and Mental Health Services
Authors: Cordeiro R. , Figueira M.
Published: March 2009

The present study was intended to explore the potential relationships between self-esteem and affective temperament (Akiskal et al., 2005) of nurses working for Psychiatric and Mental Health Departments. The ultimate goal is to establish which factor determines their professional stress and adaptation.

Methods:

Self-administered questionnaires were given to 152 nurses employed in three Portuguese public hospitals. The questionnaire items included socio demographic and job-related data and two scales: the Portuguese version of TEMPS-A Scale (Akiskal, 2005) and the Personal Self-esteem Scale (Ribeiro, J.L.P 2006). For statistical analysis besides descriptive statistics, a correlation model was used.

Results:

Hyperthimic Temperament was the more prevalent subtype. Women presented a higher Self-esteem positively correlated with Ciclothymic and Anxious temperaments. The results also show that there is a correlation between marital status and Irritable Temperament, and between the years of professional experience and the Cyclothymic and Hyperthymic Temperaments.

Conclusion:

An interaction between temperament subtypes, self-esteem and professional experience was observed. Gender differences are also significant. Further study is needed to investigate the potential relationship between temperament, self-esteem and professional satisfaction and resilience to job-related stress factors in Psychiatric Departments.
Tryptophan Hydroxylase 2 (TPH2) Gene in Bipolar I Disorder in the Romanian Population
Authors: Grigoroiu-Serbanescu M. , Diaconu C.C. , Herms S. , Vollmer J. , Bleotu C. , Noethen M.M. , Cichon S.
Published: March 2009

Objective:

Since the discovery of the tryptophan hydroxylase 2 gene (TPH2) several studies reported association of TPH2 genetic variation with bipolar I disorder (BPI). Our objectives were to replicate in the Romanian population the recently described association of a rare functional SNP (rs17110563) and of a haplotype covering the 5′ region of TPH2 with BPI (Cichon et al., 2008) and to investigate the influence of the phenotypic traits age-of-onset, family history and parent-of-origin”, defined according to clinical criteria, on the degree of association between TPH2 and BPI.

Method:

Sixteen TPH2 SNPs were genotyped in a Romanian sample of 198 BPI patients and 180 controls screened for psychiatric disorders. Statistical analysis of the data was performed with Haploview3.32 and FAMHAP.

Results:

The functional SNP rs17110563 (encoding a Pro206Ser substitution) was present in Romanian BPI patients and absent in controls. SNPs located in the 5′-region (rs11178997, rs11178998, rs7954758), significantly associated with BPI in German patients were not associated with BPI in Romanian patients at single-marker level, but gave evidence for association at haplotypic level in a subgroup of patients with paternal transmission of BPI. Evidence for association was identified between haplotypes located in the 3′-region of TPH2 and BPI in the overall sample as well as in the subgroups of familial cases, the subgroup with paternal transmission, and the subgroup with AO≤25 years.

Conclusion:

Our data provide support for the involvement of TPH2 in the etiology of BPI.
Decision Making, Working Memory and Executive Functions in Euthymic Bipolar Patients
Authors: Jaracz M. , Drozdz W. , Borkowska A.
Published: March 2009

Aims:

Decision making, as well as working memory and executive functions are among the most significant cognitive processes, associated with prefrontal cortex function. Decision making is associated with the orbitofrontal cortex function. Working memory and executive functions are dependent on the dorsolateral prefrontal cortex. Orbitofrontal, as well as dorsolateral prefrontal cortex dysfunction in bipolar disorder has been reported. The aim of the study was to assess decision making and executive functions in euthymic bipolar patients.

Methods:

The study included 13 euthymic bipolar patients (6 female, 7 male), aged 43±11 years and 11 age, sex and education years matched healthy controls. Decision making was assessed with Iowa Gambling Task (IGT). Working memory and executive functions were assessed with Wisconsin Card Sorting Test (WCST) and Trail Making Test (TMT). Depressive and/ or manic symptoms were measured with Hamilton Depression Scale (HAM-D) and Young Mania Rating Scale (YMRS).

Results:

Euthymic bipolar patients made more nonperseverative errors (t=2,53, p=0,01), gave less conceptual level responses (t=-2,33, p=0,03), completed less categories (t=-1,66, p=0,005) and used more cards to complete first category (t=1,49, p=0,003) in WCST. They also gained less money in IGT (t=-1,34, p=0,03).

Conclusions:

Bipolar patients performed significantly worse on several measures of WCST. Euthymic bipolar patients gained less money in IGT compared to healthy controls, although no significant differences in responding style in IGT were found.
Social Cognition and General Functioning in Bipolar Disorder
Authors: Lahera G. , Herrería E. , Ruiz-Murugarren S. , Ruiz-Bennásar C. , Iglesias P. , Fernández-Liria A. , Montes J.M.
Published: March 2009

Introduction:

Bipolar patients show a significant degree of psychosocial disfunction even in euthymia. Recent studies have reported deficits in Theory of Mind and emotion recognition in BD. Our hypothesis is that social cognition deficit could be associated with a poor general functioning and psychosocial disadvantage in BD.

