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Sample records for manic depressive illness

  1. Artistic productivity and lithium prophylaxis in manic-depressive illness.

    PubMed

    Schou, M

    1979-08-01

    Twenty-four manic-depressive artists, in whom prophylactic lithium treatment had attenuated or prevented recurrences to a significant degree, were questioned about their creative power during the treatment. Twelve artists reported increased artistic productivity, six unaltered productivity, and six lowered productivity. The effect of lithium treatment on artistic productivity may depend on the severity and type of the illness, on individual sensitivity, and on habits of utilizing manic episodes productively.

  2. MULTIPLE BIOCHEMICAL CORRELATES OF MANIC-DEPRESSIVE ILLNESS

    DTIC Science & Technology

    depressive illness. Two hospitalized rapidly cycling manic- depressive patients underwent daily clinical ratings of mood, daily measurements of blood...obtained and discussed: (1) Urine volume and creatinine excretion were lower during depression , most likely on the basis of reduced fluid intake. (2) VMA...excretion was higher during mania and correlated with level of physical activity. (3) Kynurenine excretion was lower during depression , possibly on

  3. Linkage study between manic-depressive illness and chromosome 21

    SciTech Connect

    Ewald, H.; Mors, O.; Flint, T.

    1996-04-09

    Chromosome 21, of interest as potentially containing a disease gene for manic-depressive illness as possible evidence for a gene predisposing to affective disorder, has recently been reported in a single large family as well as samples of families. The present study investigates for linkage between manic-depressive illness and markers covering the long arm of chromosome 21 in two manic-depressive families, using ten microsatellite polymorphisms as markers. No conclusive evidence for a disease gene on the long arm of chromosome 21 was found. Assuming either a dominant or recessive mode of inheritance, close linkage to the marker PFKL, which has been reported as possibly linked to affective disorder, seems unlikely in the families studied here. PFKL and more telomeric markers yielded small positive lod scores at higher recombination fractions in the largest family, and small positive lod scores at lower recombination fractions in the affecteds-only analyses in the smallest family. 32 refs., 2 figs., 3 tabs.

  4. MANIFEST PSYCHOPATHOLOGY AND URINE BIOCHEMICAL MEASURES: MULTIVARIATE ANALYSES IN MANIC-DEPRESSIVE ILLNESS

    DTIC Science & Technology

    Two hospitalized rapidly cycling manic- depressive patients underwent daily ratings by nursing staff using the Overall-Gorham Brief Psychiatric Rating... depressive illness and delineates specific manic and depressive symptom clusters for each patient. Regression equations for the biochemical measures...system influences, such as ACTH release, and non-specific changes, such as level of motor activity, occurring with shifts between mania and depression

  5. Effects of rubidium chloride on the course of manic-depressive illness.

    PubMed Central

    Paschalis, C; Jenner, F A; Lee, C R

    1978-01-01

    Clinical studies of the effects of rubidium ions on the course of manic-depressive illness are reported. It seems that rubidium tends to increase the length of manic phases and possibly reduces the extremes of mood. Rubidium did not seem to produce any severe side effects in the dose administered, but it has a long biological half-life and caution is still required. Some details of the CSF, RBC, saliva and plasma and urine kinetics are also reported. PMID:349155

  6. Linkage analysis between manic-depressive illness and 35 classical markers

    SciTech Connect

    Ewald, H.; Mors, O.; Eiberg, H.

    1994-06-15

    The present study used carefully established phenotypes, several methods to reduce misclassification, and conservative genetic parameters. For the 35 markers investigated no evidence of linkage to manic-depressive illness was found, especially not to the markers on chromosomes 4q, 9q, and 19, which earlier has been suggested as possibly being linked to subtypes of manic-depressive illness. Close linkage to FY and SS(GYPB) was excluded for all chosen phenotypic models and to ACP1 and ADA for broader phenotypic models. 25 refs., 1 fig., 1 tab.

  7. Systematic chromosome examination of two families with schizophrenia and two families with manic depressive illness

    SciTech Connect

    Friedrich, U.; Mors, O.; Ewald, H.

    1996-02-16

    Systematic and detailed chromosome analysis, combined with a semistructured interview, was performed in 2 families with schizophrenia and in 2 families with manic depressive illness. Prometaphase technique did not reveal any subtle structural chromosome abnormalities. However, in standard techniques, gain and loss of sex chromosomes were observed. This occurred in patients at a younger age than in unaffected persons. This gives rise to the suspicion that sex chromosome aneuploidy may somehow be related to the development of psychosis. But since the data set is small, especially with respect to schizophrenia, further studies are needed to elucidate this observation. In one family, cosegregation of the disease locus with a marker on chromosome 21 was seen. Therefore, further research should determine if chromosome 21 contains a gene for manic depressive illness. 10 refs., 3 figs., 2 tabs.

  8. An association between Manic-depressive illness and a pseudoautosomal DNA marker

    SciTech Connect

    Yoneda, Hiroshi; Sakai, Toshiaki; Ishida, Toru; Inayama, Yasuhiro; Nonomura, Yasuhiro; Kono, Yoshihiro; Asaba, Hiroyuki )

    1992-11-01

    This article reports on the association between manic-depressive illness and a polymorphic DNA marker in the pseudoautosomal region (Xp22.32; Yp11.3). The authors studied two markers in 49 biologically unrelated patients and 119 normal controls. Probe 362A (DXYS20) identified four alleles. Frequencies of the A4 allele were significantly higher in patients than in controls. 9 refs., 1 tab.

  9. Linkage analysis between manic-depressive illness and markers on the long arm of chromosome 11

    SciTech Connect

    Ewald, H.; Mors, O.; Eiberg, H.

    1995-10-09

    The long arm of chromosome 11 is one of the most interesting regions in the search for major genes involved in the etiology of manic-depressive illness. Several candidate genes have been identified, including the gene encoding the dopamine D2 receptor, the M1 muscarinic receptor, and porfobillinogen deaminase. Furthermore, different families with co-segregation of psychiatric illness and structural chromosome abnormalities involving regions 11q21, 11q22.3, and 11q25 have been reported. Using narrow as well as broad phenotypic models, conservative genetic parameters, models with dominant or recessive modes of inheritance, and various methods to reduce misclassification, the present study did not find evidence for a major gene causing manic-depressive illness on the long arm of chromosome 11. In the broader phenotypic models multi-point analyses excluded at least 11q14 to 11q23.3, approximately 60 cM, even in one large family. Assuming homogeneity, close linkage to DRD2 was excluded for all dominant models, and also in the affecteds-only analyses in the large family alone. 38 refs., 3 figs., 1 tab.

  10. Lack of association between manic-depressive illness and a highly polymorphic marker from GABRA3 gene

    SciTech Connect

    Puertollano, R.; Piqueras, J.F.; Visedo, G.

    1995-10-09

    We have carried out an association study between a dinucleotide repeat polymorphism in GABRA3 gene and manic-depressive illness in a Spanish population. This may be an important candidate gene for bipolar affective disorders since it is located in the Xq28 region, previously implicated in linkage studies. In addition, severe GABergic alterations have been reported in patients. We have not found significant differences between controls and patients in allele frequencies or genotypes. 9 refs., 1 tab.

  11. Familial cosegregation of manic-depressive illness and a form of hereditary cerebellar ataxia

    SciTech Connect

    Piqueras, J.F.; Santos, J.; Puertollano, R.

    1995-06-19

    We report on a Spanish family with co-occurrence of manic-depression and a form of hereditary cerebellar ataxia. All affected individuals in the second generation showed cerebellar ataxia and manic-depression simultaneously. Since anticipation has been described in both disorders and the pattern of segregation may be autosomal as well as X-linked, we have searched for a possible involvement of two candidate genes which are located either on an autosome (SCA1) or on the X-chromosome (GABRA3). We concluded that expansion of trinucleotide repeats at SCA1 gene cannot be considered as a disease-causing mutation, and this gene should be initially discarded. 19 refs., 3 figs.

  12. Absence of linkage between chromosome 11p15 markers and manic-depressive illness in a Belgian pedigree.

    PubMed

    Mendlewicz, J; Leboyer, M; De Bruyn, A; Malafosse, A; Sevy, S; Hirsch, D; Van Broeckhoven, C; Mallet, J

    1991-12-01

    The original finding of genetic linkage in an Old Order Amish pedigree has been contradicted by the results of several subsequent studies. Using the same genetic parameter values, diagnostic criteria, and 11p15 genetic markers as those used to study the initial Amish population, the authors performed a linkage study of a four-generation informative pedigree in Belgium. Recombinant DNA technology was used to analyze three markers for the chromosome 11p15 location: the genes for tyrosine hydroxylase (TH) and insulin (INS) and the c-Harvey-ras oncogene (HRAS). Diagnoses of the relatives of a proband with bipolar affective disorder were determined with the Schedule for Affective Disorders and Schizophrenia--Lifetime Version and based on the Research Diagnostic Criteria. Relatives were considered affected if they had bipolar disorder, unipolar disorder, or cyclothymia; a diagnostic hierarchy was developed to include unipolar disorder and cyclothymia in the linkage analysis. Pairwise analyses of the disease locus and each of the three polymorphisms excluded the possibility of close linkage between manic-depressive illness and the three chromosome 11p15 markers. Multipoint linkage analysis combining the information from all three genes also excluded linkage. The conflict between the original results from the Amish study and the many negative reports on chromosome 11 linkage of manic-depression has been interpreted as indicating genetic heterogeneity, but heterogeneity has not been documented for the 11p15 locus. Conversely, the linkage approach has major drawbacks, so other genetic strategies should also be considered.

  13. Chromosome 18 DNA markers and manic-depressive illness: evidence for a susceptibility gene.

    PubMed Central

    Berrettini, W H; Ferraro, T N; Goldin, L R; Weeks, D E; Detera-Wadleigh, S; Nurnberger, J I; Gershon, E S

    1994-01-01

    In the course of a systematic genomic survey, 22 manic-depressive (bipolar) families were examined for linkage to 11 chromosome 18 pericentromeric marker loci, under dominant and recessive models. Overall logarithm of odds score analysis for the pedigree series was not significant under either model, but several families yielded logarithm of odds scores consistent with linkage under dominant or recessive models. Affected sibling pair analysis of these data yielded evidence for linkage (P < 0.001) at D18S21. Affected pedigree member analysis also suggests linkage, with multilocus results for five loci giving P < 0.0001 and P = 0.0007 for weighting functions f(p) = 1 and 1/square root p, respectively, where p is the allele frequency. These results imply a susceptibility gene in the pericentromeric region of chromosome 18, with a complex mode of inheritance. Two plausible candidate genes, a corticotropin receptor and the alpha subunit of a GTP binding protein, have been localized to this region. PMID:8016089

  14. Reconsidering the classification of schizophrenia and manic depressive illness--a critical analysis and new conceptual model.

    PubMed

    Boteva, Kalina; Lieberman, Jeffrey

    2003-04-01

    The idea of 'disease entity' in psychiatry and the nosologic map of insanity with the distinction between dementia praecox (schizophrenia since Bleuler 1911) and manic depressive insanity, originally developed by Emil Kraepelin (1986), is an important landmark in the history of psychiatry (Jablensky 1995). This classification, however, has been vigorously debated throughout the years, and new evidence emerging from epidemiological, clinical, genetic and biological research demonstrates that the two nosological categories have distinct features as well as share many similarities in their risk factors, genetic predisposition, brain pathology, neurophysiology, clinical phenomenology and response to treatment, thus raising questions about the validity of the categorical classification of psychoses. In this paper we examine some of the similarities and differences between schizophrenia and bipolar illness emerging from recent biological and clinical research and attempt to clarify major inherent logical contradictions in the application of the 'disease' model of psychiatric diagnosis to the categorical classification of schizophrenia and bipolar illness. Then we examine how similar predicaments have been resolved in other natural classification systems, namely the biological classification of species and the periodic table of the elements. Finally we propose a hypothetical conceptual approach to the classification of psychoses that has been greatly informed by the organizing principle underlying the periodic table of the elements, and is distinct from the 'disease' model of psychiatric classification.

  15. Integrated theory to unify status among schizophrenia and manic depressive illness.

    PubMed

    Fukuda, K

    2015-10-01

    Tryptophan hydroxylase 1 is primarily expressed in the gastrointestinal tract, and has been associated with both schizophrenia and depression. Although decreased serotonin activity has been reported in both depression and mania, it is important to investigate the interaction between serotonin and other neurotransmitter systems. There are competitive relationships between branched-chain amino acids, and tryptophan and tyrosine that relate to physical activity, and between L-3,4-dihydroxyphenylalanine (L-DOPA) and 5-hydroxytryptophan (5-HTP), both highly dependent on intracellular tetrahydrobiopterin concentrations. Here, I propose a chaos theory for schizophrenia, mania, and depression using the competitive interaction between tryptophan and tyrosine with regard to the blood-brain barrier and coenzyme tetrahydrobiopterin. Mania may be due to the initial conditions of physical hyperactivity and hypofunctional 5-HTP-producing cells inducing increased dopamine. Depression may be due to the initial conditions of physical hypoactivity and hypofunctional 5-HTP-producing cells inducing decreased serotonin. Psychomotor excitation may be due to the initial conditions of physical hyperactivity and hyperfunctional 5-HTP-producing cells inducing increased serotonin and substantially increased dopamine. The hallucinatory-paranoid state may be due to the initial conditions of physical hypoactivity and hyperfunctional 5-HTP-producing cells inducing increased serotonin and dopamine. Copyright © 2015 Elsevier Ltd. All rights reserved.

  16. In vivo assessment of dopamine D-2 and serotonin S-2 receptors measured by C-11 N-methylspiperone (NMSP) in manic-depressive illness

    SciTech Connect

    Wong, D.F.; Pearlson, G.; Wagner, H.N. Jr.; Dannals, R.F.; Suneja, S.; Bjorgvinsson, E.; Links, J.M.; Ravert, H.T.; Wilson, A.A.; Schaerf, F.

    1985-05-01

    The hypothesis has been suggested that either the dopaminergic or serotonergic neurotransmitter systems may be involved in manic-depressive illness (MD). The authors have studied 16 subjects with C-11 NMSP PET imaging. Two had never received neuroleptics; 4 were drug free for 1 month at the time of scanning; of these 3 were acutely manic; the rest were on stable lithium treatment. The dopamine and serotonin binding was estimated by the 43 min. caudate/cerebellum (Ca/Cb) and frontal/cerebellum (FC/Cb) ratios, respectively. No statistically significant difference was detected when compared to 44 age and sex matched controls. Based upon the variance in the normal data and the average age of the patient group studied, the probability of detecting a difference of >30% between patients and normals is >0.8. Hence, identification of receptor abnormalities if present will be improved with increased sample size of both normals and patients.

  17. Associations of Serum Cytokine Receptor Levels with Melancholia, Staging of Illness, Depressive and Manic Phases, and Severity of Depression in Bipolar Disorder.

    PubMed

    Siwek, Marcin; Sowa-Kućma, Magdalena; Styczeń, Krzysztof; Misztak, Paulina; Nowak, Rafał J; Szewczyk, Bernadeta; Dudek, Dominika; Rybakowski, Janusz K; Nowak, Gabriel; Maes, Michael

    2016-09-23

    To examine cytokine receptor biomarkers in bipolar disorder (BD), we recruited 133 well-phenotyped BD patients and 50 normal controls and measured serum levels of soluble interleukin 1 receptor antagonist (sIL-1RA), soluble interleukin-2 receptor (sIL-2R), sIL-6R, and tumor necrosis factor receptor 60 and 80 kDa (sTNFR60/80). sIL-1RA and sTNFR80 are significantly higher in BD than in controls and sTNFR80 and higher in melancholic than in non-melancholic patients and controls. Kapczinski's stages 3 + 4 are characterized by lowered sIL-2R and increased sTNFR80 levels. Acute phase depression is characterized by increased sTNFR80 levels as compared with controls, manic, and euthymic patients. Both sTNFR60 and sTNFR80 levels are significantly and positively related with severity of depression but not mania. Logistic regression analysis showed that the significant predictors for BD are increased sIL-1RA levels, nicotine dependence and a family history of depression and alcoholism. The risk factors for stages 3 + 4 are lowered sIL-2R levels and nicotine dependence. Melancholia is predicted by higher sTNFR80 levels and female sex. Severity of depression is predicted by female sex, nicotine dependence, and increased sTNFR60 and sTNFR80 levels. Cell-mediated immunity is activated during a current episode of depression but not (hypo)mania or the euthymic state. There are no associations between the biomarkers and age at onset, duration of illness, severity of mania, bipolar (BP)2 or BP1 subtypes, rapid cycling, atypical depression, psychotic or suicidal symptoms, and a family history of psychiatric disease. The results show that increased sIL-1RA may be a trait marker of BD, increased sTNFR80 a state marker of the depressive phase, especially melancholia, while lower sIL-2R but higher sTNFR80 may be staging biomarkers.

  18. Pseudoautosomal marker DXYS20 and manic depression

    SciTech Connect

    Noethen, M.M.; Cichon, S.; Erdmann, J.; Koerner, J.; Rietschel, M.; Propping, P. ); Rappold, G.A. ); Fritze, J. )

    1993-04-01

    Yoneda et al. (1992) observed a significant association between manic-depressive illness and a 13.5-kb band of the pseudoautosomal marker DXYS20 (probe 362A) in EcoRI digests of 49 Japanese patients compared with 119 controls. The 13.5-kb allele was designated [open quotes]A4 allele[close quotes] and was found on at least one chromosome in 46.9% of the patients, compared with 26.1% of the controls. The relative risk of the A4 allele for the disease was 2.51. The authors have genotyped the EcoRI RFLP in 73 patients (40 females and 33 males) who fulfill DSM-III-R criteria of manic-depressive illness (bipolar affective disorder) and in 79 controls (34 females and 45 males). All subjects included in the study were unrelated and were of German descent. They used the probe 3cos-PP, which, by sequence analysis, was shown to be directly homologous to the independently cloned probe 362A (Rappold et al. 1992). The pseudoautosomal locus DXYS20 represents a VNTR-like minisatellite, and many polymorphic bands are recognized by means of several restriction endonucleases (Page et al. 1987). In EcoRI digests, sizes of bands cluster, and the authors grouped their bands according to allele sizes used by Yoneda et al. In addition to the alleles reported by Yoneda et al., they observed a 10-kb band in five subjects. The results are shown in a table. The frequency of the A4 allele did not differ significantly between patients and controls. Thus, the data do not support a widespread or consistent association between DXYS20 and bipolar affective disorder. A large degree of ethnic variation is seen with DXYS20 (Rappold et al. 1992) and might explain the difference of allele frequencies in controls from Japan and Germany. Since VNTRs evolve rapidly, they may not always be the best markers to detect disease associations, where a positive effect requires linkage disequilibrium. In any case, it should be useful to study larger samples of Japanese patients and controls. 3 refs., 1 tab.