Methods:

A sample of 27 euthymic bipolar patients were recluted. Based on Global Assessment of Functioning, they were divided into two groups: good or low general functioning. Euthymia was defined as YMRS < 6 and HDRS < 8, during a 3-month period. Patients with high (n 18) and low (n 9) functioning were compared on several clinical variables and on social / general cognitive measures. Both verbal and non verbal Theory of Mind capacities were assesed (faux pas test and face emotion recognition test). Finally, sustained attention and executive functions were evaluated (Asarnow Test and WSCT).

Results:

High- and low-functioning groups did not differ with respect to demographic and clinical variables (age, sex, age at onset, years of evolution of illness, history of prior psychotic symptoms; p = n.s.). However, low-functioning group showed poorer performance than high-functioning group both in faux pas test (U Mann Whitney; p=0.035) and face emotion recognition (U; p = 0.021). In addition, low-functioning group also showed a significant impairment in general cognitive funtions such as sustained attention (U, p = 0.007) and executive funtions (U, p = 0.046).

Conclusion:

Social cognition deficit is associated with a poorer general functioning and psychosocial disadvantage.
Association Between Olfactory Identification and Face Emotion Recognition in Euthymic Bipolar Patients
Authors: Lahera G. , Herrería E. , Ruiz-Murugarren S. , Ruiz-Bennásar C. , Iglesias P. , Fernández-Liria A. , Montes J.M.
Published: March 2009

Introduction:

The close anatomical and functional connection between the orbitofrontal cortex and olfactory processing suggests that emotion regulation and olfactory identification could be associated. Smell identification deficit (SID) is common in adult schizophrenia, but it has been less studied in bipolar patients, who also show a significant degree of social disadvantage.

Methods:

A sample of 27 euthymic bipolar patients were recluted. Euthymia was defined as YMRS < 6 and HDRS < 8, during a 3-month period. Patients were assessed with the University of Pennsylvania Smell Identification Test (UPSIT), Face Recognition Test and a verbal Theory of Mind test (Faux Pas Test), in order to examine the association between olfactory identification ability and social cognition domains.

Results:

According to the hypothesis, olfactory identification was positively correlated with Face Emotion Recognition (Pearson, p = 0.007) and verbal Theory of Mind (Pearson, p=0.030). Smell identification was similar in smoker (15/27) and non-smoker subgroup of the sample (U Mann Whitney; p = n.s). No differences were neither found between male (14/27) and female subgroup (U; p = n.s).

Conclusion:

Olfactory identification and social cognition (specially, face emotion recognition) appear to represent two correlated traits in bipolar disorder, suggesting a possible common neural substrate.
Looking for the Cyclothymic Temperament Within Major Depressive Patients: Under-recognising the Bipolar Spectrum?
Authors: Largueche M. , Abla T. Ben , M'Rad M.F.
Published: March 2009

Background:

Under-recognised bipolar spectrum disorder is going to be one of the most important debates in new articles and researches. Recent data, enlarging bipolar criteria to temperament, family history and more, try to help clinicians in the recognition of the broader spectrum of bipolarity and so getting the most adequate therapeutic attitude.

Methods:

Consecutive 86 Tunisian patients who meet the DSM IV criteria for major depressive episode (MDE) were interviewed with the temperament evaluation of Memphis,Pisa,Paris and San Diego in order to assess the frequency of cyclothymic temperament (CT).Then we compared the distribution of bipolar criteria, as defined by Akiskal between cyclothymic depressive patients and non cyclothymic ones.Finally the evolution under antidepressants was studied using the GFE:the global functioning evaluation.

Results:

34.9% of patients meet the criteria of cyclothymic temperament and compared to the 65.1% who did not, they had significantly lower age of onset, higher recurrence of MDE, more atypical features and more suicidal attempts and comorbidities (anxious disorders and drug abuse).Family history of bipolar disorder was more frequently found within the cyclothymic group as well as psychotic symptoms but not with a significant difference. Finally 71.4% of the non cyclothymic patients improved under antidepressants (GFE score >= 70) compared to only 26.6% in the group of cyclothymic ones.

Conclusion:

If we consider the large criteria of bipolarity and the concept of an affective spectrum, the prevalence of bipolar disorder become higher than previously believed, making clinicians reconsider the relevance of the diagnostic of unipolar trouble and the pertinence of the antidepressant treatment.
Subthreshold Manifestations of Bipolar Disorders as Health Care’s tool
Authors: Mazza M. , Harnic D. , Marano G. , Catalano V. , Janiri L. , Bria P.
Published: March 2009

Introdution:

Our study represents a pilot evaluation about how the MOOD-SR recognizes subthreshold manifestations that may be associated with clinical symptomatology in a group of bipolar patients.

Methods:

At Day Hospital of Psychiatry, Policlinico “A. Gemelli”, Bipolar Disorders Unit, it has been conducted an experimental study on a heterogeneous sample of 24 patients with a diagnosis of Bipolar Disorder type I. Patients have been assessed with the MOOD-SR, a clinical self-reported interview, that is specific for the spectrum of subthreshold pathology, and with the Quality of Life (QoL), that investigates the patient's quality of life.

Results:

We have found that 16 patients on 24 report a score higher than 60 (68,4%). Among these, 10 female patients on 15 have a total score higer than 61 (68.75%) while 6 male patients on 9 obtain a total score higher than 60 (62,5%). However, these results have only preliminary value, further studies are needed in order to obtain a deeper evaluation.

Conclusion:

Spectrum manifestations are both indicator of course and response to treatment and predictive for relapse. This finding may represent an important preventive instrument for maniacal relapse in patients with Bipolar Disorder, that is often underdiagnosed or confused for Unipolar Depression. By adequately recognizing the problem we will be able to refine diagnosis and individualize therapy.
Gynaecological and Obstetric Comorbidities in Patients with Bipolar Disorder: A Systematic Review
Authors: Bobes J. , Montes J.M. , Mostaza J. , Rico-Villademoros F. , Vieta E. , Saiz-Ruiz J.
Published: March 2009

Objective:

To synthesize the available knowledge on gynaecological and obstetric comorbidities in patients with bipolar disorder (BD).

Methods:

Relevant studies were identified by a MEDLINE search from 1966 to January 2008, and supplemented by a manual review of reference lists of the articles identified and previous review articles. We included studies with any design, in patients with BD as diagnosed by any criteria, with sample size ≥30 patients, and reporting any measure of frequency or association as regards the comorbidities. When available, priority was given to comparative studies.

Results:

We identified 4 studies: 3 were comparative; 1 was cross-sectional and 3 were retrospective cohort studies; 1 was population-based study; and 4 used a convenience sample. A retrospective study reported an increased risk of pregnancy complications in patients with BD (OR1.23, 95%CI 1.06-1.44) but not of labor/delivery or neonatal complications; as compared to controls, patients with BD had an increased risk of placenta previa (OR2.04, 95% CI 1.11-3.73), antepartum hemorrhage (OR 1.66, 95%CI 1.15-2.39), and drug side-effects (OR 3.94, 95%CI 1.46-10.62). In another retrospective study, patients with BD had an increased risk of endometriosis (OR: 1.93, 95%CI 1.37-2.70), inflammatory disease of ovary (OR 2.17, 95%CI 1.84-2.57), and disorders of menstruation (OR 1.79, 95%CI 1.56-2.05). In a cross-sectional study, gynaecological disorders were more common in patients with BD than in patients with schizophrenia (4% vs 1.3%).

Conclusion:

Although the information is scanty, available data suggest that patients with BD might have an increased risk of gynaecological and obstetric comorbidities/complications.
Spanish Consensus on Physical Health in Patients with Bipolar Disorder [P01-205]
Authors: Saiz-Ruiz J. , Bobes J. , Vieta E. , Mostaza J.
Published: March 2009

Background and objective:

Bipolar disorder is a serious mental illness which may affect between 2% and 5% of the population. These patients present much higher morbidity and mortality rates than the general population. In addition to a higher mortality rate from suicide, they also have a higher prevalence of other physical disorders.

The purpose of this consensus is to establish recommendations for diagnostic procedures and clinical interventions in order to control the risk factors which have repercussions on the physical health of the patients.

Methods:

After carrying out a systematic review of medical co-morbidity and mortality rates in bipolar disorder, two multidisciplinary consensus meetings were held in which 31 psychiatrists and 11 experts from other medical specialities participated.

Working groups were formed for each speciality for the purposes of adapting the guidelines applied in the general population to these patients.

Results:

The bibliographical review revealed an increased risk of hypertension, obesity, smoking, pulmonary diseases, migraine and HIV infection. There is evidence of higher mortality rates from cardiovascular and respiratory diseases and infections, as well as from suicide. The expert group reached consensus on a series of basic measures for detecting medical co-morbidity. The resulting recommendations will be validated by Spanish Psychiatry and General Medicine Associations.

Conclusion:

The physical health of patients with bipolar disorder could be improved. It is hoped that the publication of this consensus will have an impact in terms of better psychosocial functioning, quality of life and life expectancy for these patients in Spain.
A 6-month, Randomized, Placebo-controlled, Double Blind Trial of Ziprasidone Plus a Mood Stabilizer in Subjects With Bipolar I Disorder
Authors: Vieta E. , Bowden C. , Ice K. , Gurtovaya O. , Schwartz J. , Wang P.
Published: March 2009

Background:

The objective of this study was to evaluate the efficacy and safety of ziprasidone adjunctive to a mood stabilizer for the maintenance treatment of bipolar mania.

Methods:

Male and female subjects with bipolar I disorder with MRS 3 14 were enrolled. Subjects achieving ≥ 8 consecutive weeks of stability with open-label ziprasidone (80-160 mg/d) and lithium or divalproex were randomized into the 6-month double-blind maintenance period, to ziprasidone + mood stabilizer or placebo + mood stabilizer. The primary and key secondary end points were the time to intervention for a mood episode, and time to discontinuation for any reason, respectively. Inferential analysis was performed using a Kaplan-Meier product-limit estimator (Log-rank test).