  19. [Bipolar disorder and manic-depressive disorder on the Internet].

    PubMed

    Seyringer, Michaela-Elena; Schrank, Beate; Berger, Peter; Katschnig, Heinz; Amering, Michaela

    2007-01-01

    The internet is an important source of information and exchange for patients and can exert considerable influence on their health-related behaviours and decisions. This makes the quality of information on the internet an important factor. The present study analyzes the quality of German-language internet information on "bipolar disorder" and "manic-depressive disorder". Two separate searches were conducted with the terms "bipolar disorder" and "manic-depressive disorder", using the Google search engine set to produce only German hits. The quality of the first hundred resulting sites was assessed according to a range of criteria considering form and content. Comprehensive information on the nature of the illness (such as symptoms and diagnosis) was provided more frequently by sites resulting from the search term "manic-depressive disorder". The term "bipolar disorder" produced more results offering information on evidence-based therapeutic strategies. It is necessary to improve the available internet information on the term "bipolar disorder", and to establish the term as firmly as its predecessor, the term "manic-depressive disorder".

  20. Predictors of the onset of manic symptoms and a (hypo)manic episode in patients with major depressive disorder.

    PubMed

    Boschloo, Lynn; Spijker, Annet T; Hoencamp, Erik; Kupka, Ralph; Nolen, Willem A; Schoevers, Robert A; Penninx, Brenda W J H

    2014-01-01

    One third of patients with a major depressive episode also experience manic symptoms or, even, a (hypo)manic episode. Retrospective studies on the temporal sequencing of symptomatology suggest that the majority of these patients report depressive symptoms before the onset of manic symptoms. However, prospective studies are scarce and this study will, therefore, prospectively examine the onset of either manic symptoms or a (hypo)manic episode in patients with a major depressive disorder. In addition, we will consider the impact of a large set of potential risk factors on both outcomes. Four-year follow-up data were used to determine the onset of manic symptoms as well as a CIDI-based (hypo)manic episode in a large sample (n = 889, age: 18-65 years) of outpatients with a major depressive disorder and without manic symptoms at baseline. Baseline vulnerability (i.e., sociodemographics, family history of depression, childhood trauma, life-events) and clinical (i.e., isolated manic symptoms, depression characteristics, and psychiatric comorbidity) factors were considered as potential risk factors. In our sample of depressed patients, 15.9% developed manic symptoms and an additional 4.7% developed a (hypo)manic episode during four years. Baseline isolated manic symptoms and comorbid alcohol dependence predicted both the onset of manic symptoms and a (hypo)manic episode. Low education only predicted the onset of manic symptoms, whereas male gender, childhood trauma and severity of depressive symptoms showed strong associations with, especially, the onset of (hypo)manic episodes. A substantial proportion (20.6%) of patients with a major depressive disorder later developed manic symptoms or a (hypo)manic episode. Interestingly, some identified risk factors differed for the two outcomes, which may indicate that pathways leading to the onset of manic symptoms or a (hypo)manic episode might be different. Our findings indirectly support a clinical staging model.

  1. Polymorphic DNA marker on X chromosome and manic depression.

    PubMed

    Mendlewicz, J; Simon, P; Sevy, S; Charon, F; Brocas, H; Legros, S; Vassart, G

    1987-05-30

    Heredity is an important factor in vulnerability to manic depression. A genetic linkage has been demonstrated between manic depression and coagulation factor IX at Xq27 with a TaqI polymorphism at the F9 locus in DNA samples from peripheral leucocytes of manic depressive probands and relatives in 10 informative families. Statistical analysis of the pedigrees gave a maximum lod score of 3.10 at a recombination fraction of 0.11, demonstrating a linkage between a manic depressive locus and the F9 locus in the Xq27 region.

  2. The clinical picture of mania in manic-depressive black patients.

    PubMed

    Jones, B E; Robinson, W M; Parson, E B; Gray, B A

    1982-06-01

    Recent studies have shown that misdiagnosis of manic-depressive illness among blacks is a frequent occurrence. There are a number of historical and institutional dynamics involved in this process that have the roots of racism as their foundation. In light of this the authors decided to look at the clinical symptoms and behaviors of manic-depressive illness among black patients to see if their interpretation might be another contributing factor in misdiagnosis.The authors found the clinical symptoms of manic-depressive illness in black patients to be essentially what one would expect as determined by criteria in the Diagnostic and Statistical Manual (DSM III). However, there were cultural and socioeconomic determinants of behavior that affected the clinical manifestations.

  3. Two manic-depressives, two tyrants, two world wars.

    PubMed

    Lieb, Julian

    2008-01-01

    Napoleon Bonaparte, Adolph Hitler and Joseph Stalin were tyrants who attained absolute power, and misused it in a gargantuan fashion, leaving in his wake a trail of hatred, devastation and death. All made war on their perceived enemies and on their own countrymen. In "A Brotherhood of Tyrants: Manic Depression and Absolute power" (1994) Amherst, Prometheus Books, D. Jablow Hershman and I expose manic-depressive disorder as the force that drove them to absolute power and the terrible abuse of it. We uncover manic-depressive disorder as a hidden cause of dictatorship, mass killing and war, and show how the psychopathology of the disorder can be a key factor in the political pathology of tyranny. In our earlier "The Key To Genius: Manic-Depression and the Creative Life" (1998) Amherst Prometheus Books we catalog the role of the disorder in the lives and careers of Isaac Newton, Ludwig von Beethoven, Charles Dickens, Vincent van Gogh and other creative geniuses. Thus manic-depressive disorder is variable to the extreme of paradox. Key to the destroyers is an indifference to the suffering of others, a need to control everyone and everything, a resistance to reason, and grandiose and paranoid delusions. The paranoid and grandiose delusions of manic-depressives are as infectious and as virulent as a deadly microbe, and can easily infect those in thrall to the host figure. It is a phenomenon known as "induced psychosis" and its imprint is often to be seen on the world stage. In this article I will add Kaiser Wilhelm to the list of manic-depressive warmongers, and passages from Robert Payne's "The Life and Death of Adolph Hitler" that are not only pathognomonic of manic-depressive disorder, but of the mixed variant.

  4. Plasma tryptophan concentration in depressive illness and mania.

    PubMed

    Peet, M; Moody, J P; Worrall, E P; Walker, P; Naylor, G J

    1976-03-01

    Total and free plasma trytophan levels were measured in depressive and manic patients before and after recovery. No change was found in total or free plasma trytophan concentration on recovery from depressive illness. Free plasma tryptophan levels were higher in recovered manics than in active manics, and a group of four manic patients tested before and after recovery showed a significant increase in free plasma tryptophan concentration on recovery.

  5. Manic symptoms during depressive episodes in 1,380 patients with bipolar disorder: findings from the STEP-BD.

    PubMed

    Goldberg, Joseph F; Perlis, Roy H; Bowden, Charles L; Thase, Michael E; Miklowitz, David J; Marangell, Lauren B; Calabrese, Joseph R; Nierenberg, Andrew A; Sachs, Gary S

    2009-02-01

    Little is known about how often bipolar depressive episodes are accompanied by subsyndromal manic symptoms in bipolar I and II disorders. The authors sought to determine the frequency and clinical correlates of manic symptoms during episodes of bipolar depression. From among 4,107 enrollees in the National Institute of Mental Health's Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD), 1,380 individuals met criteria for bipolar I or II depressive syndromes at the time of enrollment and were assessed for concomitant manic symptoms. Illness characteristics were compared in patients with pure bipolar depressed episodes and those with mixed depressive presentations. Two-thirds of the subjects with bipolar depressed episodes had concomitant manic symptoms, most often distractibility, flight of ideas or racing thoughts, and psychomotor agitation. Patients with any mixed features were significantly more likely than those with pure bipolar depressed episodes to have early age at illness onset, rapid cycling in the past year, bipolar I subtype, history of suicide attempts, and more days in the preceding year with irritability or mood elevation. Manic symptoms often accompany bipolar depressive episodes but may easily be overlooked when they appear less prominent than depressive features. Subsyndromal manic symptoms during bipolar I or II depression demarcate a more common, severe, and psychopathologically complex clinical state than pure bipolar depression and merit recognition as a distinct nosologic entity.

  6. Creatine kinase levels in patients with bipolar disorder: depressive, manic, and euthymic phases.

    PubMed

    Feier, Gustavo; Valvassori, Samira S; Rezin, Gislaine T; Búrigo, Márcio; Streck, Emilio L; Kapczinski, Flávio; Quevedo, João

    2011-06-01

    Bipolar disorder is a severe, recurrent, and often chronic psychiatric illness associated with significant functional impairment, morbidity, and mortality. Creatine kinase is an important enzyme, particularly for cells with high and fluctuating energy requirements, such as neurons, and is a potential marker of brain injury. The aim of the present study was to compare serum creatine kinase levels between bipolar disorder patients, in the various phases (depressive, manic, and euthymic), and healthy volunteers. Forty-eight bipolar patients were recruited: 18 in the euthymic phase; 17 in the manic phase; and 13 in the depressive phase. The control group comprised 41 healthy volunteers. The phases of bipolar disorder were defined as follows: euthymic-not meeting the DSM-IV criteria for a mood episode and scoring < 8 on the Hamilton Depression Rating Scale (HDRS) and Young Mania Rating Scale (YMRS); manic-scoring < 7 on the HDRS and > 7 on the YMRS; depressive-scoring > 7 on the HDRS and < 7 on the YMRS. Patients in mixed phases were excluded. Blood samples were collected from all participants. Creatine kinase levels were higher in the manic patients than in the controls. However, we observed no significant difference between euthymic and depressive patients in terms of the creatine kinase level. Our results suggest that the clinical differences among the depressive, manic, and euthymic phases of bipolar disorder are paralleled by contrasting levels of creatine kinase. However, further studies are needed in order to understand the state-dependent differences observed in serum creatine kinase activity.

  7. Continuum of depressive and manic mixed states in patients with bipolar disorder: quantitative measurement and clinical features.

    PubMed

    Swann, Alan C; Steinberg, Joel L; Lijffijt, Marijn; Moeller, Gerard F

    2009-10-01

    Bipolar mixed states combine depressive and manic features, presenting diagnostic and treatment challenges and reflecting a severe form of the illness. DSM-IV criteria for a mixed state require combined depressive and manic syndromes, but a range of mixed states has been described clinically. A unified definition of mixed states would be valuable in understanding their diagnosis, mechanism and treatment implications. We investigated the manner in which depressive and manic features combine to produce a continuum of mixed states. In 88 subjects with bipolar disorder (DSM-IV), we evaluated symptoms and clinical characteristics, and compared depression-based, mania-based, and other published definitions of mixed states. We developed an index of the extent to which symptoms were mixed (Mixed State Index, MSI) and characterized its relationship to clinical state. Predominately manic and depressive mixed states using criteria from recent literature, as well as Kraepelinian mixed states, had similar symptoms and MSI scores. Anxiety correlated significantly with depression scores in manic subjects and with mania scores in depressed subjects. Discriminant function analysis associated mixed states with symptoms of hyperactivity and negative cognitions, but not subjective depressive or elevated mood. High MSI scores were associated with severe course of illness. For depressive or manic episodes, characteristics of mixed states emerged with two symptoms of the opposite polarity. This was a cross-sectional study. Mixed states appear to be a continuum. An index of the degree to which depressive and manic symptoms combine appears useful in identifying and characterizing mixed states. We propose a depressive or manic episode with three or more symptoms of the opposite polarity as a parsimonious definition of a mixed state.

  8. Attempted suicide in manic-depressive disorder.

    PubMed

    Goldring, N; Fieve, R R

    1984-07-01

    Structured interviews were used to study rates of past suicide attempts among 123 outpatients treated for affective disorders. Subjects met the Feighner criteria for major affective illness, and bipolar and unipolar groups were identified in accordance with the Fieve-Dunner criteria. Although a small group (N = 6), the women with a history of hospitalization for depression and outpatient treatment for hypomania (BP II) had the highest rate of past suicide attempts. (66 percent). This confirms previous findings. Women showed higher rates overall (39 percent vs. 28 percent for men). Suicide attempters were found to be significantly younger than nonattempters, which is in line with previous reports that suicide risk is high early in the course of bipolar illness. A trend for attempters to have received their first treatment at a younger age suggests that early onset may be a risk factor. No differences in marital status were found between attempters and nonattempters. Males and females did not differ in number, seriousness, or lethality of attempts.

  9. Manic depression in literature: the case of Virginia Woolf.

    PubMed

    Koutsantoni, Katerina

    2012-06-01

    The steady growth of the discipline of medical humanities has facilitated better understanding of the symptoms and signs of mental health conditions and the feelings of the humans experiencing them. In this project, the arts have been seen as enabling re-engagement of the practitioner with the patient's own perceptions and feelings. With respect to the association between creativity and bipolar disorder in particular, work within medical humanities has meant that mentally ill creative individuals have been subject to scientific scrutiny and investigation, rather than continuing to be viewed as naively romanticised cases of mental illness. This paper is an attempt to supplement traditional literary criticism by examining Virginia Woolf's history of bipolar disorder through a medical humanities lens. I will provide an overview of Woolf's history of manic-depressive episodes, their symptoms and manifestation, look back on her circumstances during their occurrence, and observe the author's losing battle to salvage her identity in the throes of the disease. The aim is to offer further insight into Woolf's psychopathology and to gain some understanding of the causes and progression of the condition that led to her death by suicide.

  10. Seasonal variation of manic and depressive symptoms in bipolar disorder

    PubMed Central

    Akhter, Ahmed; Fiedorowicz, Jess G.; Zhang, Tao; Potash, James B.; Cavanaugh, Joseph; Solomon, David A.; Coryell, William H.

    2013-01-01

    Objectives Analyses of seasonal variation of manic and depressive symptoms in bipolar disorder in retrospective studies examining admission data have yielded conflicting results. We examined seasonal variation of mood symptoms in a prospective cohort with long-term follow-up: The Collaborative Depression Study (CDS). Methods The CDS included participants from five academic centers with a prospective diagnosis of bipolar I or II disorder. The sample was limited to those who were followed for at least 10 years of annual or semi-annual assessments. Time series analyses and autoregressive integrated moving average (ARIMA) models were used assess seasonal patterns of manic and depressive symptoms. Results A total of 314 individuals were analyzed [bipolar I disorder: (n = 202) and bipolar II disorder: (n = 112)] with both disorders exhibiting the lowest depressive symptoms in summer and highest around the winter solstice, though the winter peak in symptoms was statistically significant only with bipolar I disorder. Variation of manic symptoms was more pronounced in bipolar II disorder, with a significant peak in hypomanic symptomatology in the months surrounding the fall equinox. Conclusions Significant seasonal variation exists in bipolar disorder with manic/hypomanic symptoms peaking around the fall equinox and depressive symptoms peaking in months surrounding the winter solstice in bipolar I disorder. PMID:23621686

  11. AN INTENSIVE STUDY OF TWELVE CASES OF MANIC-DEPRESSIVE PSYCHOSIS

    DTIC Science & Technology

    An intensive study of 12 manic- depressive patients was made in order to reformulate, and further develop the dynamics of the character structure of...present state of development of psychopathological theory in regard to manic- depressive states. The manic- depressive character was investigated from

  12. Genetic linkage analysis of manic depression in Iceland.

    PubMed Central

    Curtis, D; Sherrington, R; Brett, P; Holmes, D S; Kalsi, G; Brynjolfsson, J; Petursson, H; Rifkin, L; Murphy, P; Moloney, E

    1993-01-01

    Genetic linkage analysis has been used to study five Icelandic pedigrees multiply affected with manic depression. Genetic markers were chosen from regions which had been implicated by other studies or to which candidate genes had been localized. The transmission model used was of a dominant gene with incomplete penetrance and allowing for a large number of phenocopies, especially for unipolar rather than bipolar cases. Multipoint analysis with linked markers enabled information to be gained from regions spanning large distances. Using this approach we have excluded regions of chromosome 11p, 11q, 8q, 5q, 9q and Xq. Candidate genes excluded include those for tyrosine hydroxylase, the dopamine type 2 receptor, proenkephalin, the 5HT1A receptor and dopamine beta hydroxylase. Nevertheless, we remain optimistic that this approach will eventually identify at least some of the genes predisposing to manic depression. PMID:8105081

  13. Contribution to the physique of women with manic-depressive disorder in Hungary.

    PubMed

    Tóth, Gábor A; Buda, Botond L; Eiben, Ottó G

    2003-12-01

    The purpose of this study was to get new data about the physique (somatotype) of manic-depressive patients. The somatotypes of manic-depressive females (n = 31, mean age: 30 year) investigated show a balanced mesomorphic-endomorphic predominance. The mean somatotype was 6.34, 5.27, 1.39. Previous Hungarian studies showed a meso-endomorphic somatotype in manic-depressive females. The physique of these patients determined by Kretschmer as pycnic did not show significant alteration due to environmental changes. Thus, according to the recent study, Kretschmer's statements (1921) are still valid in manic-depressive females. They are invariably characterized by a pycnic physique.