Results:

127 and 112 subjects were randomized to and treated in the ziprasidone and placebo groups, respectively. The time to intervention for a mood episode was significantly different, favoring ziprasidone (p = 0.0104). 19.7% and 32.4% of ziprasidone and placebo subjects, respectively, required intervention for a mood episode. Time to discontinuation for any reason was significantly different (p = 0.0047), favoring ziprasidone. Among treatment-emergent adverse events occurring in the double-blind period, the only event occurring more frequently in the ziprasidone group than in the placebo group (≥ 5%) was tremor (6.3% vs 3.6%, respectively).

Conclusions:

These results demonstrate that ziprasidone is an effective, safe, and well-tolerated adjunctive treatment with a mood stabilizer for long-term maintenance treatment of bipolar mania.
Quetiapine or Lithium Versus Placebo for Maintenance Treatment of Bipolar I Disorder After Stabilization on Quetiapine
Authors: Nolen W.A. , Weisler R.H. , Neijber A. , Hellqvist Å. , Paulsson B.
Published: March 2009

Purpose:

Quetiapine combined with lithium or divalproex is an effective maintenance treatment for bipolar I disorder.1,2 This double-blind, randomized trial (D1447C00144) investigated quetiapine monotherapy as maintenance treatment.

Methods:

Adults experiencing manic, depressed, or mixed episodes of bipolar disorder received open-label quetiapine. Patients achieving stabilization (YMRS ≤12 and MADRS ≤12, 4 consecutive weeks) were randomized to continue quetiapine (300-800 mg/d) or to switch to placebo or lithium (target serum 0.6-1.2 mEq/L) for up to 104 weeks or recurrent mood event. The primary endpoint was time to recurrence of any mood event. The study was terminated when interim analysis provided positive results.

Results:

Of 2438 patients starting open-label quetiapine, 1226 (50.3%) were randomized to study medication with 1172 in the ITT population. Mean median quetiapine dose was 546 mg/d; mean median lithium serum level was 0.63 mEq/L. Time to recurrence of any mood event was longer for continued quetiapine versus switching to placebo (HR, 0.29; 95% CI, 0.23-0.38; P< 0.0001), for switching to lithium versus switching to placebo (HR, 0.46; 95% CI, 0.36-0.59; P< 0.0001), and for continued quetiapine versus switching to lithium (HR, 0.66; 95% CI, 0.49-0.88; P=0.005). Safety findings were consistent with known profiles.

Conclusions:

In patients stabilized on quetiapine, continued quetiapine significantly decreased time to recurrence of any mood event versus switching to placebo. Switching to lithium was also more effective than switching to placebo and conferred no additional benefit versus continuing quetiapine.Supported by funding from AstraZeneca Pharmaceuticals LP.
Bipolar Disorder (BD) and Obsessive Compulsive Disorder (OCD) Comorbidty or Varied Episodes in the Same Disorder [P01-209]
Authors: Oral E. , Ozan E. , Deveci E. , Aydın N. , Kirpinar I.
Published: March 2009

Previous studies have suggested that OCD has comorbidity with bipolar disorder (BD) (1,2). We evaluated the three bipolar OCD cases.

C1: Because of the OCD symptoms Chlomipramine was started. Her OCD symptoms improved in several days but manic symptoms was apeeared, switched to Lithium Carbonate. In her out patient exams, manic and obsessive compulsive symptoms were almost never observed simultaneously at the course.

C2: In 2003, her complaints started as combined OCD and Manic symptoms, Risperidon and Lithium carbonate were started, manic and OCD symptoms improved. In 2005, OCD and Depressive symptoms appeared together. She got improved with Lithium Carbonate and Chlomipramine. She had one episode with obsessive and manic symptoms or obsessive and depressive symptoms every year till now. Her uncle had Depression and her aunt had Bipolar disorder.

C3: Because of his OCD symptoms we prescribed SSRI and lower dose antipsychotic. At that time he hospitalized for his manic symptoms, his OCD was partially remitted. His manic symptoms improved with Lithium carbonate1200p/d. He had resistant obsessive compulsive symptoms and episodic manic symptoms. His father had M. Depressive episodes.

Conclusion:

Our cases suggest that bipolar OCD has episodic course, treatment resistant symtomatology, high family loading and high frequency of recurrence.
Quetiapine: Mood Stabilization Across all Phases of Bipolar Disorder
Authors: Paulsson B. , Olausson B. , Young A.H.
Published: March 2009

Background:

Following resolution of acute symptoms (manic and depressed), most patients with bipolar disorder experience affective recurrences and residual functional impairment. This indicates a need for a treatment that not only manages the acute phase of illness but also maintains the stabilized patient.

Methods:

Data are presented to support the effectiveness of quetiapine in: managing the acutely ill patient; maintaining the euthymic patient by preventing mood event recurrence; and improving patient-perceived functioning.