  14. [Neuropsychological aspects of the manic syndrome in the course of bipolar affective illness].

    PubMed

    Lewandowska, Anna; Rybakowski, Janusz

    2009-01-01

    Neuropsychological deficits in schizophrenia and affective illnesses have been a topic of increasing research interest for more than two decades. Currently, the cognitive dysfunctions are regarded as an essential element of these illnesses, occurring already in their prodromal phase, with an increment during the course of illness and with some deficits persisting also during the remission period. In schizophrenia, deficits in working memory and executive functions are most frequently demonstrated. In patients with affective illnesses, the initial research focused mainly on depression, where psychomotor slowness, deficits of attention, verbal and working memory and executive functions have been observed. It has been shown that during depression in the course of bipolar affective illness, the cognitive dysfunctions have been more marked as compared with recurrent depression. In this paper, the neuropsychological changes occurring during the period of mania and hypomania have been presented. The disturbances that have been shown most frequently include selective cognitive dysfunctions such as disturbances of attention and learning process, working memory and executive functions. During periods of mania/hypomania, the specific distortions of thinking occur ("anastrophic" thinking), as well as disturbances in the decision making process, connected with increased impulsivity. Another characteristic of the episode of elevated mood has been a change of information processing of affective type, mostly a lower ability for perception and recognition of negative emotions. Among persons with bipolar affective illness, especially during the hypomanic period, an increased level of creativity than in control persons has been observed, what may facilitate higher artistic activity. Recently, the evidence has been accumulated pointing to more severe cognitive dysfunctions in bipolar affective illness, type I (with manic states) compared with bipolar affective illness, type II (with

  15. On the periodicity of manic-depressive insanity, by Eliot Slater (1938): translated excerpts and commentary.

    PubMed

    Oepen, Godehard; Baldessarini, Ross J; Salvatore, Paola; Slater, Eliot

    2004-01-01

    Since the classic descriptions of the course of bipolar and recurrent depressive forms of manic-depressive illness by Emil Kraepelin a century ago, it has been considered a truism that the rate of cycling increases, and wellness intervals shorten, with rising counts of recurrences, particularly early in the natural history of the illness. Less well known is that the analysis of this phenomenon is vulnerable to a computational artifact first described by Eliot Slater, based on his reanalysis of data from manic-depressive patients first evaluated by Kraepelin at the Munich Psychiatric Institute. Slater realized that there is an increasingly disproportionate representation of faster-cycling patients in sub-samples involving higher cycle-counts in pooled samples of subjects. More accurate results require analyzing illness-course either within individuals, or in groups matched for episode-counts. This artifact is pervasive in the older and modern research literature, but still not widely recognized. Since Slater's 1938 report in German is not well known, we provide an abbreviated English translation with commentary and additional reanalysis to highlight the phenomenon that might be termed 'Slater's Fallacy'.

  16. Weygandt's On the Mixed States of Manic-Depressive Insanity: a translation and commentary on its significance in the evolution of the concept of bipolar disorder.

    PubMed

    Salvatore, Paola; Baldessarini, Ross J; Centorrino, Franca; Egli, Samy; Albert, Matthew; Gerhard, Angela; Maggini, Carlo

    2002-01-01

    Wilhelm Weygandt's Uber die Mischzustände des manisch-depressiven Irreseins (On the Mixed States of Manic-Depressive Insanity) describes and conceptualizes mixed states of mood, behavior, and thinking commonly found in manic-depressive disorders. These ideas emerged from Weygandt's service in the 1890s at the Psychiatric Clinic of the University of Heidelberg, directed by Emil Kraepelin. In the sixth (1899) edition of Kraepelin's influential textbook, the concept of manic-depressive illnesses underwent a fundamental shift from a complex group of syndromal subtypes to a single integrated disorder, widely known from the 1921 English translation of the eighth (1920) edition. In the 1899 edition, Kraepelin acknowledged Weygandt for a new section on mixed manic-depressive states within the new integrated view of manic-depressive disorder. We provide biographical notes on Weygandt, a little-known but historically important figure, as well as the first English translation of his monograph and interpretive summaries of his findings. We also consider whether Weygandt's important insight that the same person could be both manic and depressed not only at different times but even at the same time served as an important stimulus to Kraepelin's unified manic-depressive disorder concept, which survives as bipolar disorder a century later.

  17. Search for a gene predisposing to manic-depression on chromosome 21

    SciTech Connect

    Byerley, W.; Holik, J.; Hoff, M.; Coon, H.

    1995-06-19

    Six kindreds containing multiple cases of manic-depressive illness (MDI) were genotyped with seven highly polymorphic microsatellite loci used in the construction of an index map for chromosome 21. The kindreds were also genotyped with a microsatellite polymorphism for PFKL, a chromosome 21 locus that has shown suggestive linkage to MDI in one pedigree. Evidence of linkage was not found assuming either autosomal dominant or recessive inheritance. The nonparametric affected sib pair test did not yield significant evidence of linkage. 11 refs., 1 fig., 3 tabs.

  18. Virginia Woolf: manic-depressive psychosis and genius. An illustration of separation-individuation theory.

    PubMed

    Bond, A H

    1985-04-01

    Virginia Stephen was a member of one of England's great literary families, many of whom were also mentally ill. An exquisitely endowed infant, she was beautifully matched with her mother during the symbiotic state of development, and later called this period "the base upon which life stands." Difficulties presumably began as early as the differentiation subphase of separation. Mrs. Stephen appeared to be a narcissistic woman, who required constant affirmation, and thus was unable to respond to the needs of a developing child. Virginia probably was rescued from engulfment by a powerful biologically determined practicing period of separation-individuation. This great organismic surge, in all likelihood, is as characteristic of toddlers who are incipient manics as of children of future genius. Because of the strong regressive pull, it is probable that Virginia experienced a particularly high-powered glee in evading the field of her mother. This "economic condition," according to Freud, is a given that is felt by the manic as he overthrows the imprisoning restraints of the superego. Deflated by events beyond her control, such as the sadism of her siblings, Virginia probably attempted to return to her mother. But it appears that Mrs. Stephen was not available. Hence Virginia was forced to split off her anger and turn it against herself, keeping her aggression unavailable for neutralization. As a result she was unable to proceed to an age-adequate level of development. The raw rage lay smoldering within until many years later, when it burst forth to power her manic attacks. This failure of rapprochement presumably deflated Virginia, and resulted in a basic mood of depression already apparent in the nursery. Virginia also experienced a second basic mood, elation, which appears to have been characteristic of her even in well periods, and resembles the description of the typical manic victim given by Beck.

  19. Predictability of course of illness in manic patients positive for life events.

    PubMed

    Ambelas, A; George, M

    1986-11-01

    The intention of this study was to examine the possibility of predicting course of illness in manic patients, using a stress variable as a predictor, together with other more traditional indices. On the basis of information on three easily available parameters--family history, age at onset, and stress intensity--20 manic patients who had independent life events preceding an index admission were allocated into various risk groups and predictions were then made with regard to future course of illness for 5 years. On follow-up, the predictions were found to be correct in 85% of cases overall, and two high-risk factors were totally predictive.

  20. Stigma and self-esteem in manic depression: an exploratory study.

    PubMed

    Hayward, Peter; Wong, Grace; Bright, Jenifer A; Lam, Dominic

    2002-05-01

    As part of a larger study on coping styles in manic depressive patients, it was felt that self-esteem and stigmatisation, two areas that have received little attention in connection with this illness, warranted investigation. A questionnaire on self-esteem and feelings of stigmatisation was piloted. The rationale of the questionnaire is explained and data on its reliability and validity are presented. This pilot study suggests a relationship between mood and self-esteem, while feelings of stigmatisation seem to be relatively independent of mood. However, some relationship between self-esteem and stigmatisation is suggested. This study focused on an atypical group of patients, and the questionnaire had never been used before. For this reason, the results can be best seen as suggesting further research. We believe that issues of self-esteem and stigmatisation can have considerable clinical significance in this client group. For this reason, we hope this paper will stimulate interest in these areas.

  1. The number of past manic episodes is the best predictor of antidepressant-emergent manic switch in a cohort of bipolar depressed patients.

    PubMed

    Gorwood, Philip; Richard-Devantoy, Stéphane; Sentissi, Othman; Le Strat, Yann; Olié, Jean Pierre

    2016-06-30

    The present study sought to identify factors associated with the onset of a manic or hypomanic episode during the month following a new antidepressant therapy in depressed bipolar patients. Patients receiving mood stabilizers for ≥3 months were screened from 400 French centers and were assessed for a 4-week period following prescription of a first or a new antidepressant. Of the 1242 included participants, 4.8% (n=60) experienced antidepressant-emergent manic switch (AEMS). AEMS was more frequently associated with lifetime manic, depressive, and total mood episodes, and with past AEMS. A higher score at two items of the Montgomery-Åsberg Depression Rating Scale (pessimistic and suicidal thoughts) were significantly associated with AEMS. Logistic regression analysis showed that the number of lifetime manic episodes and past AEMS were the two most factors associated with an AEMS. Having more than four past manic episodes was associated with a 2.84 fold increased risk of AEMS. Cumulative number of past mood episodes seems to be the most important factor for switching to a manic episode following antidepressants in patients with bipolar disorder. Longer-term studies are required to further delineate antidepressant causality from natural disease course.

  2. A genome-wide search for genes predisposing to manic-depression, assuming autosomal dominant inheritance

    SciTech Connect

    Coon, H.; Jensen, S.; Hoff, M.; Holik, J.; Plaetke, R.; Reimherr, F.; Wender, P.; Leppert, M.; Byerley, W. )

    1993-06-01

    Manic-depressive illness (MDI), also known as [open quotes]bipolar affective disorder[close quotes], is a common and devastating neuropsychiatric illness. Although pivotal biochemical alterations underlying the disease are unknown, results of family, twin, and adoption studies consistently implicate genetic transmission in the pathogenesis of MDI. In order to carry out linkage analysis, the authors ascertained eight moderately sized pedigrees containing multiple cases of the disease. For a four-allele marker mapping at 5 cM from the disease gene, the pedigree sample has >97% power to detect a dominant allele under genetic homogeneity and has >73% power under 20% heterogeneity. To date, the eight pedigrees have been genotyped with 328 polymorphic DNA loci throughout the genome. When autosomal dominant inheritance was assumed, 273 DNA markers gave lod scores <[minus]2.0 at [theta] = .05, and 4 DNA marker loci yielded lod scores >1 (chromosome 5 -- D5S39, D5S43, and D5S62; chromosome 11 -- D11S85). Of the markers giving lod scores >1, only D5S62 continued to show evidence for linkage when the affected-pedigree-member method was used. The D5S62 locus maps to distal 5q, a region containing neurotransmitter-receptor genes for dopamine, norepinephrine, glutamate, and gamma-aminobutyric acid. Although additional work in this region may be warranted, the linkage results should be interpreted as preliminary data, as 68 unaffected individuals are not past the age of risk. 72 refs., 2 tabs.

  3. Conformity and Psychopathology: A Comparative Study of Conformity Behaviors in Manic-depressive, Paranoid Schizophrenic and Normal Populations

    ERIC Educational Resources Information Center

    Marsella, Anthony J.

    1975-01-01

    The present study investigated the relationship between conformity and psychopathology in male and female manic-depressive (MD), paranoid schizophrenics (PS), and normals (N) on two conformity tasks under conditions of live social pressure. (Author)

  4. Why some patients prefer to become manic-depressive rather than schizophrenic.

    PubMed Central

    Stierlin, H.; Weber, G.; Schmidt, G.; Simon, F.

    1985-01-01

    This paper reports the authors' observations on fifteen families in which a young adult member had been diagnosed as manic-depressive. All families were seen in systemic family therapy, with intervals of four to six weeks between sessions. The circular questioning method developed by Selvini-Palazzoli [1] and her team was widely employed. All families could be described as extremely rigid and bound-up systems characterized by a "restrictive parental complementarity," typical dynamics of reciprocal delegation, and certain cognitive features and shared assumptions. These "manic-depressive" families show similarities as well as differences when compared with families with schizophrenic members (i.e., "schizo-present" families). Finally, some therapeutic implications of this view and approach are developed. PMID:4049908

  5. Serum neurotrophin-3 is increased during manic and depressive episodes in bipolar disorder.

    PubMed

    Walz, Julio C; Andreazza, Ana C; Frey, Benício N; Cacilhas, Alice A; Ceresér, Keila M M; Cunha, Angelo B M; Weyne, Fernanda; Stertz, Laura; Santin, Aida; Gonçalves, Carlos A; Kapczinski, Flávio

    2007-03-19

    Accumulating evidence suggest that neural changes and cognitive impairment may accompany the course of bipolar disorder. Such detrimental effects of cumulative mood episodes may be related to changes in neurotrophins that take place during mood episodes but not during euthymic phases. The present study investigated serum neurotrophin-3 (NT-3) levels in patients with bipolar disorder during manic, depressed, and euthymic states, using an enzyme-linked immunosorbent assay (sandwich-ELISA). Serum NT-3 levels were increased in manic (p<0.001) and depressed (p<0.001) BD patients, as compared with euthymic patients and normal controls. These findings suggest that the NT-3 signaling system may play a role in the pathophysiology of BD.

  6. Impaired sensory processing measured by functional MRI in Bipolar disorder manic and depressed mood states.

    PubMed

    Shaffer, Joseph J; Johnson, Casey P; Fiedorowicz, Jess G; Christensen, Gary E; Wemmie, John A; Magnotta, Vincent A

    2017-07-03

    Bipolar disorder is characterized by recurring episodes of depression and mania. Defining differences in brain function during these states is an important goal of bipolar disorder research. However, few imaging studies have directly compared brain activity between bipolar mood states. Herein, we compare functional magnetic resonance imaging (fMRI) responses during a flashing checkerboard stimulus between bipolar participants across mood states (euthymia, depression, and mania) in order to identify functional differences between these states. 40 participants with bipolar I disorder and 33 healthy controls underwent fMRI during the presentation of the stimulus. A total of 23 euthymic-state, 16 manic-state, 15 depressed-state, and 32 healthy control imaging sessions were analyzed in order to compare functional activation during the stimulus between mood states and with healthy controls. A reduced response was identified in the visual cortex in both the depressed and manic groups compared to euthymic and healthy participants. Functional differences between bipolar mood states were also observed in the cerebellum, thalamus, striatum, and hippocampus. Functional differences between mood states occurred in several brain regions involved in visual and other sensory processing. These differences suggest that altered visual processing may be a feature of mood states in bipolar disorder. The key limitations of this study are modest mood-state group size and the limited temporal resolution of fMRI which prevents the segregation of primary visual activity from regulatory feedback mechanisms.

  7. Creativity and executive function across manic, mixed and depressive episodes in bipolar I disorder.

    PubMed

    Soeiro-de-Souza, Márcio Gerhardt; Dias, Vasco Videira; Bio, Danielle Soares; Post, Robert M; Moreno, Ricardo A

    2011-12-01

    Creativity is a complex construct involving affective and cognitive components. Bipolar Disorder (BD) has been associated with creativity and is characterized by a wide range of affective and cognitive symptoms. Although studies of creativity in BD have tended to focus on creativity as a trait variable in medicated euthymic patients, it probably fluctuates during symptomatic states of BD. Since creativity is known to involve key affective and cognitive components, it is plausible to speculate that cognitive deficits and symptoms present in symptomatic BD could interfere with creativity. Sixty-seven BD type I patients medication free, age 18-35 years and experiencing a maniac, mixed, or depressive episodes, were assessed for creativity, executive functioning, and intelligence. Manic and mixed state patients had higher creativity scores than depressive individuals. Creativity was influenced by executive function measures only in manic patients. Intelligence did not influence creativity for any of the mood episode types. We propose that creativity in BD might be linked to the putative hyperdopaminergic state of mania and be dependent on intact executive function. Future studies should further explore the role of dopaminergic mechanisms in creativity in BD. Copyright © 2011 Elsevier B.V. All rights reserved.

  8. Specific alterations in plasma proteins during depressed, manic, and euthymic states of bipolar disorder

    PubMed Central

    Song, Y.R.; Wu, B.; Yang, Y.T.; Chen, J.; Zhang, L.J.; Zhang, Z.W.; Shi, H.Y.; Huang, C.L.; Pan, J.X.; Xie, P.