Results:

Quetiapine monotherapy demonstrates efficacy against mania symptoms as early as Day 4 (Trials 104 and 105 [pooled datasets]; P< 0.05 vs placebo) and Week 1 in bipolar depression (BOLDER and EMBOLDEN [pooled datasets]; P< 0.001 vs placebo). The acute antidepressive effect was significant for both bipolar I and II populations. As continuation therapy in bipolar depression, quetiapine is associated with a significant reduction in the risk of depressive mood event recurrence (EMBOLDEN I and II; P< 0.001 vs placebo). Moreover, quetiapine significantly reduces the risk of recurrence of mania or depression events as an adjunct to lithium or divalproex (Trials 126 and 127; P< 0.0001), and as monotherapy (Trial 144; P< 0.001). Quetiapine is generally well tolerated in all phases.

Conclusions:

Quetiapine fulfills mood stabilization criteria by demonstrating efficacy in all phases of bipolar disorder. To date, quetiapine is the only treatment to show robust efficacy against both poles of bipolar disorder, without causing an excess shift to the opposite pole, and to prevent mood episode recurrence irrespective of the index episode.Supported by funding from AstraZeneca Pharmaceuticals LP.
Psychiatric Comorbidity in Fibromyalgia
Authors: Arroita A. , Barreiro A. , Ugarte K. , Losada N. , Rico P. , Touzon R. , Lopez M.D.M.
Published: March 2009

Introduction:

Fibromyalgia is an entity that affects approximately 2% of the population, mainly women.

According to many studies, approximately half of women with fibromyalgia have a history of traumatic events during childhood or adulthood.

Affective disorders before and after fibromyalgia diagnosis are particularly frequent.

Materials and methods:

Comprehensive review of the scientific literature (Medline, Psychoinfo, Medex) on psychiatric comorbidity in women diagnosed with fibromyalgia published over the last three years.

Results:

40-60% of women diagnosed with fibromyalgia report sexual abuse during childhood or adulthood; A higher percentage of women (over 70%) report other kinds of physical or emotional trauma.

Fibromyalgia has been linked to mood disorders in 50-70% of patients. More precisely, it appears in combination with major depression in 20% of cases. To a lesser but still noteworthy extent, women with fibromyalgia are also diagnosed with dysthymia, anxiety disorders, phobias or panic disorders.

Conclusion:

Despite the common characteristics of these patients there is no such thing as a “fibromyalgic personality”.

As for comorbidity, mood disorders are highly prevalent, more specifically depression, even though no direct relationship has been established between them. Fibromyalgia symptoms are more acute in patients with comorbid psychiatric disorders.
Healthcare Resource Utilization and Costs of Mild, Moderate, and Severe Depression in the Workforce in the United States
Authors: Birnbaum H. , Kessler R. , Joish V. , Kelley D. , Ben-Hamadi R. , Hsieh M. , Greenberg P.
Published: March 2009

Objective:

Document the healthcare resource utilization and costs by severity for persons in the workforce with major depressive disorder (MDD).

Methods:

Using the National Comorbidity Survey-Replication data, workforce respondents (n=4,465) were categorized by clinical severity (not clinically depressed, mild, moderate, severe) using standard scales (CIDI/QIDS-SR). Outcomes measured over 12 months included prevalence of medical services/antidepressant use, average number of visits and days on antidepressants, prevalence of treatment adequacy, and medical/drug costs. Costs represent insurer payments to providers and were estimated by weighting utilization measures by unit costs obtained for similar services used by depressed patients in a U.S. employer claims database for the corresponding period (2000-2001). Outcomes were compared across depression severity groups using multivariate analyses adjusting for demographics.

Results:

Among the 539 depressed workforce respondents, 13.8% were mildly, 38.5% moderately and 47.7% severely depressed. A significant association existed between severity and prevalence of mental health services usage (19.1%, 27.2%, and 40.3% respectively, p< 0.01) and average number of mental health practitioner visits. The use of antidepressants increased with depression severity (21.1%, 27.3%, and 39.5% respectively, p< 0.01). Similarly, the adequacy of mental health services increased with depression severity (6.2%, 11.8%, and 21.3% respectively, p< 0.05). Average 12-month costs per MDD patient were substantially higher for severe vs. mild (mental health services: $697 vs. $388; general medical services: $138 vs. $53; anti-depressant usage $256 vs. $88).

Conclusions:

Among workforce respondents, there was a significant association between depression severity and treatment usage and costs, and between treatment adequacy and severity.
Self-Evaluation of Memory Functioning in Depressed Patients During a Symptomatic Episode and After Recovery
Authors: Biringer E. , Sundet K. , Lund A.
Published: March 2009

Objective:

Depressed patients tend to under-estimate their everyday memory function. Whether this under-estimation is related to the depressive state, or whether it represents underlying personality traits present also between or after depressive episodes, is not clear.

Methods:

Comparisons of subjective memory evaluation as measured by the Everyday Memory Questionnaire (EMQ) were made between sub-groups with Current Depression (N=14), Previous Depression (N=19), and Healthy Controls (N=10). Analyses were adjusted for effects of sociodemographic variables, use of medication, and premorbid intellectual abilities (Similarities sub-test (WASI)). To assess the relationship between affective state and subjective memory function irrespective of actual memory performance, adjustment for objective memory performance as represented by the Total recall sub-task from CVLT and Long-delayed free recall from RCFT was included in a final step in the ANCOVA model.