    2015-01-01

    Bipolar disorder (BD) is a common psychiatric mood disorder affecting more than 1-2% of the general population of different European countries. Unfortunately, there is no objective laboratory-based test to aid BD diagnosis or monitor its progression, and little is known about the molecular basis of BD. Here, we performed a comparative proteomic study to identify differentially expressed plasma proteins in various BD mood states (depressed BD, manic BD, and euthymic BD) relative to healthy controls. A total of 10 euthymic BD, 20 depressed BD, 15 manic BD, and 20 demographically matched healthy control subjects were recruited. Seven high-abundance proteins were immunodepleted in plasma samples from the 4 experimental groups, which were then subjected to proteome-wide expression profiling by two-dimensional electrophoresis and matrix-assisted laser desorption/ionization-time-of-flight/time-of-flight tandem mass spectrometry. Proteomic results were validated by immunoblotting and bioinformatically analyzed using MetaCore. From a total of 32 proteins identified with 1.5-fold changes in expression compared with healthy controls, 16 proteins were perturbed in BD independent of mood state, while 16 proteins were specifically associated with particular BD mood states. Two mood-independent differential proteins, apolipoprotein (Apo) A1 and Apo L1, suggest that BD pathophysiology may be associated with early perturbations in lipid metabolism. Moreover, down-regulation of one mood-dependent protein, carbonic anhydrase 1 (CA-1), suggests it may be involved in the pathophysiology of depressive episodes in BD. Thus, BD pathophysiology may be associated with early perturbations in lipid metabolism that are independent of mood state, while CA-1 may be involved in the pathophysiology of depressive episodes. PMID:26375446

  9. Clinical course of children with a depressive spectrum disorder and transient manic symptoms

    PubMed Central

    Nadkarni, Radha B; Fristad, Mary A

    2010-01-01

    Objective To assess rates of conversion to bipolar spectrum disorder (BPSD) and risk factors associated with conversion in children with depressive spectrum disorders (DSD) and transient manic symptoms (TMS) over 18 months. TMS are manic-like symptoms of insufficient duration or number to warrant a diagnosis of BPSD. Methods Participants were 165 children (mean = 9.9 years, SD = 1.3) with mood disorders from the Multi-Family Psychoeducational Psychotherapy (MF-PEP) treatment study; 37 with DSD+TMS, 13 with DSD, and 115 with BPSD. All were assessed with standardized instruments on four occasions over 18-months, with half receiving MF-PEP after their baseline assessment and half receiving MF-PEP after a one-year wait-list condition. Results At baseline, the Children’s Global Assessment Scale scores did not differ significantly between the DSD+TMS, DSD, and BPSD groups. Conversion rates to BPSD were significantly higher for the DSD+TMS group (48.0%) compared to the DSD group (12.5%). Conversion was significantly more frequent for participants in the one-year wait-list control group (60%) compared to the immediate treatment group (16%). Clinical presentation, family environment, and family history did not differ significantly between the small subset of DSD+TMS participants who did convert to BPSD at follow-up and those who did not convert. Baseline functional impairment was greater for the converted group than the non-converted group. Conclusions Transient manic symptoms are a risk factor for eventual conversion to BPSD; psychoeducational psychotherapy may be protective. As this exploratory study had a small sample size and did not correct for multiple comparisons, additional studies with larger sample sizes are needed. PMID:20712750

  10. Writing Amish culture into genes: biological reductionism in a study of manic depression.

    PubMed

    Floersch, J; Longhofer, J; Latta, K

    1997-06-01

    Critical realism is used to explore the problem of reductionism in a classic (the Amish Study) and widely-cited study of manic depression. Along with related ideas drawn from the works of R.C. Lewontin, Arthur Kleinman, and Byron Good, it is shown that natural and social scientists deploy atomistic and holistic reductionism; this, in turn, leads to the construction of artificially 'closed systems' through the control of variables or exogenous forces. The psychiatric genetic studies of the Amish were predicated on the assumption that Amish society is homogeneous and unchanging and, therefore, closed. We conclude by arguing that interactions between behaviors and genes, where they exist, take place only within open systems, characterized by multiple mechanisms-social and biological-that together co-determine any event. To move forward, it is argued, behavior and gene research requires recognition and resolution of the philosophical conundrums that accompany reductionism.

  11. Philosophical whitewashing. Ludwig Binswanger (1881-1966) and the sterilisation of manic-depressive patients.

    PubMed

    Marazia, Chantal

    2011-01-01

    The Swiss psychiatrist Ludwig Binswanger is known as the founder of the Daseinsanalyse (existential analysis) and more generally for having applied contemporary philosophical concepts and theories to psychiatry. The fortune of the philosopher Binswanger constituted a formidable obstacle to a historical scrutiny of his actual clinical practice. In the long run, the philosopher overshadowed the psychiatrist. The present paper takes the move from a "minor" work, an essay on the sterilisation of manic-depressive patients Binswanger published in 1938. This essay represents a rare exception in Binswanger's scientific production in many respects: for its editorial collocation, for the subject (a concrete medical intervention) and the complete absence of philosophical references. Nevertheless, or precisely for this reason, the essay has been largely ignored by the scholarship, both of Swiss eugenics and of Binswanger himself. This paper explores the epistemological circumstances of this negligence and its historiographic significance, with special attention to the philosophical-anthropological refashioning of a psychiatric myth.

  12. Differential Diagnosis of an Elderly Manic-Depressive Patient with Depersonalization and Other Symptoms

    PubMed Central

    Ogata, Shigehiro; Itohiya, Yu; Sakamoto, Yuri; Sato, Yuki; Suyama, Yudai; Atsuta, Hidenori; Iwata, Ken

    2016-01-01

    The case study of an elderly man having persecutory delusions and bizarre complaints at the first psychiatric interview is reported. The patient complained: “I have no sense of time” and “I have no sense of money.” He refused nursing care. He had delusions centered on himself including that of his own death, which were difficult to diagnose but suggested the possibility of Cotard's syndrome. We assumed that the man was depressed and treated him for depression. However, as a result of this treatment he became temporarily manic but finally recovered completely. After his recovery, we learnt the patient's past history of hospitalization for psychiatric problems, and based on that history he was diagnosed as suffering from a bipolar I disorder. The lack of typical symptoms of depression and the remarkable depersonalization and derealization in this patient made it difficult to infer a depressive state. Nevertheless, being attentive to his strange feelings related to the flow of time would have helped us to make an accurate diagnosis earlier. PMID:27293942

  13. Evidence for a susceptibility locus for manic-depressive disorder in Xq26

    SciTech Connect

    Pekkarinen, P.; Bredbacka, P.E.; Terwilliger, J.

    1994-09-01

    Manic-depression (MD) is a severe psychiatric disorder affecting 1% of the population. Several linkage studies have provided evidence for a susceptibility locus for MD in chromosome Xq27-28. However, validity of these findings have remained unclear for several reasons: linkage has been suggested to two distinct chromosomal regions (F9 and CB-G6PD) separated by 30 cM, linkage has been found in only few of the pedigrees analyzed and ascertainment bias have probably been introduced when using classical markers like CB. The aim of our study was to analyze several markers expanding both of these regions in one extended Finnish pedigree with 13 affected individuals (bipolar or schizoaffective disorder) and without male-to-male transmission. Together 27 polymorphic X chromosomal markers were studied, 22 of them in Xq25-q28. Linkage analyses were carried out using a dominant model, 0.005 disease gene frequency, age-dependent penetrance with a maximum penetrance of 0.80 and low phenocopy rate. Two-point linkage analyses resulted in clearly negative lod scores (<-2) to almost all markers outside the chromosomal region of Xq26. Three markers DXS458, GABRA3 and G6PD, gave uninformative lod scores but respective chromosomal areas could be excluded by other markers in the vicinity. Opposite to this, several markers on Xq26 resulted in positive lod scores. A maximum lod score of 3.4 was obtained with the marker AFM205wd2 at {theta}=0.0. This marker is located about 7 cM centromeric to F9. When all published linkage data on Xq26-q28 was reanalyzed no evidence for locus heterogeneity emerged suggesting a more general significance of this DNA region in the predisposition to manic-depressive disorder.

  14. Depressive illness and Navajo healing.

    PubMed

    Storck, M; Csordas, T J; Strauss, M

    2000-12-01

    What is the experience of Navajo patients in Navajo religious healing who, by the criteria and in the vernacular of contemporary psychiatry, would be diagnosed with the disorder called depression? We ask this question in the context of a double dialogue between psychiatry and anthropology and between these disciplines' academic constructs of illness and those of contemporary Navajos. The dialogue is conducted in the arena of patient narratives, providing a means for observing and explicating processes of therapeutic change in individuals, for illustrating variations in forms of Navajo religious healing sought out by patients demonstrating similar symptoms of distress, and for considering the heuristic utility of psychiatric diagnoses and nomenclature in the conceptualization of illness, recovery, and religious healing. From among the 37 percent of patients participating in the Navajo Healing Project who had a lifetime history of a major depressive illness, three are discussed herein, their selection based on two criteria: (1) all met formal psychiatric diagnostic criteria for a major depressive episode at the time of their healing ceremonies, and (2) together, their experiences illustrate the range of contemporary Navajo religious healing, including Traditional, Native American Church (NAC), and Christian forms. We suggest that, despite the explicit role of the sacred in religious healing interventions available to Navajo patients, differences between biomedical and religious healing systems may be of less significance than their shared existential engagement of problems such as those glossed as depression.

  15. Comparison of inflammatory cytokine levels among type I/type II and manic/hypomanic/euthymic/depressive states of bipolar disorder.

    PubMed

    Bai, Ya-Mei; Su, Tung-Ping; Tsai, Shih-Jen; Wen-Fei, Chiou; Li, Cheng-Ta; Pei-Chi, Tu; Mu-Hong, Chen

    2014-09-01

    Inflammatory cytokines have been suggested to be the trait or state markers of bipolar disorder, but with inconsistent results. This may be related to small sample sizes and poor control of some important confounding factors. Gender/age-matched outpatients with bipolar disorder and normal controls were enrolled. The clinical symptoms were rated using the Montgomery Åsberg Depression Rating Scale and Young Mania Rating Scale. Inflammatory cytokines, including soluble interleukin-6 receptor (sIL-6R), soluble interleukin-2 receptor (sIL-2R), C-reactive protein (CRP), soluble tumor necrosis factor receptor type 1 (sTNF-R1), soluble P-selectin receptor (sP-selectin), and monocyte chemotactic protein-1 (MCP-1), were assessed by enzyme-linked immunosorbent assays. In total, 130 patients with bipolar disorder and 130 normal subjects were enrolled. Among the patients with bipolar disorder, 77 (59.2%) had bipolar I disorder, 53 (40.8%) had bipolar II disorder; 75 (57.7%) were in a euthymic state, 14 (10.8%) were in a manic/hypomanic state, and 41 (31.5%) were in a depressive state. The 130 bipolar patients had significantly higher levels of all cytokines than the normal controls (all p<0.0001). Using multivariate regression analysis with controlling of age, gender, BMI, smoking, duration of illness, and medication grouping, the patients with bipolar II disorder had significantly lower levels of sTNF-R1 than the patients with bipolar I disorder (p=0.038); the patients in a depressive state had significantly lower levels of sTNF-R1 than the patients in manic/hypomanic and euthymic states (p=0.009). The study supported the association of bipolar disorder with inflammatory dysregulation, and sTNF-R1 may be a potential biomarker for staging bipolar disorder. Copyright © 2014 Elsevier B.V. All rights reserved.

  16. Ernst Rüdin’s Unpublished 1922-1925 Study “Inheritance of Manic-Depressive Insanity”: Genetic Research Findings Subordinated to Eugenic Ideology

    PubMed Central

    Kösters, Gundula; Steinberg, Holger; Kirkby, Kenneth Clifford; Himmerich, Hubertus

    2015-01-01

    In the early 20th century, there were few therapeutic options for mental illness and asylum numbers were rising. This pessimistic outlook favoured the rise of the eugenics movement. Heredity was assumed to be the principal cause of mental illness. Politicians, scientists and clinicians in North America and Europe called for compulsory sterilisation of the mentally ill. Psychiatric genetic research aimed to prove a Mendelian mode of inheritance as a scientific justification for these measures. Ernst Rüdin’s seminal 1916 epidemiological study on inheritance of dementia praecox featured large, systematically ascertained samples and statistical analyses. Rüdin’s 1922–1925 study on the inheritance of “manic-depressive insanity” was completed in manuscript form, but never published. It failed to prove a pattern of Mendelian inheritance, counter to the tenets of eugenics of which Rüdin was a prominent proponent. It appears he withheld the study from publication, unable to reconcile this contradiction, thus subordinating his carefully derived scientific findings to his ideological preoccupations. Instead, Rüdin continued to promote prevention of assumed hereditary mental illnesses by prohibition of marriage or sterilisation and was influential in the introduction by the National Socialist regime of the 1933 “Law for the Prevention of Hereditarily Diseased Offspring” (Gesetz zur Verhütung erbkranken Nachwuchses). PMID:26544949

  17. Ernst Rüdin's Unpublished 1922-1925 Study "Inheritance of Manic-Depressive Insanity": Genetic Research Findings Subordinated to Eugenic Ideology.

    PubMed

    Kösters, Gundula; Steinberg, Holger; Kirkby, Kenneth Clifford; Himmerich, Hubertus

    2015-11-01

    In the early 20th century, there were few therapeutic options for mental illness and asylum numbers were rising. This pessimistic outlook favoured the rise of the eugenics movement. Heredity was assumed to be the principal cause of mental illness. Politicians, scientists and clinicians in North America and Europe called for compulsory sterilisation of the mentally ill. Psychiatric genetic research aimed to prove a Mendelian mode of inheritance as a scientific justification for these measures. Ernst Rüdin's seminal 1916 epidemiological study on inheritance of dementia praecox featured large, systematically ascertained samples and statistical analyses. Rüdin's 1922-1925 study on the inheritance of "manic-depressive insanity" was completed in manuscript form, but never published. It failed to prove a pattern of Mendelian inheritance, counter to the tenets of eugenics of which Rüdin was a prominent proponent. It appears he withheld the study from publication, unable to reconcile this contradiction, thus subordinating his carefully derived scientific findings to his ideological preoccupations. Instead, Rüdin continued to promote prevention of assumed hereditary mental illnesses by prohibition of marriage or sterilisation and was influential in the introduction by the National Socialist regime of the 1933 "Law for the Prevention of Hereditarily Diseased Offspring" (Gesetz zur Verhütung erbkranken Nachwuchses).

  18. Mixed states with predominant manic or depressive symptoms: baseline characteristics and 24-month outcomes of the EMBLEM cohort.

    PubMed

    Azorin, Jean-Michel; Baraille, Laurent; Gérard, Stéphanie; Bertsch, Jordan; Reed, Catherine; Lukasiewicz, Michael

    2013-04-25

    While factors associated with mixed states have been extensively studied, data are scant regarding the clinical heterogeneity of mixed states. The EMBLEM study was a prospective, observational study on patients with manic and mixed states. We describe and compare baseline characteristics and 24-month clinical course of mixed states with predominant depressive symptoms (MSDS) and mixed states with predominant manic symptoms (MSMS). Adult inpatients/outpatients with bipolar disorder were enrolled within the standard course of care if they initiated or changed oral medication for acute mania or mixed states. A logistic regression was used to identify the baseline factors associated with each polarity. Comparisons with mixed episode without symptom predominance (OMS) were performed for informational purpose only. About 573 mixed patients were analyzed (23.7% of the cohort): 59.5% (n=341) had MSMS, 11.9% (n=68) had MSDS, and 28.6% (n=164) had OMS. At baseline, hallucinations/delusions during the index episode, inpatient status, high CGI-BP overall score, and low education level were more often associated with MSMS versus MSDS. Alcohol abuse or dependence and selective serotonin reuptake inhibitor (SSRI) or benzodiazepine use at inclusion were significantly more frequent with MSDS. MSDS had a significantly lower 24-month recurrence rate than MSMS; MSMS experienced more switches to mania whereas MSDS switched more to depression. The post hoc dimensional definitions in the study require caution in the interpretation of the results. These results present evidence of clinical heterogeneity within mixed states. Predominant manic or depressive symptoms within mixed episode could influence clinicians' decisions in term of hospitalization, treatment, and perception of bipolar severity. Copyright © 2012 Elsevier B.V. All rights reserved.

  19. INFLUENCE OF HIGH FAT DIET ON STEADY STATE BIOAVAILABILITY OF LITHIUM CARBONATE IN MANIC DEPRESSIVE PATIENTS - A PRELIMINARY REPORT

    PubMed Central

    Tripathi, S.K.; Basu, D.; Kulhara, P.; Garg, S.K.; Sharma, P.L.

    1993-01-01

    SUMMARY The effect of high fat food in the steady state bioavailability of lithium carbonate (900 or 1200mg daily, in divided doses) was studied in three patients of manic-depressive psychosis in a self-control cross-over design. Serial blood samples were collected by venepuncture until 8 hours following drug administration and lithium was assayed by flame photometry. The results indicated a reduction in the extent of bioavailability of lithium by the high fat food as compared to standard normal diet, in all the three patients studied Caution should be exercised in regard to lithium administration along with food rich in fat content. PMID:21743634

  20. Performance of Bipolar Disorder Patients in Attention Testing: Comparison with Normal Controls and Among Manic, Depressive, and Euthymic Phases.

    PubMed

    Camelo, Evelyn V M; Mograbi, Daniel; de Assis da Silva, Rafael; Bifano, Jaqueline; Wainstok, Mayra; Silveira, Luciana Angélica Silva; Netto, Tânia; Santana, Cristina M T; Cheniaux, Elie

    2017-03-01

    Several studies on cognition in bipolar disorder (BD) have been developed on the last decade. Neuropsychological evaluation of attention in BD patients is fundamental since alterations in attention affect other cognitive functions. Evaluate if performance of BD patients in attention tests varies according to each phase of the disease and verify if there are differences in attention when comparing BD patients with normal controls. The study included 101 BD patients, with ages between 18 and 65 years, being 52 euthymic, 22 manic and 27 depressive, besides 30 normal controls. All subjects were evaluated though Hamilton Depression Scale, Young Mania Rating Scale and Global Assessment of Functioning, bipolar version (CGI-BP). Attention was evaluated through a neuropsychological battery. Normal controls had a better performance in selective attention tests than BD patients. No differences were found among manic, depressive and euthymic phases. Attention is markedly impaired in BD. Nevertheless, the results of this study do not imply that the severity of the attention deficit in BD patients varies according to decease phase.

  1. A Case Report of Isotretinoin-induced Manic Psychosis

    PubMed Central

    Lucca, Jisha M; Varghese, Niphy Annie; Ramesh, Madhan; Ram, Dushad

    2016-01-01

    Isotretinoin, an oral vitamin A derivative, used to treat severe treatment-resistant acne. Psychiatric side effects of isotretinoin particularly depression and suicidal thoughts have been well documented. We report a case of isotretinoin-induced manic psychosis in a young female without a family history and history of mental illness. PMID:26955128

  2. Add-on Lamotrigine Treatment for Subsyndromal Depression after Manic or Mixed States in Bipolar Disorder Improved the Quality of Life

    PubMed Central

    Muneoka, Katsumasa; Kon, Katsushi; Kawabe, Masaharu; Ui, Rui; Miura, Taichi; Iimura, Touta; Kimura, Shou

    2012-01-01

    Two cases of patients experienced subsyndromal depression after manic or mixed hypomanic and depressive episodes due to bipolar I (case 1) and II (case 2) disorders prior to the use of lamotrigine. Case 1 showed episodes of mood switching induced by antidepressants and seasonal mood instability. Case 2 showed hippocampal atrophy and a persistent dull headache that preceded the use of lamotrigine. Both were successfully treated with add-on lamotrigine therapy, and the dull headache was effectively treated with olanzapine. Both patients improved in social activity and work performance after these add-on treatments. Thus, add-on treatment with lamotrigine alone or in combination with olanzapine was an effective strategy to improve the quality of life in bipolar depression. Subsyndromal depression that present after the disappearance of the manic or mixed state was suggested to be practical indication for the use of lamotrigine. PMID:23049569

  3. Plain Talk about Depression. Plain Talk Series.

    ERIC Educational Resources Information Center

    Sargent, Marilyn

    Depression is defined as a "whole-body" illness, involving the body, mood, and thoughts. Three of the most prevalent types of depressive disorders are described: major depression, dysthymia, and bipolar disorders (formerly called manic-depressive illness). Eleven symptoms of depression and 10 symptoms of mania are listed. Causes of depression are…

  4. Manic depressive psychosis and schizophrenia are neurological disorders at the extremes of CNS maturation and nutritional disorders associated with a deficit in marine fat.

    PubMed

    Saugstad, L F

    2001-12-01

    The maturational theory of brain development comprises manic depressive psychosis and schizophrenia. It holds that the disorders are part of human diversity in growth and maturation, which explains their ubiquity, shared susceptibility genes and multifactorial inheritance. Rate of maturation and age at puberty are the genotype; the disorders are localized at the extremes with normality in between. This is based on the association between onset of puberty and the final regressive event, with pruning of 40% of excitatory synapses leaving the inhibitory ones fairly unchanged. This makes excitability, a fundamental property of nervous tissue, a distinguishing factor: the earlier puberty, the greater excitability--the later puberty, the greater deficit. Biological treatment supports deviation from the norm: neuroleptics are convulsant; antidepressives are anti-epiletogenic. There is an association between onset of puberty and body-build: early maturers are pyknic broad-built, late ones linearly leptosomic. This discrepancy is similar to that in the two disorders, supporting the theory that body-build is the phenotype. Standard of living is the environmental factor, which affects pubertal age and shifts the panorama of mental illness accordingly. Unnatural death has increased with antipsychotics. Other treatment is needed. PUFA deficit has been observed in RBC in both disorders and striking improvements with addition of minor amounts of PUFA. This supports that dietary deficit might cause psychotic development and that prevention is possible. Other neurological disorders also profit from PUFA, underlining a general deficit in the diet.

  5. Suicidality and symptoms of anxiety, irritability, and agitation in patients experiencing manic episodes with depressive symptoms: a naturalistic study

    PubMed Central

    Eberhard, Jonas; Weiller, Emmanuelle

    2016-01-01

    Purpose Patients with a bipolar I disorder (BD-I) manic episode meeting the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5), criteria for “with mixed features” have a high incidence of suicide attempts and of anxiety, irritability, and agitation (AIA) symptoms. The aim of this analysis was to explore the relationship between suicidality and AIA symptoms in patients with BD-I experiencing mania with depressive symptoms, using data from a previous naturalistic study. Patients and methods Psychiatrists completed an online questionnaire about their adult patients who had a current BD-I manic episode. Questions covered the DSM-5 “with mixed features” specifier, the severity of AIA symptoms, the frequency and controllability of suicidal ideation, and the number of suicide attempts. Results Of 1,035 patients with BD-I mania who were included in the analyses, 348 (33.6%) met the criteria for the DSM-5 “with mixed features” specifier (three or more depressive symptoms). These patients were further stratified according to the severity of their AIA symptoms: “mild AIA” (zero or one AIA symptom above a severity threshold; 105 patients) or “severe AIA” (all three AIA symptoms above a severity threshold; 167 patients). A greater incidence of suicidal ideation was observed in the severe AIA group (71.9%) than in the mild AIA group (47.6%). Twice as many patients had easily controlled suicidal ideation than difficult-to-control suicidal ideation in both subgroups. The mean number of suicide attempts was higher in the severe AIA group than in the mild AIA group, during the current episode (0.84 vs 0.34 attempts, respectively; P<0.05) and over the patient’s lifetime (1.56 vs 1.04 attempts, respectively). Conclusion The high risk of suicide among BD-I mania patients with depressive symptoms is further increased when they experience severe AIA symptoms. Recognizing AIA symptoms in BD-I mania could provide a means of identifying

  6. The noradrenaline metabolite MHPG is a candidate biomarker between the depressive, remission, and manic states in bipolar disorder I: two long-term naturalistic case reports

    PubMed Central

    Kurita, Masatake; Nishino, Satoshi; Numata, Yukio; Okubo, Yoshiro; Sato, Tadahiro

    2015-01-01

    Background Treatment of the depressive and manic states in bipolar disorder I (BDI) is a challenge for psychiatrists. Despite the recognized importance of the switch phenomenon, the precise mechanisms underlying this process are yet to be shown. We conducted a naturalistic study in two BDI patients to determine whether biological markers (monoamine metabolites and brain-derived neurotrophic factor [BDNF]) are associated with the switch between depressive and manic states. Case presentation and methods Blood sampling and mood assessments were performed at 2-week intervals over a period of 2 (Case 1, n=72) and 6 (Case 2, n=183) years. Plasma concentrations of 3-methoxy-4-hydroxyphenylglycol (MHPG) and homovanillic acid (HVA) were analyzed by high-performance liquid chromatography with electrochemical detection. Plasma BDNF was assayed by sandwich ELISA (enzyme-linked immunosorbent assay). Results MHPG had the highest standardized coefficient (β) in the multiple regression analysis. We found a significant positive correlation between Young Mania Rating Scale scores and plasma MHPG levels (Case 1: ρ=0.429; Case 2: ρ=0.488), and a significant negative correlation between Montgomery–Asberg Depression Rating Scale scores and MHPG levels (Case 1: ρ=−0.542; Case 2: ρ=−0.465). Conversely, no significant correlation was found between the level of BDNF and the presence of a manic or depressive state, and although HVA had a slightly stronger correlation than MHPG, the levels of neither of these were found to significantly correlate with the symptoms. Conclusion These data suggest that peripheral MHPG levels (which is related to noradrenaline levels in the brain) could be used as a biomarker of mood states in BDI. The noradrenaline level in the brain is likely to reflect the clinical characteristics of the switch process in BDI, and has prognostic significance for the treatment of both manic and depressive states. PMID:25709459

  7. Depressive Illness: Pervasive Yet Mystifying.

    ERIC Educational Resources Information Center

    Blai, Boris, Jr.

    Doctors annually treat between approximately four and eight million Americans for depression. Behavioral changes in depressed individuals are characterized by sadness, loneliness, and apathy. Other symptoms include fatigue, early morning insomnia, loss of appetite, and suicide attempts. Underlying depression may mask itself in physical symptoms,…

  8. Depressive Illness: Pervasive Yet Mystifying.

    ERIC Educational Resources Information Center

    Blai, Boris, Jr.

    Doctors annually treat between approximately four and eight million Americans for depression. Behavioral changes in depressed individuals are characterized by sadness, loneliness, and apathy. Other symptoms include fatigue, early morning insomnia, loss of appetite, and suicide attempts. Underlying depression may mask itself in physical symptoms,…

  9. The maturational theory of brain development and cerebral excitability in the multifactorially inherited manic-depressive psychosis and schizophrenia.

    PubMed

    Saugstad, L F

    1994-12-01

    An association has been established between the multifactorially inherited rate of physical maturation and the final step in brain development, when some 40% of synapses are eliminated. This may imply that similarly to endocrine disease entities, we have cerebral disease entities at the extremes of the maturational rate continuum. The restriction of prepubertal pruning to excitatory synapses leaving the number of inhibitory ones fairly constant, implies changes in cerebral excitability as a function of rate of maturation (age at puberty). In early maturation there will be an excess in excitatory drive due to prematurely abridged pruning, which compounds a synchronization tendency inherent in excessive synaptic density. Lowering excitatory level with antiepileptics is hypothesized to be a logical treatment in this type of brain dysfunction. In late maturation, a deficit in excitatory drive due to failure to shut down the pruning process associated with a tendency to the breakdown of circuitry and desynchronization, adds to a similar adversity inherent in reduced synaptic density. Raising the excitatory level with convulsants is hypothesized to be the treatment for this type of CNS dysfunction. The maturational theory of Kraepelin's psychoses holds that they are naturally occurring contrasting chemical signaling disorders in the brain at the extremes of the maturational rate continuum: manic depressive psychosis is a disorder of the early maturer and comprises raised cerebral excitability and a raised density of synapses. This is successfully treated with anti-epileptics like sodium valproate and carbamazepin. Schizophrenia is a disorder in late maturation with reduced cerebral excitability and reduced synaptic density. This is accordingly treated with convulsants such as typical and atypical neuroleptics. However, the conventional effective treatments in both disorders act on inhibition only by either lowering or raising inhibitory level. While the neuroleptics

  10. The 7 up 7 down inventory: a 14-item measure of manic and depressive tendencies carved from the General Behavior Inventory.

    PubMed

    Youngstrom, Eric A; Murray, Greg; Johnson, Sheri L; Findling, Robert L

    2013-12-01

    The aim of this study was to develop and validate manic and depressive scales carved from the full-length General Behavior Inventory (GBI). The brief version was designed to be applicable for youths and adults and to improve separation between mania and depression dimensions. Data came from 9 studies (2 youth clinical samples, aggregate N = 738, and 7 nonclinical adult samples, aggregate N = 1,756). Items with high factor loadings on the 2 extracted dimensions of mania and depression were identified from both data sets, and final item selection was based on internal reliability criteria. Confirmatory factor analyses described the 2-factor model's fit. Criterion validity was compared between mania and depression scales, and with the full-length GBI scales. For both mania and depression factors, 7 items produced a psychometrically adequate measure applicable across both aggregate samples. Internal reliability of the Mania scale was .81 (youth) and .83 (adult) and for Depression was .93 (youth) and .95 (adult). By design, the brief scales were less strongly correlated with each other than were the original GBI scales. Construct validity of the new instrument was supported in observed discriminant and convergent relationships with external correlates and discrimination of diagnostic groups. The new brief GBI, the 7 Up 7 Down Inventory, demonstrates sound psychometric properties across a wide age range, showing expected relationships with external correlates. The new instrument provides a clearer separation of manic and depressive tendencies than the original. (PsycINFO Database Record (c) 2013 APA, all rights reserved).

  11. Creativity in Manic-Depressives, Cyclothymes, Their Normal Relatives, and Control Subjects.

    ERIC Educational Resources Information Center

    Richards, Ruth L.; And Others

    Although previous studies support familial and individual relationships between creativity and affective illness, most have examined eminent creative individuals. This is the first study of creativity in subjects defined only by psychodiagnostic criteria. Creative accomplishment over the adult lifetime was assessed broadly using a new instrument,…

  12. Creativity in Manic-Depressives, Cyclothymes, Their Normal Relatives, and Control Subjects.

    ERIC Educational Resources Information Center

    Richards, Ruth L.; And Others

    Although previous studies support familial and individual relationships between creativity and affective illness, most have examined eminent creative individuals. This is the first study of creativity in subjects defined only by psychodiagnostic criteria. Creative accomplishment over the adult lifetime was assessed broadly using a new instrument,…

  13. Identification of chromosome abnormalities in screening of a family with manic depression and psoriasis: predisposition to aneuploidy.

    PubMed

    Demirhan, Osman; Demirbek, Bülent; Tunç, Erdal; Uslu, Inayet Nur; Çetiner, Salih; Serin, Ayşe

    2012-06-01

    Cytogenetic analysis is an important stage in understanding the genetic background of manic depression (MD), and may provide a valuable clue to the identification of target loci and successful search for major genes. In order to identify chromosomal regions we aimed to detect the relationships between chromosomal aberrations (CAs) and immunological markers in a family with MD and psoriasis. We used the cell cultivation and conventional G-banding. We found predominantly numerical aberrations. The most common aneuploidy was chromosome 8, followed by chromosome 22, 21, 15, X and Y. However, structural aberrations consisted of duplications, deletions, translocations and breaks, with a focus on: loci on del(1)(q12-q23), del(1)(q21.1-q24), del(1)(q21.1-q23), del(10)(p11.2-pter), der(2)t(2;4)(p25;p12), t(2;22)(p14;p13), t(19;Y)? and dup(10)(q26). The susceptibility genes of MD or psoriasis may be located on these loci. Numerical sex CAs included 4(5.8%) with 45,X, 3(4.3%) with 47,XXY, and 4(5.8%) with structural chromosome X; del(X)(q13); del(X)(p11-pter) del(X)(q21.3) and inv(Y)(q11.2). We also conducted an immunological study. According results of this study, the percentage of CD2+, CD4+ and CD8+ lymphocytes of the father were significantly higher, whereas CD4+ lymphocytes were decreased in the mother, when compared the healthy persons. The percentage of CD4 level of the son was decreased, whereas CD8+ lymphocytes were higher. The CD4/CD8 ratio of the father and the son was found to be significantly high. These results may suggest that MD and psoriasis have a significant impact on both genetic and immunological parameters.

  14. Effects of asenapine on depressive symptoms in patients with bipolar I disorder experiencing acute manic or mixed episodes: a post hoc analysis of two 3-week clinical trials

    PubMed Central

    2011-01-01

    Background Asenapine demonstrated superiority over placebo for mania in bipolar I disorder patients experiencing acute current manic or mixed episodes in 2 randomized, placebo-and olanzapine-controlled trials. We report the results of exploratory pooled post hoc analyses from these trials evaluating asenapine's effects on depressive symptoms in patients from these trials with significant baseline depressive symptoms. Methods In the original trials (A7501004 [NCT00159744], A7501005 [NCT00159796]), 977 patients were randomized to flexible-dose sublingual asenapine (10 mg twice daily on day 1; 5 or 10 mg twice daily thereafter), placebo, or oral olanzapine 5-20 mg once daily for 3 weeks. Three populations were defined using baseline depressive symptoms: (1) Montgomery-Asberg Depression Rating Scale (MADRS) total score ≥20 (n = 132); (2) Clinical Global Impression for Bipolar Disorder-Depression (CGI-BP-D) scale severity score ≥4 (n = 170); (3) diagnosis of mixed episodes (n = 302) by investigative site screening. For each population, asenapine and olanzapine were independently compared with placebo using least squares mean change from baseline on depressive symptom measures. Results Decreases in MADRS total score were statistically greater with asenapine versus placebo at days 7 and 21 in all populations; differences between olanzapine and placebo were not significant. Decreases in CGI-BP-D score were significantly greater with asenapine versus placebo at day 7 in all categories and day 21 in population 1; CGI-BP-D score reductions were significantly greater with olanzapine versus placebo at day 21 in population 1 and day 7 in populations 2 and 3. Conclusions These post hoc analyses show that asenapine reduced depressive symptoms in bipolar I disorder patients experiencing acute manic or mixed episodes with clinically relevant depressive symptoms at baseline; olanzapine results appeared to be less consistent. Controlled studies of asenapine in patients with acute

  15. Effects of asenapine on depressive symptoms in patients with bipolar I disorder experiencing acute manic or mixed episodes: a post hoc analysis of two 3-week clinical trials.

    PubMed

    Szegedi, Armin; Zhao, Jun; van Willigenburg, Arjen; Nations, Kari R; Mackle, Mary; Panagides, John

    2011-06-20

    Asenapine demonstrated superiority over placebo for mania in bipolar I disorder patients experiencing acute current manic or mixed episodes in 2 randomized, placebo-and olanzapine-controlled trials. We report the results of exploratory pooled post hoc analyses from these trials evaluating asenapine's effects on depressive symptoms in patients from these trials with significant baseline depressive symptoms. In the original trials (A7501004 [NCT00159744], A7501005 [NCT00159796]), 977 patients were randomized to flexible-dose sublingual asenapine (10 mg twice daily on day 1; 5 or 10 mg twice daily thereafter), placebo, or oral olanzapine 5-20 mg once daily for 3 weeks. Three populations were defined using baseline depressive symptoms: (1) Montgomery-Asberg Depression Rating Scale (MADRS) total score ≥20 (n = 132); (2) Clinical Global Impression for Bipolar Disorder-Depression (CGI-BP-D) scale severity score ≥4 (n = 170); (3) diagnosis of mixed episodes (n = 302) by investigative site screening. For each population, asenapine and olanzapine were independently compared with placebo using least squares mean change from baseline on depressive symptom measures. Decreases in MADRS total score were statistically greater with asenapine versus placebo at days 7 and 21 in all populations; differences between olanzapine and placebo were not significant. Decreases in CGI-BP-D score were significantly greater with asenapine versus placebo at day 7 in all categories and day 21 in population 1; CGI-BP-D score reductions were significantly greater with olanzapine versus placebo at day 21 in population 1 and day 7 in populations 2 and 3. These post hoc analyses show that asenapine reduced depressive symptoms in bipolar I disorder patients experiencing acute manic or mixed episodes with clinically relevant depressive symptoms at baseline; olanzapine results appeared to be less consistent. Controlled studies of asenapine in patients with acute bipolar depression are necessary to

  16. Depression and vulnerability to incident physical illness across 10 years.

    PubMed

    Holahan, Charles J; Pahl, Sandra A; Cronkite, Ruth C; Holahan, Carole K; North, Rebecca J; Moos, Rudolf H

    2010-06-01

    While considerable research exists on the role of physical illness in initiating depressive reactions, the role of depression in the onset of physical illness is much less studied. Moreover, whereas almost all previous research on depression and incident physical illness has involved specific physical illnesses, the present study examines the link between depression and incident physical illness more generally. The study followed 388 clinically depressed patients who were entering treatment for unipolar depressive disorders and 404 matched community controls across 10 years. In self-report surveys, sociodemographic and health behavior data were indexed at baseline and physician-diagnosed medical conditions were indexed at baseline and at 1, 4, and 10 years during the follow-up period. After accounting for prior physical illness and key demographic and health behavior factors, membership in the depressed group was significantly linked to physical illness during the follow-up period. In these prospective analyses, depressed patients showed an almost two-thirds higher likelihood of experiencing physical illness during the follow-up period compared to community controls. The prospective association between depression and subsequent physical illness was evident for both less serious and more serious physical illness. Although participants were asked to report only physician-diagnosed conditions, the association between depression and physical illness may have been due to depressed individuals perceiving themselves as more ill than they were. The World Health Organization has included the co-morbidity between depression and chronic physical illness among its ten concerns in global public health. The current findings broaden the growing awareness of the co-morbidity between depression and physical illness to encompass a vulnerability of depressed individuals to physical illness more generally. Copyright 2009 Elsevier B.V. All rights reserved.