Results:

The overall crude relationship between group and EMQ total score was significant (F(2,40)=4.11, p=0.011, eta sq.= .17). In posthoc follow-up tests, the Currently Depressed reported significantly lower on EMQ than both Previously Depressed and Controls (Dunnett's C test, p= .018 and p= .034, respectively). However, after adjustment for relevant confounders and mediators, both the Previously and Currently Depressed performed significantly worse on EMQ compared to Controls (overall ANCOVA F(2,33)=9.22, p= .001, eta sq.= .36; pairwise follow-ups p= .001 and p= .011, respectively).

Conclusion:

Depressed patients’ under-estimation of their memory function is independent of mood state and it may represent a vulnerability or personality structure involving negative cognitive patterns that may be successfully targeted by cognitive therapy.
Depressive Symptoms and Emotion in Adolescence: A Developmental-Functionalist View
Authors: Bréjard V. , Bonnet A. , Pedinielli J.-L.
Published: March 2009

Adolescent depressive symptoms are recognized as having number of consequences on academic and social achievement (Glied & Pine, 2002). Many studies highlighted the specific implication of emotion regulation deficits to explain depression or affective disorders (Garnefski & Kraaij, 2006). Despite these findings, little studies focused on the relations between emotional deficits (such as low emotional awareness) and subjective emotional intensity in adolescent depressive symptoms. The aim of this study was to examine the relationships between emotion awareness as defined by Lane & Schwartz (1987), subjective emotional intensity, and depressive symptoms. We hypothesized that lack of emotional awareness associated to strong emotional intensity may explain depressive symptoms among adolescents.

448 adolescents (age: 15.54 years 0.66) were administered the following self report questionnaires:

•

The Level of Emotional Awareness Scale (Lane & al. 1990).

•

The Differential Emotion Scale (Izard & al. 1991).

•

The Centre for Epidemiological Study Depression scale (Radloff, 1977).

Statistical analysis shows significant negative correlations between emotional awareness and depression(r=-.23, p=.004), and positive correlations between subjective emotional intensity and depression r=.44, p< .0001). Moreover, multiple regressions revealed that level of emotional awareness (t= -4,75, β= -.20., p< .0001) and emotional intensity (t= 9,71, β=.41, p< .0001) were each related to depression in a significant model (R2=.25, F=48,01, p< .001). Lack of emotional awareness may lead to high level of subjective emotional intensity, and constitute a real vulnerability for affective disorders. This suggests that emotional awareness skills training could be an effective intervention for depressive symptoms at adolescence.
Impact of Paternal Depression in Father's Perceptions About Infant’s Characteristics: A Pilot Study
Authors: Vilariça P. , Nascimento M.J. , da Silva P. Caldeira
Published: March 2009

Background:

Maternal postpartum depression is known to negatively affect parenting and the mother-child relationship. When compared with non-depressed mothers, depressed ones have more often negative perceptions about their child's characteristics. This cognitive distortion can be a mechanism that mediates mother-child relationship disorders. Postpartum depression in fathers and its effects on parenting are understudied and rarely recognised as relevant in clinical practice.

Aims: Our purpose with this work is to examine the association between paternal depression and the father's perceptions about his infant, namely the infant's temperament and the difficulty in dealing with the usual daily problems posed by the new baby.

Method:

50 families were recruited in primary care consultations. Data were collected at time points ranging from 3 months to 24 months postpartum. Paternal and maternal depression were measured using the Edinburgh Postnatal Depression Scale. The father's perceptions about the infant were measured using the Infant Characteristics Questionnaire and the Daily Hassles Scale.

Results and conclusion:

The study is still ongoing.
Social Stress and Depression During Pregnancy in Women of a Low Income Country
Authors: Husain M. , Chaudhry I.B. , Saeed Q. , Khan S. , Hassan Q. , Husain N.
Published: March 2009

There has been considerable research on postnatal depression (PND), in comparison to antenatal depression (AND). We aimed to study the Prevalence of AND, testing the following hypotheses:

a.

Depressed pregnant women will have more negative life events than non depressed women.

b.

Depressed women will have less social support than non-depressed women.

Methods:

Using a cross sectional study design 1366/1401 women in their 3rd trimester of pregnancy were screened for depression using the Self-Rating Questionnaire (SRQ) and the Edinburgh Postnatal Depression Scale (EPDS). These instruments are validated, available in Urdu and have been used in the pre and postnatal period in Pakistan. The life events checklist was used to measure social stress and the Brief Disability Questionnaire (BDQ) for disability.

Results:

342 women scored ≥ 12 on the EPDS giving an estimated AND prevalence of 25.6 %. The EPDS and SRQ scores showed a high positive correlation. A significantly higher percentage of depressed women experienced problems in marital relations, work, finances, housing and domestic violence. Depressed women had higher disability scores. 32% of the depressed and 14% of non depressed were unable to perform usual daily activities. 35% of depressed women stayed in bed due to illness as compared to only 16 % of non-depressed.

Conclusion:

This study confirms a high prevalence of AND in less educated women, experiencing a large number of social difficulties.
The Comorbidity of Depression and Substance Abuse Disorders in Romanian Patients
Authors: Stefanescu C. , Chirita R. , Chirita V. , Chele G.
Published: March 2009

Depression appears to be independent from, but frequently co-occurs with, substance abuse disorders, including alcohol and drug abuse. Depression and substance use disorders are highly prevalent in the general population and often co-occur within the same individual. Many people with depression turn to alcohol or drugs, eventually developing a dependence or addiction. Conversely, people who are addicted to alcohol or drugs have a high rate of depression. Alcohol and some drugs are depressants, and depressed mood can be a direct outcome of substance abuse. Use of alcohol by people suffering from depression can increase the severity of their depressive symptoms. Fortunately, it is also treatable and the key to treatment is to recognize the symptoms and to get help. Research shows that one in three depressed people also suffer from some form of substance abuse or dependence.
Escitalopram in Treatment of Sleep Disturbances in Major Depressive Disorder
Authors: Zivkovic N. , Djokic G. , Pavicevic D. , Ilic V.
Published: March 2009

Major depressive disorder (MDD) is common and severe affective disorder with sleep disturbances and non-bizarre delusions which are organized in permanent and unshakeable delusional system. Neurobiological basis of MDD is still completely unknown, but significant role has serotoninergic and noradrenergic neuronal systems. Escitalopram is highly potent and highly selective serotonin re-uptake inhibitor.

Purpose of this study was to estimate efficacy of the escitalopram in treatment of sleep disturbances in MDD.

Methods:

This prospective clinical study included 95 patients diagnosed by ICD-10 criteria for MDD, who are randomly divided into control (30 patients) and experimental group (65 patients). Patients were observed for 6 months in hospital and outpatients conditions, according to specially designed protocol, which included Hamilton Depression Rating Scale (HAMD) and Leeds Sleeping Evaluation Questionnaire (LSEQ). Control group was treated with maprotiline (75-150 mg/24h) and experimental group with escitalopram (10-20 mg/24h).

Results:

Escitalopram therapy influenced on HAMD score with high statistical significance vs. maprotiline, p=0.000. Escitalopram therapy improves LSEQ score after 6 months in comparison to maprotiline therapy with high statistical significance p=0.000. Percentage of adverse effects is significantly lower in escitalopram (10.76%) than in maprotiline (26.67%) group.

Conclusion:

Escitalopram has significantly better efficacy and lower adverse effects rate in treatment of depressive symptoms and sleep disturbances in MDD patients comparing to maprotiline.
Aggessiveness in Persons Suffering from Major Depressive Disorder
Authors: Dutczak B.
Published: March 2009

Different types of aggressiveness occur in the course of many mental disorders - including major depressive disorder. In the literature, however, there is no model nor scientific researches that would explain explain the nature, dyrection, and dynamics of involved in this effect.The purpose of this research was to describe intensity and structure of aggressiveness in persons suffering from major depressive disorder.
Pooled Analysis of Adjunctive Extended Release Quetiapine Fumarate (Quetiapine XR) in Patients with Major Depressive Disorder (MDD)
Authors: El-Khalili N. , Bauer M. , Datto C. , Earley W. , Åstrom M. , Eriksson H.
Published: March 2009

Aim:

To evaluate quetiapine XR as adjunct to ongoing antidepressant therapy in patients with MDD showing inadequate response to antidepressant treatment.

Methods:

Data were analysed from two 6-week, multicentre, double-blind, randomised, placebo-controlled studies (D1448C00006; D1448C00007), prospectively designed to be pooled. Outpatients received adjunctive quetiapine XR 150mg/day (n=309), 300mg/day (n=307), placebo (n=303). Primary endpoint: change at Week 6 in MADRS total score. Other assessments included: MADRS individual item scores, HAM-A total scores, MADRS response and remission; AE reporting.

Results:

Quetiapine XR 150mg/day and 300mg/day (p< 0.001) reduced MADRS total scores versus placebo at Week 6 (-14.5, -14.8, -12.0) and Week 1 (-7.8, -7.3, -5.1). Subgroup analyses showed the therapeutic effect of quetiapine XR was neither limited to nor driven by factors such as gender or antidepressant class (SSRI/SNRI). Quetiapine XR demonstrated consistent improvements in individual MADRS items: 150mg/day and 300mg/day significantly improved 4/10 and 7/10 items at Week 6 versus placebo. At Week 6, MADRS response (≥50% decrease in total score) was 53.7% (p=0.063), 58.3% (p< 0.01) versus 46.2%; MADRS remission (total score ≤8) was 35.6% (p< 0.01), 36.5% (p< 0.001) versus 24.1% for quetiapine XR 150mg/day and 300mg/day and placebo, respectively. Quetiapine XR 150mg/day and 300mg/day improved HAM-A total scores versus placebo at Week 1 (-4.8 [p< 0.001], -4.2 [p< 0.01], -3.0) and Week 6 (-8.9 [p< 0.01], -9.1 [p< 0.001], -7.3). AEs (≥10%) were dry mouth, somnolence, sedation, dizziness, fatigue, constipation and headache with quetiapine XR.