  17. Do Sub-syndromal Manic Symptoms Influence Outcome in Treatment Resistant Depression in Adolescents? A Latent Class Analysis from the TORDIA study

    PubMed Central

    Maalouf, Fadi T.; Porta, Giovanna; Vitiello, Benedetto; Emslie, Graham; Mayes, Taryn; Clarke, Gregory; Wagner, Karen D.; Asarnow, Joan Rosenbaum; Spirito, Anthony; Keller, Martin; Birmaher, Boris; Ryan, Neal; Shamseddeen, Wael; Iyengar, Satish; Brent, David A.

    2013-01-01

    Background To identify distinct depressive symptom trajectories in the TORDIA study and determine their correlates. Methods Latent Class Growth Analysis (LCGA) using the Children's Depression Rating Scale—Revised (CDRS-R) through 72 weeks from intake. Results 3 classes were identified: (1) little change in symptomatic status (“NO”), comprising 24.9% of participants, with a 72-week remission rate of 25.3%; (2) slow, steady improvement (“SLOW”), comprising 47.9% of participants, with a remission rate of 60.0%, and (3) rapid symptom response (“GO”), comprising 27.2% of participants, with a remission rate of 85.7%. Higher baseline CDRS-R (p<0.001) and poorer functioning (p=0.03) were the strongest discriminators between NO and GO. Higher baseline CDRS (p<0.001) and scores on the Mania Rating Scale (MRS) (p=0.01) were the strongest discriminators between SLOW and GO. Other variables differentiating GO from both NO and from SLOW, were better baseline functioning, lower hopelessness, and lower family conflict. Both NO and SLOW showed increases on the MRS over time compared to GO (ps≤0.04), and increasing MRS was strongly associated with lack of remission by 72 weeks (p=0.02). Limitations High rate of open treatment by the end of the follow-up period creates difficulty in drawing clear inferences about the long-term impact of initial randomization. Conclusion Along with depressive severity, sub-syndromal manic symptoms, at baseline, and over time emerged as important predictors and correlates of poor outcome in this sample. Further research is needed on the treatment of severe depression, and on the assessment and management of sub-syndromal manic symptoms in treatment resistant depression. PMID:22284022

  18. Convergent integration of animal model and human studies of bipolar disorder (manic-depressive illness).

    PubMed

    Le-Niculescu, Helen; Patel, Sagar D; Niculescu, Alexander B

    2010-10-01

    Animal models and human studies of bipolar disorder and other psychiatric disorders are becoming increasingly integrated, prompted by recent successes. Particularly for genomics, the convergence and integration of data across species, experimental modalities and technical platforms is providing a fit-to-disease way of extracting reproducible and biologically important signal, in sharp contrast to the fit-to-cohort effect, disappointing findings to date, and limited reproducibility of human genetic analyses alone. Such work in psychiatry can provide an example of how to address other genetically complex disorders, and in turn will benefit by incorporating concepts from other areas, such as cancer biology and diabetes.

  19. Bipolar mixed states: an international society for bipolar disorders task force report of symptom structure, course of illness, and diagnosis.

    PubMed

    Swann, Alan C; Lafer, Beny; Perugi, Giulio; Frye, Mark A; Bauer, Michael; Bahk, Won-Myong; Scott, Jan; Ha, Kyooseob; Suppes, Trisha

    2013-01-01

    Episodes of bipolar disorder are defined as depressive or manic, but depressive and manic symptoms can combine in the same episode. Coexistence or rapid alternation of depressive and manic symptoms in the same episode may indicate a more severe form of bipolar disorder and may pose diagnostic and treatment challenges. However, definitions of mixed states, especially those with prominent depression, are not well established. The authors performed literature searches for bipolar disorder, multivariate analyses, and the appearance of the terms "mixed" in any field; references selected from the articles found after the search were combined after a series of conferences among the authors. The authors reviewed the evolution of the concept of mixed states and examined the symptom structure of mixed states studied as predominantly manic, predominantly depressive, and across both manic and depressive episodes, showing essentially parallel structures of mixed states based on manic or depressive episodes. The authors analyzed the relationships between mixed states and a severely recurrent course of illness in bipolar disorder, with early onset and increased co-occurring anxiety-, stress-, and substance-related disorders, and they used this information to derive proposed diagnostic criteria for research or clinical use. The definitions and properties of mixed states have generated controversy, but the stability of their characteristics over a range of clinical definitions and diagnostic methods shows that the concept of mixed states is robust. Distinct characteristics related to the course of illness emerge at relatively modest opposite polarity symptom levels in depressive or manic episodes.

  20. Noradrenaline plays a critical role in the switch to a manic episode and treatment of a depressive episode

    PubMed Central

    Kurita, Masatake

    2016-01-01

    Although antidepressants may increase the risk of switching to mania in bipolar disorder (BD), clinicians have been using antidepressants to treat patients with bipolar depression. Appropriate treatments for bipolar depression remain controversial. In BD, antidepressants comprise a double-edged sword in terms of their efficacy in treating depression and the increased risk of switching. This review presents an important table outlining the benefit in terms of depression improvement and the risk of switching in the clinical setting. It also proposes strategies based on the characteristics of antidepressants such as their pharmacology, specifically the equilibrium dissociation constant (KD) of the noradrenaline transporter. This table will be useful for clinicians while considering benefit and risk. Antidepressants augmenting noradrenaline may be effective in bipolar depression. However, it is easily presumed that such antidepressants may also have a risk of switching to mania. Therefore, antidepressants augmenting noradrenaline will be the recommended treatment in combination with an antimanic agent, or they may be used for short-term treatment and early discontinuation. The corresponding medical treatment guidelines probably need to be reevaluated and updated based on biological backgrounds. From previous studies, we understand that the stability of noradrenaline levels is important for BD amelioration, based on the pathophysiology of the disorder. It is hoped that researchers will reevaluate BD by conducting studies involving noradrenaline. PMID:27703355

  1. Major depression, physical illness, and suicidal ideation in primary care.

    PubMed

    Goodwin, Renee D; Kroenke, Kurt; Hoven, Christina W; Spitzer, Robert L

    2003-01-01

    To determine the association between major depression and suicidal ideation and the role of physical illness in this link among primary care patients. More than 3,000 randomly selected primary care patients at eight sites across the United States completed the PRIME-MD PHQ, a screen for mental disorders for use in primary care. Physicians independently diagnosed physical illnesses. Multiple logistic regression analyses were used to determine the relationship between PRIME-MD depression, physical illness, and suicidal ideation. Pulmonary disease was associated with an increased likelihood of suicidal ideation, even among patients without major depression [odds ratio = 1.9 (1.04, 3.4)]. There was evidence of statistical interaction between pulmonary disease and depression in increasing the odds of suicidal ideation. Specifically, patients with pulmonary disease without depression, those with depression without pulmonary disease, and patients with both pulmonary disease and depression had significantly increased odds of suicidal ideation with odd ratios of 1.9 (1.04, 3.4), 7.4 (5.6, 9.7), and 9.6 (5.1, 18.0), respectively. These data suggest that some physical disorders may be associated with increased suicidal ideation in primary care and may also play a role in the relationship between depression and suicidal ideation among primary care patients. Primary care physicians may wish to engage in an in-depth evaluation of psychiatric problems, especially current suicidal ideation, among patients with specific ongoing physical illnesses.

  2. Effects of Prefracture Depressive Illness and Postfracture Depressive Symptoms on Physical Performance After Hip Fracture.

    PubMed

    Rathbun, Alan M; Shardell, Michelle; Orwig, Denise; Gruber-Baldini, Ann L; Ostir, Glenn; Hicks, Gregory E; Miller, Ram R; Hochberg, Marc C; Magaziner, Jay

    2016-11-01

    To compare the effect of prefracture depressive illness and postfracture depressive symptoms on changes in physical performance after hip fracture. Longitudinal observational cohort. Baltimore metropolitan area. Older adults with hip fracture (N = 255). Prefracture depressive illness (from medical records) at baseline and postfracture depressive symptoms at 2 months (using the Center for Epidemiologic Studies Depression Scale) were measured. Physical performance was measured 2, 6, and 12 months after fracture using the Short Physical Performance Battery (SPPB), a composite metric of functional status with a score ranging from 0 to 12. Weighted estimating equations were used to assess mean SPPB over time, comparing participants with and without prefracture depressive illness and subjects with and without postfracture depressive symptoms. Participants with prefracture depressive illness had an SPPB increase of 0.4 units (95% confidence interval (CI) = -0.5-1.3) from 2 to 6 months, smaller than the increase of 1.0 SPPB unit (95% CI = 0.4-1.6) in those without prefracture depressive illness. Participants with postfracture depressive symptoms had an SPPB increase of 0.2 units (95% CI = -1.0-1.5) from 2 to 12 months, and those without postfracture depressive symptoms had a larger increase of 1.2 units (95% CI = 0.6-1.8) over the same period. Nevertheless, prefracture depressive illness and postfracture depressive symptoms were not significantly associated with SPPB. Neither prefracture depressive illness nor postfracture depressive symptoms were significantly associated with changes in physical performance after hip fracture, but the magnitude of estimates suggested possible clinically meaningful effects on functional recovery. © 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.

  3. Illness representations of depression and perceptions of the helpfulness of social support: comparing depressed and never-depressed persons.

    PubMed

    Vollmann, Manja; Scharloo, Margreet; Salewski, Christel; Dienst, Alexander; Schonauer, Klaus; Renner, Britta

    2010-09-01

    Interactions between depressed persons and persons within their social network are often characterized by misunderstanding and unsuccessful social support attempts. These interpersonal problems could be fostered by discrepancies between depressed and never-depressed persons' illness representations of depression and/or discrepancies in the perceived helpfulness of supportive behaviors. Illness representations of depression (IPQ-R) and perceptions of the helpfulness of different social support behaviors (ISU-DYA and ISAD) were assessed in 41 currently depressed persons and 58 persons without a history of depression. Never-depressed persons perceived depression as more controllable by treatment and as less emotionally impairing than depressed persons, but also as having more severe consequences. Never-depressed persons considered activation-oriented support (motivation to approach problems) as more helpful and protection-oriented support (allowance to draw back) as less helpful in comparison to depressed persons. Data were collected in unrelated samples of depressed and never-depressed persons. Discrepancies in illness representations and perceptions of the helpfulness of social support do exist and may be the origin of problematic social interactions between depressed patients and persons within their social network. Therapeutic interventions should address the issue of conflicting perceptions and encourage depressed patients to acknowledge and discuss this topic within their social network. 2010 Elsevier B.V. All rights reserved.

  4. [Association between anxiety and depression in allergic illnesses].

    PubMed

    Noriega, Nicolás H

    2013-01-01

    This study aims at determining whether there was an association among anxiety, depression and allergic illnesses. It suggests the proper therapeutic treatment. During a year, our research work team worked with a group of 82 female and male patients (from 13 to 76 years old) who suffered from various types of allergies. Two psychometric scales were used to carry out this study: Hamilton's scale for anxiety whereas Beck Depression Inventory (BDI-II) and Zung's for depression. The association and its percentage were analyzed in patients who reported typical symptoms during their first check-up. They were free of psychopharmacologic drugs and psychotherapies. The presence of anxiety and depression was interpreted as another factor in the development of allergic symptoms. The following results were achieved as regards: for anxiety, an association positive 95 %. For depression, the results showed that there was a positive tendency for the association with an allergic illness. The conclusions showed that there is a positive association between anxiety and allergies. As regards depression and allergic illness, there is only a positive tendency. These final results would raise awareness of how to deal with anxiety and depression in allergic patients, both psychopharmacologically and psychotherapeutically.

  5. Evaluating depressive symptoms in hypomanic and manic episodes using a structured diagnostic tool: validation of a new Mini International Neuropsychiatric Interview (M.I.N.I.) module for the DSM-5 'With Mixed Features' specifier.

    PubMed

    Hergueta, Thierry; Weiller, Emmanuelle

    2013-01-01

    The Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5), includes a new 'With Mixed Features' specifier for mood episodes. In (hypo-)manic episodes, the specifier is given if three or more depressive symptoms are present nearly every day during the episode. A new module of the Mini International Neuropsychiatric Interview (M.I.N.I.) has been developed as a patient-completed questionnaire to evaluate the DSM-5 specifier for (hypo-)manic episodes. The objective of this study was to validate this new module. In Phase I, patients with a manic episode in the past 6 months completed the module and were asked whether the wording was clear, understandable, relevant and specific. Based on their feedback, the module was refined and finalised. In Phase II, psychiatrists each invited five patients to complete the module. The psychiatrists completed record forms for these five patients, which included their diagnoses, made according to DSM-5 criteria during clinical interviewing. The module was validated by comparing depressive symptoms reported by the patients themselves using the M.I.N.I. module with those evaluated by their psychiatrist using DSM-5 criteria during clinical interviewing. In Phase I, a few changes were made to the M.I.N.I. module based on feedback from 20 patients (60% of whom had mixed features). In Phase II, 23 psychiatrists completed record forms for 115 patients, 99 (86.1%) of whom completed the M.I.N.I. module. Agreement between psychiatrists' DSM-5 diagnoses and patients' M.I.N.I. responses was substantial (Cohen's kappa coefficient, 0.60). The overall sensitivity of the M.I.N.I. was 0.91 and its specificity was 0.70. Sensitivity ranged from 0.63 for psychomotor retardation to 0.90 for suicidal thoughts. Specificity ranged from 0.63 for diminished interest/pleasure to 0.90 for suicidal thoughts. The module's positive and negative predictive values were 0.72 and 0.90, respectively. In summary, the M.I.N.I. module demonstrated good

  6. Cost-of-illness studies of depression: a systematic review.

    PubMed

    Luppa, Melanie; Heinrich, Sven; Angermeyer, Matthias C; König, Hans-Helmut; Riedel-Heller, Steffi G

    2007-02-01

    Depression is a very common disease with substantial economic consequences. This paper reviews all published cost-of-illness studies of depression worldwide. A systematic search of cost-of-illness studies of depression in the databases MEDLINE, Web of Science, Cochrane Library, and PSYNDEXplus was conducted. Identified studies were classified by their basic characteristics. Costs reported were inflated in original currency to the year 2003 and then converted into US-dollar using purchasing power parities (US$ PPP). Additionally, national-costs were converted in costs per case and per inhabitant. 24 papers with notable methodical differences were identified and classified by their basic characteristics. Summary estimates from the studies for the average annual costs per case ranged from $1000 to $2500 for direct costs, from $2000 to $3700 for morbidity costs and from $200 to $400 for mortality costs. The basic quantity of interest in COI-studies of depression was stated. Methodical differences limited comparison substantially. Depression is associated with a high economic burden. Conducting COI-studies of depression along the line noted in the review could help provide the opportunity to expose differences in costs associated with different approaches to disease management.

  7. Illness perceptions, adjustment to illness, and depression in a palliative care population.

    PubMed

    Price, Annabel; Goodwin, Laura; Rayner, Lauren; Shaw, Emma; Hansford, Penny; Sykes, Nigel; Monroe, Barbara; Higginson, Irene; Hotopf, Matthew; Lee, William

    2012-05-01

    Representations of illness have been studied in several populations, but research is limited in palliative care. To describe illness representations in a population with advanced disease receiving palliative care and to examine the relationship between illness perceptions, adaptive coping, and depression. A cross-sectional survey of 301 consecutive eligible patients recruited from a palliative care service in south London, U.K. Measures used included the Brief Illness Perception Questionnaire (Brief IPQ), the Mental Adjustment to Cancer (MAC) Scale, and the Primary Care Evaluation of Mental Disorders Patient Health Questionnaire-9. Scores were not normally distributed for most questions on the Brief IPQ. The correlations found between items on the Brief IPQ were understandable in the context of advanced disease. MAC helplessness-hopelessness and fighting spirit were highly correlated with items on the Brief IPQ in opposite directions. The Brief IPQ domains of consequences, identity, concern, personal control, and emotion were associated with depression, a relationship that was not explained by adaptive coping. Seven causal attribution themes were identified: don't know, personal responsibility, exposure, pathological process, intrinsic personal factors, chance, fate or luck, and other. Both lung cancer diagnosis and gender were found to be independently associated with personal responsibility attribution. None of the attribution themes were associated with the presence of depression. Assessment of illness perceptions in palliative care is likely to yield important information about risk of depression and will help clinicians to personalize management of advanced disease. Copyright © 2012 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.