Conclusion:

In patients with MDD and an inadequate response to antidepressant therapy adjunctive quetiapine XR is effective and generally well tolerated.
The Influence of Clinical and Socio-Demographical Characteristics on Medical Co-Morbidity Occurrence in Unipolar Depressive Individuals
Authors: Enatescu V.R.
Published: March 2009

Aims/Objectives:

Our main purpose was to examine the clinical and socio-demographical influencing factors that play a significant role to medical co-morbidity occurrences in unipolar depressives.

Methods:

We performed two types of clinical studies, one longitudinal retrospective study on 248 unipolar depressives admitted in our Clinic during 2001 - 2005 and second represented by a cross-sectional study on 45 inpatients and outpatients that had meet diagnostic criteria of unipolar depression according to ICD-10 and DSM-IV.

Results:

Socio-demographical factors that concurring to medical co-morbidity in unipolar depressives were represented by advanced current age and low educational level. Interestingly, the total duration of unipolar depression was not significant correlated with medical co-morbidity. A positive familial history of depression was correlated with a significant higher risk for coronary hearth diseases (depressives - average=0.443, S.D. =0.652; bipolars+delusionals - average=0.252, S.D.=0.499; t=2,665, p=0.008). Cluster C personality traits have had higher risk of cardiovasculare diseases (p=0.024). Inversely, in cross-sectional research those who met diagnostic criteria for cluster A and/or B personality disorders have had significant higher risk to develop medical co-morbidity. The higher level of co-existing anxiety, both as a trait as well as a state, was correlated with medical co-morbidity of unipolar depression. Surprisingly, in both type of studies, the severity of depression was not significant correlated with the extension of medical co-morbidity. Unipolar depressives were more prone to use dysfunctional copings as psychoactive substance use.

Conclusions:

Both clinical and socio-demographical data profiles could give us some valuable informations in predicting medical co-morbidity in unipolar depressives.
Psychosocial Factors Related to Suicidal Attempts in Adults
Authors: Estevens D. , Carvalho M. , Tur O.
Published: March 2009

In the south of Portugal, suicide rates are more prevalent compared to other regions. We will present the results of an on-going research, carried out with the main purpose of analysing different risk factors associated to suicidal attemps in a sample of 60 adults, both males and females, recurring to emergency room in a general hospital. A multimodal assessment matrix will be used to evaluate depression, suicidal ideation and intention, and individual, social, and environmental factors commonly related to the onset of major depression, namely hopelessness and pessimism, cognitive processing, interpersonal relations, life events. We expect to find a positive correlation between hopelessness and the indicators of suicidal attempts and also a mediator effect, of cognitive processes, on the relationship between hopelessness and pessimism with depression and, consequently, suicidal intention.
Depressive Symptoms as Predictors of the Severity of Fatigue in Major Depression
Authors: Ferentinos P. , Kontaxakis V. , Havaki-Kontaxaki B. , Dikeos D. , Papadimitriou G.
Published: March 2009

Objective:

Fatigue in patients with major depression is understudied, although highly prominent. The objective of this study was to investigate the independent correlation of various depressive symptoms with the severity of fatigue in major depression.

Methods:

Eighty-one patients (70 female/11 male, 40 inpatients/41 outpatients), aged 23-65 years (mean 48.6±10.6), with a DSM-IV main diagnosis of Major Depressive Disorder (М.Ι.Ν.Ι. 5.0.0.) and currently in a Major Depressive Episode [17-item Hamilton Depression Rating Scale (HDRS) score ≥15], were studied. Patients with physical diseases or other fatigue-related conditions were excluded. The 14-item Fatigue Questionnaire (FQ) was used for the assessment of reported fatigue. Factor analysis of all HDRS items was performed. Pearson's correlations between the derived regression factor scores and the FQ score were calculated. Age, gender, and factor scores that significantly correlated with the FQ score entered a multiple regression analysis, with the FQ score as the dependent variable.

Results:

Factor analysis of HDRS items indicated a 6-factor structure (F1 ‘depressed mood’, F2 ‘middle/late insomnia and somatic anxiety’, F3 ‘anorexia/ weight loss’, F4 ‘general somatic symptoms’, F5 ‘anxiety/hypochondriasis’, F6 ‘early insomnia’). Only factors F1 (items 1,3,7,8), F2 (items 5,6,11) and F4 (items 13,14,17) were significantly correlated with the FQ score (p< 0.05). F1, F2 and F4 turned out to be significant predictors of FQ in the multiple regression, with standardised beta coefficients of 0.291, 0.290 and 0.278 (p< 0.05), respectively.

Conclusions:

Depressed mood, somatic anxiety, middle and late insomnia correlate independently with the severity of fatigue reported by patients with major depression.