  8. Unstructured interviews: challenges when participants have a major depressive illness.

    PubMed

    Moyle, Wendy

    2002-08-01

    There is debate about undertaking sensitive research with vulnerable populations. Primarily, the literature has focused on informed consent, confidentiality and the principle of beneficence, with little discussion about data collection methods. This paper discusses the challenges of conducting unstructured interviews when participants have a major depressive illness. Issues arose during a phenomenological study that explored the meaning of being nurtured with seven people who were hospitalized for depression. The depressive illness and treatment were found to impact on participants' articulation and recalling of their experience, and raised ethical concerns about their informed consent. Personal engagement with participants raised the ethical issue of research vs. therapy. Furthermore, participants being in a hospital complicated the necessity for privacy. The methodological issue of bracketing of assumptions was deemed to be important to 'see' the phenomenological relevance of patients' experiences. Knowledge and experience are required when conducting unstructured interviews. Debates about the challenges of unstructured interviewing needs to be highlighted in research texts to assist novice researchers. Support from an experienced research mentor would assist novice interviewers through the interview process and provide post-interview debriefing.

  9. Portrayal of Depression and Other Mental Illnesses in Australian Nonfiction Media

    ERIC Educational Resources Information Center

    Francis, Catherine; Pirkis, Jane; Blood, R. Warwick; Dunt, David; Burgess, Philip; Morley, Belinda; Stewart, Andrew

    2005-01-01

    This study describes Australian media portrayal of mental illnesses, focusing on depression. A random sample of 1,123 items was selected for analysis from a pool of 13,389 nonfictional media items about mental illness collected between March 2000 and February 2001. Depression was portrayed more frequently than other mental illnesses. Items about…

  10. Portrayal of Depression and Other Mental Illnesses in Australian Nonfiction Media

    ERIC Educational Resources Information Center

    Francis, Catherine; Pirkis, Jane; Blood, R. Warwick; Dunt, David; Burgess, Philip; Morley, Belinda; Stewart, Andrew

    2005-01-01

    This study describes Australian media portrayal of mental illnesses, focusing on depression. A random sample of 1,123 items was selected for analysis from a pool of 13,389 nonfictional media items about mental illness collected between March 2000 and February 2001. Depression was portrayed more frequently than other mental illnesses. Items about…

  11. Lithium carbonate and affective disorders. V: A double-blind study of prophylaxis of depression in bipolar illness.

    PubMed

    Dunner, D L; Stallone, F; Fieve, R R

    1976-01-01

    The efficacy of lithium carbonate as a prophylactic drug against depression in bipolar manic depressive patients was assessed through a double-blind, placebo-controlled study of patients who had histories of recurrent depressions and hypomanias ("bipolar II"). The results revealed that treatment with lithium carbonate resulted in a reduction in the frequency of depressive attacks was observed with lithium carbonate treatment during the study (mean length of study, approximately 16 months), although there was a suggestion that the depressive attacks that occurred during treatment with lithium carbonate might be less severe than with placebo treatment.

  12. Cannabis use and first manic episode.

    PubMed

    Bally, Nathalie; Zullino, Daniele; Aubry, Jean-Michel

    2014-08-01

    Cannabis is the most commonly abused drug among patients with bipolar disorder. Available data has shown that the risk of psychotic disorders increases with the frequency and intensity of cannabis abuse. The present purpose was to review relevant studies to investigate whether cannabis use can be linked to the onset of mania in bipolar disorder. Articles published between 1972 and December 2013 were searched on Medline and PsychInfo using the following keywords: first manic episode, or onset mania, or bipolar disorder and cannabis. Relevant papers cited in the references of selected articles were further considered for inclusion into the review. Lifetime use of cannabis among bipolar patients appears to be around 70% and approximately 30% of patients with a bipolar disorder present a comorbidity of cannabis abuse or dependence. Cannabis use is associated with younger age at onset of first mania and with more frequent depressive or manic episodes, although the evidence is somewhat inconsistent. Likewise cannabis consumption is related to poorer outcome and an increased risk of rapid cycling or mixed episodes. In contrast, neuro-cognitive functioning seems to be positively affected in patients with psychiatric comorbidity. While cannabis use often precedes first manic episodes, the causal direction remains to be determined. Variations in definition of cannabis use/dependence. Lack of controlled studies limiting definite conclusions about a putative causal relationship between cannabis and onset of mania. Further investigations are needed to clarify the relationships between cannabis use and first manic episode. Copyright © 2014 Elsevier B.V. All rights reserved.

  13. Symptoms of Depression in a Hispanic Primary Care Population With and Without Chronic Medical Illnesses

    PubMed Central

    Reinschmidt, Kerstin M.; Moreno, Francisco A.

    2010-01-01

    Objective: To describe somatic and psychiatric symptoms reported by Hispanic primary care patients with and without depression and/or chronic medical illnesses. Method: Adult Hispanic patients (n = 104) in a Mobile Health Program in underserved southern Arizona participated in a survey conducted between September 2006 and February 2007 to obtain information about the somatic and psychiatric symptoms that they were experiencing. They were asked to rate the severity of their symptoms listed in the depression screen Personal Health Questionnaire-9 (PHQ-9), the Symptom Checklist-90-Revised (SCL-90-R), and 5 new symptoms described by patients in focus groups conducted in the first phase of the project. Patients were categorized as depressed if their PHQ-9 scores were 10 or above, and they were further categorized as having or not having chronic illnesses based on self-report. Analyses of variance were conducted for each SCL-90-R symptom dimension to compare across the 4 groups (group 1: not depressed and not medically ill; group 2: medically ill but not depressed; group 3: depressed but not medically ill; and group 4: depressed and medically ill). Results: Patients with chronic medical illnesses comorbid with depression were found to report significantly more somatic symptoms than those with only chronic medical illnesses or depression alone (P ≤ .001). They also reported significantly more psychopathology than patients with depression alone (P ≤ .05 or better). Conclusions: Patients with medical illnesses comorbid with depression are more likely to exhibit psychopathology than patients with medical illnesses or depression alone. PMID:20944771

  14. Social cognition and the manic defense: attributions, selective attention, and self-schema in bipolar affective disorder.

    PubMed

    Lyon, H M; Startup, M; Bentall, R P

    1999-05-01

    Manic patients, depressed bipolar patients, and normal controls were compared on measures of social cognition. Manic patients showed a normal self-serving bias on the Attributional Style Questionnaire, but depressed patients attributed negative events more than positive events to self. On an implicit test of attributional style, both patient groups attributed negative events more than positive events to self. Both patient groups showed slowed color naming for depression-related but not euphoria-related words. Manic patients, like normal controls, endorsed mainly positive words as true of self but, like the depressed patients, recalled mainly negative words. Findings from the implicit tests indicate a common form of psychological organization in manic and depressed patients, whereas the contrasts between the scores on the implicit and explicit measures are consistent with the hypothesis of a manic defense.

  15. Reevaluation of patients with bipolar disorder on manic episode: improving the diagnosing of mixed episode.

    PubMed

    Kim, Kyung Ran; Cho, Hyun-Sang; Kim, Se Joo; Seok, Jeong-Ho; Lee, Eun; Jon, Duk-In

    2013-08-01

    Mixed manic/depressive episodes in patients with bipolar disorder are underdiagnosed because of restrictive diagnostic criteria. Using the broader definition of a mixed episode represented by the Cincinnati criteria, we reevaluated the medical records of patients with bipolar disorder hospitalized for a manic episode. We also examined the predictive power of previously unrecognized depressive symptoms. Of 520 inpatients with mania, we retrospectively diagnosed 59 (11.3%) as having a probable mixed episode. Compared with the patients with pure mania, the patients with mixed episodes were more likely to have a family history of psychiatric illness, comorbid personality disorder, and a history of suicide attempts. Binary logistic regression revealed that loss of interest, loss of energy, feelings of worthlessness, and feelings of helplessness had good positive predictive value (>0.7) for mixed episodes. Accurate diagnosis of mixed episodes may require a broadening of diagnostic criteria and emphasis on symptoms such as loss of interest, loss of energy, and feelings of worthlessness and helplessness.

  16. Multimorbidity in a Mexican Community: Secondary Analysis of Chronic Illness and Depression Outcomes

    PubMed Central

    O'Connor, Kathleen; Vizcaino, Maricarmen; Ibarra, Jorge M.; Balcazar, Hector; Perez, Eduardo; Flores, Luis; Anders, Robert L.

    2015-01-01

    The aims of this article are: 1) to examine the associations between health provider-diagnosed depression and multimorbidity, the condition of suffering from more than two chronic illnesses; 2) to assess the unique contribution of chronic illness in the prediction of depression; and 3) to suggest practice changes that would address risk of depression among individuals with chronic illnesses. Data collected in a cross-sectional community health study among adult Mexicans (n= 274) living in a low income neighborhood (colonia) in Ciudad Juárez, Chihuahua, Mexico, were examined. We tested the hypotheses that individuals who reported suffering chronic illnesses would also report higher rates of depression than healthy individuals; and having that two or more chronic illnesses further increased the risk of depression. PMID:26640817

  17. Multimorbidity in a Mexican Community: Secondary Analysis of Chronic Illness and Depression Outcomes.

    PubMed

    O'Connor, Kathleen; Vizcaino, Maricarmen; Ibarra, Jorge M; Balcazar, Hector; Perez, Eduardo; Flores, Luis; Anders, Robert L

    2015-06-01

    The aims of this article are: 1) to examine the associations between health provider-diagnosed depression and multimorbidity, the condition of suffering from more than two chronic illnesses; 2) to assess the unique contribution of chronic illness in the prediction of depression; and 3) to suggest practice changes that would address risk of depression among individuals with chronic illnesses. Data collected in a cross-sectional community health study among adult Mexicans (n= 274) living in a low income neighborhood (colonia) in Ciudad Juárez, Chihuahua, Mexico, were examined. We tested the hypotheses that individuals who reported suffering chronic illnesses would also report higher rates of depression than healthy individuals; and having that two or more chronic illnesses further increased the risk of depression.

  18. Patients understanding of depression associated with chronic physical illness: a qualitative study

    PubMed Central

    2014-01-01

    Background Detection of depression can be difficult in primary care, particularly when associated with chronic illness. Patient beliefs may affect detection and subsequent engagement with management. We explored patient beliefs about the nature of depression associated with physical illness. Methods A qualitative interview study of patients registered with general practices in Leeds, UK. We invited patients with coronary heart disease or diabetes from primary care to participate in semi-structured interviews exploring their beliefs and experiences. We analysed transcripts using a thematic approach, extended to consider narratives as important contextual elements. Results We interviewed 26 patients, including 17 with personal experience of depression. We developed six themes: recognising a problem, complex causality, the role of the primary care, responsibility, resilience, and the role of their life story. Participants did not consistently talk about depression as an illness-like disorder. They described a change in their sense of self against the background of their life stories. Participants were unsure about seeking help from general practitioners (GPs) and felt a personal responsibility to overcome depression themselves. Chronic illness, as opposed to other life pressures, was seen as a justifiable cause of depression. Conclusions People with chronic illness do not necessarily regard depression as an easily defined illness, especially outside of the context of their life stories. Efforts to engage patients with chronic illness in the detection and management of depression may need further tailoring to accommodate beliefs about how people view themselves, responsibility and negative views of treatment. PMID:24555886

  19. The correlates of stigma toward mental illness among Jordanian patients with major depressive disorder.

    PubMed

    Rayan, Ahmad; Mahroum, Maryam Husnee; Khasawneh, Aws

    2017-05-23

    This study aims to assess the correlates of stigma toward mental illness among patients diagnosed with major depressive disorder (MDD). One hundred and sixty one Jordanian outpatients suffering from MDD completed the study. Participants completed the demographic questionnaire, the Center for Epidemiological Studies for the intensity of depression, and the Devaluation-Discrimination Scale to assess stigma. Participants reported a moderate level of perceived stigma toward mental illness. Age, perceived pain, the number of relapses, and severity of depressive symptoms were significantly correlated with stigma toward mental illness among the study sample. The severity of depressive symptoms was the strongest correlate of stigma toward mental illness. Factors associated with stigma toward mental illness should be carefully considered when implementing anti-stigma programs for patients. © 2017 Wiley Periodicals, Inc.

  20. Clinical evaluation of Kushmanda Ghrita in the management of depressive illness

    PubMed Central

    Chandre, Rajni; Upadhyay, B. N.; Murthy, K. H. H. V. S. S. Narasimha

    2011-01-01

    Depressive illness has been considered as a problematic mental illness since antiquity. The treatment modalities of depressive illness are of many kinds. Use of Medhya Rasayana drugs is a unique method of treatment described in Ayurveda for depressive illness. Kushmanda (Benincasa hispida) is one of the Medhya Rasayana as described by Bhava Mishra. Ghrita is also considered as Medhya Rasayana by almost all Acharyas. Keeping this background Kushmanda Ghrita has been selected as a trial drug to treat the patients of depressive illness. The study was carried out in 35 clinically diagnosed cases of depressive illness by using DSM-IV diagnostic criteria of depressive illness. All patients were given 20 ml of Kushmanda Ghrita in two divided doses morning and evening with 40 ml of lukewarm water for a period of one month. It has shown statistically significant results with psychometric parameters–Hamilton depression rating scale (t = 24.36, P < 0.001), Hamilton anxiety rating scale (t = 26.20, P < .001), immediate memory span direct (t = 4.35, P < 0.001), and indirect test (t = 3.43, P < 01) along with clinical symptoms. PMID:22408308

  1. Illness perceptions mediate the relationship between depression and quality of life in patients with epilepsy.

    PubMed

    Shallcross, Amanda J; Becker, Danielle A; Singh, Anuradha; Friedman, Daniel; Montesdeoca, Jacqueline; French, Jacqueline; Devinsky, Orrin; Spruill, Tanya M

    2015-11-01

    The current study examined whether negative illness perceptions help explain the link between depression and quality of life. Seventy patients with epilepsy completed standardized self-report questionnaires measuring depression, illness perception, and quality of life (QOL). Illness perception statistically mediated the relationship between depression and QOL (Indirect effect (CI; confidence interval) = -.72, lower limit = -1.7, upper limit = -.22, p < .05). Results held with and without adjusting for potential confounding variables (age, sex, ethnicity, income, and seizure frequency) and when operationalizing depression as a continuous variable that indexed severity of symptoms or as a dichotomous variable that indexed criteria consistent with a diagnosis of major depressive disorder. This study is the first to suggest that illness perceptions may be a useful target in screening and intervention approaches in order to improve QOL among low-income, racially/ethnically diverse patients with epilepsy. Wiley Periodicals, Inc. © 2015 International League Against Epilepsy.

  2. [Creativity and mental illness].

    PubMed

    Rihmer, Zoltán; Gonda, Xénia; Rihmer, Annamária

    2006-01-01

    It has been known for a long time that people with salient social and artistic creativity suffer more frequently from psychiatric illnesses than the average population. In their review paper, the authors assess the Hungarian and international scientific literature regarding the association of creativity and psychopathology. They conclude that contrary to the concept prevailing in the first part of the 20th century about the strong association between schizophrenia and creativity, the results of empirical research now unambiguously suggest that prominent social and artistic creativity is associated primarily with affective, and more specifically with bipolar affective illnesses. In addition, we already know that as regards the development of creativity, it is not the given affective (depressive, manic, hypomanic) episode which is important, but the hyperthymic or cyclothymic temperament structure which also predisposes for affective illness.

  3. Understanding depression associated with chronic physical illness: a Q-methodology study in primary care.

    PubMed

    Alderson, Sarah L; Foy, Robbie; House, Allan

    2015-06-01

    Detection of depression can be difficult in primary care, particularly when associated with chronic illness. Patient beliefs may affect detection and subsequent engagement with management. Q-methodology can help to identify viewpoints that are likely to influence either clinical practice or policy intervention. To identify socially shared viewpoints of comorbid depression, and characterise key overlaps and discrepancies. A Q-methodology study of patients registered with general practices or community clinics in Leeds, UK. Patients with coronary heart disease or diabetes and depression from three practices and community clinics were invited to participate. Participants ranked 57 statements about comorbid depression. Factor analyses were undertaken to identify independent accounts, and additional interview data were used to support interpretation. Thirty-one patients participated; 13 (42%) had current symptoms of depression. Five accounts towards comorbid depression were identified: overwhelmed resources; something medical or within me; a shameful weakness; part of who I am; and recovery-orientated. The main differences in attitudes related to the cause of depression and its relationship with the patient's chronic illness, experience of shame, and whether medical interventions would help recovery. There are groups of patients who do not perceive a relationship between their depression and chronic illness; they may not understand the intention behind policy initiatives to identify depression during chronic illness reviews. Tailoring detection strategies for depression to take account of different clusters of attitudes and beliefs could help improve identification and personalise management. © British Journal of General Practice 2015.

  4. Bipolar outcome in the course of depressive illness. Phenomenologic, familial, and pharmacologic predictors.

    PubMed

    Akiskal, H S; Walker, P; Puzantian, V R; King, D; Rosenthal, T L; Dranon, M

    1983-05-01

    Twenty percent of a cohort of 206 outpatient depressives with no past bipolar history switched during prospective observation. These 41 probands developed manic periods on the average of 6.4 years (median 4, range 1-25) after their first depressive episode. The change in polarity occurred throughout the life span, but was most common in adolescence and early adulthood. The following variables were found useful in predicting this outcome: onset less than or equal to 25 years, bipolar family history, loaded pedigrees, precipitation by childbirth, hypersomnic-retarded phenomenology, and pharmacologically-mobilized hypomania. Although the respective sensitivities of these findings were relatively low (32-71%), their specificities ranged from 69% to 100% for bipolar outcome; the diagnostic specificity of any 3 of these variables when combined was 98%. When compared with nonbipolar depression, bipolar disorder was seldom chronologically secondary to nonaffective psychiatric disorders. These findings suggest that many young depressives with lethargy and oversleeping are not manifesting a "neurotic" disorder, but rather a precursor of primary bipolar affective disorder. Finally, a psychotically depressed adolescent or young adult with positive bipolar family history should be observed for eventual bipolar outcome, especially when the clinical presentation is that of stupor.

  5. Illness history: Not associated with remission during treatment of major depression in 515 mood disorder patients.

    PubMed

    Baldessarini, Ross J; Tondo, Leonardo; Visioli, Caterina; Vázquez, Gustavo H

    2016-02-01

    There is suggestive evidence that prior illness history may have little association with response to long-term treatment in bipolar disorder (BD) or recurrent major depressive disorder (MDD), but relationships of illness-history to treatment-response in acute episodes of depression require further testing. We tested for associations of selected measures of illness history with remission during treatment of an acute index episode of major depression in 515 mood-disorder patients (327 MDD, 188 BD), using bivariate and multivariate methods. Remission of depression was more likely with lesser initial symptom-severity and bipolar diagnosis, but not related to years since illness-onset, previous depressions or episodes (based on counts, yearly rates, or %-of months ill), or other indices of illness-severity (hospitalization, co-morbidity, suicide attempt). Likelihood of response to standard treatments for acute major depressive episodes in MDD or BD appeared to be largely independent of prior illness-history. Copyright © 2015 Elsevier B.V. All rights reserved.

  6. The prevalence and illness characteristics of DSM-5-defined "mixed feature specifier" in adults with major depressive disorder and bipolar disorder: Results from the International Mood Disorders Collaborative Project.

    PubMed

    McIntyre, Roger S; Soczynska, Joanna K; Cha, Danielle S; Woldeyohannes, Hanna O; Dale, Roman S; Alsuwaidan, Mohammad T; Gallaugher, Laura Ashley; Mansur, Rodrigo B; Muzina, David J; Carvalho, Andre; Kennedy, Sidney H

    2015-02-01

    A substantial proportion of individuals with mood disorders present with sub-syndromal hypo/manic features. The objective of this analysis was to evaluate the prevalence and illness characteristics of the Diagnostic and Statistical Manual Version-5 (DSM-5) - defined mixed features specifier (MFS) in adults with major depressive disorder (MDD) and bipolar disorder (BD). Data from participants who met criteria for a current mood episode as part of MDD (n=506) or BD (BD-I: n=216, BD-II: n=130) were included in this post-hoc analysis. All participants were enrolled in the International Mood Disorders Collaborative Project (IMDCP): a collaborative research platform at the Mood Disorders Psychopharmacology Unit, University of Toronto and the Cleveland Clinic, Cleveland, Ohio. Mixed features specifier was operationalized as a score ≥ 1 on 3 or more select items on the Young Mania Rating Scale (YMRS) or ≥ 1 on 3 select items of the Montgomery Åsberg Depression Rating Scale (MADRS) or Hamilton Depression Rating Scale (HAMD-17) during an index major depressive episode (MDE) or hypo/manic episode, respectively. A total of 26.0% (n=149), 34.0% (n=65), and 33.8% (n=49) of individuals met criteria for MFS during an index MDE as part of MDD, BD-I and BD-II, respectively. Mixed features specifier during a hypo/manic episode was identified in 20.4% (n=52) and 5.1% (n=8) in BD-I and BD-II participants, respectively. Individuals with MDE-MFS as part of BD or MDD exhibited a more severe depressive phenotype (p=0.0002 and p<0.0002, respectively) and reported a higher rate of alcohol/substance use disorder in the context of BD but not MDD (p=0.002). Individuals with MFS were more likely to have co-existing heart disease suggestive of a distinct pattern of comorbidity and neurobiology. Data were post-hoc and obtained from individuals utilizing a university-based mood disorder centre which may affect generalizability. Diagnostic and Statistical Manual Version-5-defined MFS is common

  7. The relationship between anxiety, depression and illness perception in tberculosis patients in Pakistan

    PubMed Central

    2008-01-01

    Objective As the rates of TB world over have increased during the past 10 years, there has been a growing awareness of depression and its role in the outcome of chronic disorders. Though depression is common in patients with TB no study as yet has examined the prevalence of depression in this group in Pakistan. We aimed to determine the presence of depression, anxiety and illness perceptions in patients suffering from Tuberculosis (TB) in Pakistan. Methods 108 consecutive outpatients with tuberculosis completed the Hospital Anxiety and Depression scale (HADS) and the Illness Perception Questionnaire (IPQ). Results Out of 108 patients, 50 (46.3%) were depressed and 51 (47.2%) had anxiety. Raised depression and anxiety scores were associated with an increase in the number of symptoms reported (HADS Depression: r = 0.346, p = < 0.001), more serious perceived consequences (HADS Depression: r = 0.279, p = 0.004, HADS Anxiety: r = 0.234, p = 0.017) and less control over their illness (HADS Depression: r = 0.239, p = 0.014, HADS Anxiety: r = 0.271, p = 0.005). Conclusion We found that about a half of patients in our sample met the criteria for probable depression and anxiety based on HADS score. Negative illness perceptions were clearly related to reports of mood symptoms. As depression and lack of perceived control over illness in those suffering from tuberculosis are reported to be independent predictors of poor adherence further studies to investigate their relationship with medication adherence are required. PMID:18302758

  8. Should major depressive disorder with mixed features be classified as a bipolar disorder?

    PubMed

    Liu, Xiaohua; Jiang, Kaida

    2014-10-01

    The new diagnostic category in the Depressive Disorders chapter of DSM-5 entitled 'Major Depressive Disorder With Mixed Features' is applied to individuals who meet criteria for Major Depressive Disorder and have concurrent subsyndromal hypomanic or manic symptoms. But the operational definition of this new specifier is much closer to that of hypomania and mania than to the definition of atypical depression or the older 'mixed depression.' Moreover, multiple studies have shown that the characteristics of individuals with this condition and the clinical trajectory of their illness is much closer to that of bipolar patients than to that of depressed individuals without comorbid hypomanic or manic symptoms. Thus we believe that this condition would be more appropriately placed in the Bipolar Disorders chapter of DSM-5. We also believe that this blurring of the depressive disorder- bipolar disorder boundary is one cause for the low inter-rater reliability in the diagnosis of Major Depressive Disorder.

  9. Identifying the Links between Chronic Illness and Depression: Cognitive-Behavioral Mediators.

    ERIC Educational Resources Information Center

    Turk, Dennis C.; And Others

    All chronic illnesses represent assaults on multiple areas of functioning, not just the body. To examine the association between painful chronic illnesses and depression from a cognitive-behavioral perspective, 100 patients of the Pain Management Program at the West Haven, Connecticut Veterans Administration Hospital (78% males) completed a…

  10. Depressive symptoms in Parkinson’s disease and in non-neurological medical illnesses

    PubMed Central

    Assogna, Francesca; Fagioli, Sabrina; Cravello, Luca; Meco, Giuseppe; Pierantozzi, Mariangela; Stefani, Alessandro; Imperiale, Francesca; Caltagirone, Carlo; Pontieri, Francesco E; Spalletta, Gianfranco

    2013-01-01

    Background Patients with neurological and non-neurological medical illnesses very often complain of depressive symptoms that are associated with cognitive and functional impairments. We compared the profile of depressive symptoms in Parkinson’s disease (PD) patients with that of control subjects (CS) suffering from non-neurological medical illnesses. Methods One-hundred PD patients and 100 CS were submitted to a structured clinical interview for identification of major depressive disorder (MDD) and minor depressive disorder (MIND), according to the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, text revision (DSM-IV-TR), criteria. The Hamilton Depression Rating Scale (HDRS) and the Beck Depression Inventory (BDI) were also administered to measure depression severity. Results When considering the whole groups, there were no differences in depressive symptom frequency between PD and CS apart from worthlessness/guilt, and changes in appetite reduced rates in PD. Further, total scores and psychic and somatic subscores of HDRS and BDI did not differ between PD and CS. After we separated PD and CS in those with MDD, MIND, and no depression (NODEP), comparing total scores and psychic/somatic subscores of HDRS and BDI, we found increased total depression severity in NODEP PD and reduced severity of the psychic symptoms of depression in MDD PD, with no differences in MIND. However, the severity of individual symptom frequency of depression was not different between PD and CS in MDD, MIND, and NODEP groups. Conclusion Although MDD and MIND phenomenology in PD may be very similar to that of CS with non-neurological medical illnesses, neurological symptoms of PD may worsen (or confound) depression severity in patients with no formal/structured DSM-IV-TR, diagnosis of depressive mood disorders. Thus, a thorough assessment of depression in PD should take into consideration the different impacts of neurological manifestations on MDD, MIND, and NODEP. PMID

  11. Chronic Illness and Depressive Symptoms among Chinese Older Adults: A Longitudinal Study

    ERIC Educational Resources Information Center

    Chou, Kee-Lee; Chi, Iris

    2002-01-01

    Depression is quite common among the elderly members of Hong Kong Chinese society. This study examined the impact of a series of chronic illnesses on change in depressive symptoms among the older people. The respondents were 260 people aged 70 years or older from a longitudinal study of a representative community sample of the elderly population…

  12. The Comparison of Depression in Ill and Healthy Adolescents in Iran.

    ERIC Educational Resources Information Center

    Zarin, H. K.

    The development of depression in ill and healthy adolescents is explored and the question of whether hospitalization is accompanied by improvement in depression among cancer and non-cancer patients is addressed. Two studies, one between and one within subjects, longitudinal design with repeated measurement over 4 months, were carried out. MANOVA…

  13. Chronic Illness and Depressive Symptoms among Chinese Older Adults: A Longitudinal Study

    ERIC Educational Resources Information Center

    Chou, Kee-Lee; Chi, Iris

    2002-01-01

    Depression is quite common among the elderly members of Hong Kong Chinese society. This study examined the impact of a series of chronic illnesses on change in depressive symptoms among the older people. The respondents were 260 people aged 70 years or older from a longitudinal study of a representative community sample of the elderly population…

  14. Bipolar illness: factors in drinking behavior.

    PubMed

    Dunner, D L; Hensel, B M; Fieve, R R

    1979-04-01

    Alcohol use and abuse was investigated in 73 patients with bipolar I manic-depressive illness who were attending a lithium clinic. Alcohol-related problems were identified in 7 of the male and none of the female patients. Family data revealed a higher morbid risk for alcoholism among relatives of patients with drinking problems than among relatives of patients without drinking problems. Morbid risks for affective disorder for these two groups of relatives were similar, suggesting that alcoholism among relatives of patients with bipolar illness is not solely "genotypically" related to the affective disorder.

  15. The wing of madness: the illness of Vincent van Gogh.

    PubMed

    Morrant, J C

    1993-09-01

    This paper briefly describes some aspects of Vincent van Gogh's life and attitudes. It discusses absinthe and several psychodynamic factors that may have contributed to his psychotic episodes at Arles, when he cut off his ear. It discusses Vincent's descriptions of his illness, especially at Saint Rémy de Provence and concludes that he probably suffered from partial complex seizures (temporal lobe epilepsy) with manic depressive mood swings aggravated by absinthe, brandy, nicotine and turpentine.

  16. Anxiety and depression in mothers and fathers of a chronically ill child.

    PubMed

    van Oers, H A; Haverman, L; Limperg, P F; van Dijk-Lokkart, E M; Maurice-Stam, H; Grootenhuis, M A

    2014-10-01

    We aimed to determine the levels of anxiety and depression in mothers and fathers of a chronically ill child (0-18 years) and to study which parental and child variables are associated with anxiety and depression. In a cross-sectional design, anxiety and depression were assessed with the Hospital Anxiety and Depression Scale. Scores were compared to a Dutch reference group by analysis of variance and logistic regression analysis. Linear regression analyses were performed to examine which variables were associated with anxiety and depression. Mothers of a chronically ill child (n = 566) scored significantly higher than the reference group (p < .001) on anxiety (Mean 5.9 vs 4.8) and depression (Mean 4.5 vs 3.1). Fathers (n = 123) had higher depression scores (Mean 4.5 vs 3.6; p < .05), but fathers' anxiety scores were comparable to the reference group. The percentages of mothers in the clinical range of anxiety (31.8 vs 20.7 %, OR 2.03, 95 % CI 1.46-2.83) and depression (23.0 vs 12.0 %, OR 2.76, 95 % CI 1.84-4.13) were higher (p < .001) than in the reference group. No differences were found for fathers in the clinical range for anxiety and depression. Practical problems in daily life (a: β = .33, d: β = .25) and parenting stress (a: β = .30, d: β = .32) showed the strongest association with anxiety and depression for parents as a group. Illness-related characteristics of the child were not related. Parents of a chronically ill child, especially mothers, reported high levels of anxiety and depression. Awareness about parental anxiety and depression in pediatrics is important as well as targeted interventions.

  17. Illness beliefs of Chinese American immigrants with major depressive disorder in a primary care setting.

    PubMed

    Chen, Justin A; Hung, Galen Chin-Lun; Parkin, Susannah; Fava, Maurizio; Yeung, Albert S

    2015-02-01

    Underutilization of mental health services in the U.S. is compounded among racial/ethnic minorities, especially Chinese Americans. Culturally based illness beliefs influence help-seeking behavior and may provide insights into strategies for increasing utilization rates among vulnerable populations. This is the first large descriptive study of depressed Chinese American immigrant patients' illness beliefs using a standardized instrument. 190 depressed Chinese immigrants seeking primary care at South Cove Community Health Center completed the Explanatory Model Interview Catalogue, which probes different dimensions of illness beliefs: chief complaint, labeling of illness, stigma perception, causal attributions, and help-seeking patterns. Responses were sorted into categories by independent raters and results compared to an earlier study at the same site and using the same instrument. Contrary to prior findings that depressed Chinese individuals tend to present with primarily somatic symptoms, subjects were more likely to report chief complaints and illness labels related to depressed mood than physical symptoms. Nearly half reported they would conceal the name of their problem from others. Mean stigma levels were significantly higher than in the previous study. Most subjects identified psychological stress as the most likely cause of their problem. Chinese immigrants' illness beliefs were notable for psychological explanations regarding their symptoms, possibly reflecting increased acceptance of Western biomedical frameworks, in accordance with recent research. However, reported stigma regarding these symptoms also increased. As Asian American immigrant populations increasingly accept psychological models of depression, stigma may become an increasingly important target for addressing disparities in mental health service utilization.

  18. Illness Beliefs of Chinese American Immigrants with Major Depressive Disorder in a Primary Care Setting

    PubMed Central

    Chen, Justin A.; Hung, Galen Chin-Lun; Parkin, Susannah; Fava, Maurizio; Yeung, Albert S.

    2014-01-01

    Underutilization of mental health services in the U.S. is compounded among racial/ethnic minorities, especially Chinese Americans. Culturally based illness beliefs influence help-seeking behavior and may provide insights into strategies for increasing utilization rates among vulnerable populations. This is the first large descriptive study of depressed Chinese American immigrant patients’ illness beliefs using a standardized instrument. 190 depressed Chinese immigrants seeking primary care at South Cove Community Health Center completed the Explanatory Model Interview Catalogue, which probes different dimensions of illness beliefs: chief complaint, labeling of illness, stigma perception, causal attributions, and help-seeking patterns. Responses were sorted into categories by independent raters and results compared to an earlier study at the same site and using the same instrument. Contrary to prior findings that depressed Chinese individuals tend to present with primarily somatic symptoms, subjects were more likely to report chief complaints and illness labels related to depressed mood than physical symptoms. Nearly half reported they would conceal the name of their problem from others. Mean stigma levels were significantly higher than in the previous study. Most subjects identified psychological stress as the most likely cause of their problem. Chinese immigrants’ illness beliefs were notable for psychological explanations regarding their symptoms, possibly reflecting increased acceptance of Western biomedical frameworks, in accordance with recent research. However, reported stigma regarding these symptoms also increased. As Asian American immigrant populations increasingly accept psychological models of depression, stigma may become an increasingly important target for addressing disparities in mental health service utilization. PMID:25563074

  19. Becoming a patient-illness representations of depression of Anglo-Australian and Sri Lankan patients through the lens of Leventhal's illness representational model.

    PubMed

    Antoniades, Josefine; Mazza, Danielle; Brijnath, Bianca

    2017-08-01

    Depression is prevalent globally. While the uptake of mental health services is poor in the general community, the lack of service engagement is particularly profound in migrant and refugee communities. To understand why there is under-utilisation cross-cultural comparisons of how people make sense of mental illnesses such as depression are essential. To verify how differing cultural aetiologies about depression influence mental health service use, this study investigated illness representational models of depression held by Sri Lankan migrants and Anglo-Australians living with depression. In-depth interviews ( n = 48) were conducted with Sri Lankan migrants and Anglo-Australians living with depression to explore their illness beliefs. Data were analysed using Leventhal's illness representational model. Significant overlaps in illness representational models were noted but distinctive differences were found between causal and chronicity beliefs; Sri Lankan migrants more frequently endorsed depression as a time-limited condition underpinned by situational factors, whereas Anglo-Australians endorsed a chronic, biopsychosocial model of depression. Findings highlight the importance of forging a shared understanding of patient beliefs in the clinical encounter to ensure that interventions are coherent with illness beliefs or at least work towards improving mental health literacy. Differences in illness beliefs also provide insights into possible interventions. For example, psychosocial interventions that align with their illness beliefs may be more suited to Sri Lankan migrants than pharmaceutical or psychological ones.

  20. Epidemiology and treatment of depression in patients with chronic medical illness

    PubMed Central

    J. Katon, Wayne.

    2011-01-01

    There is a bidirectional relationship between depression and chronic medical disorders. The adverse health risk behaviors and psychobiological changes associated with depression increase the risk for chronic medical disorders, and biological changes and complications associated with chronic medical disorders may precipitate depressive episodes. Comorbid depression is associated with increased medical symptom burden, functional impairment, medical costs, poor adherence to self-care regimens, and increased risk of morbidity and mortality in patients with chronic medical disorders. Depression may worsen the course of medical disorders because of its effect on proinflammatory factors, hypothalamic-pituitary axis, autonomic nervous system, and metabolic factors, in addition to being associated with a higher risk of obesity, sedentary lifestyle, smoking, and poor adherence to medical regimens. Both evidence-based psychotherapies and antidepressant medication are efficacious treatments for depression. Collaborative depression care has been shown to be an effective way to deliver these treatments to large primary care populations with depression and chronic medical illness. PMID:21485743

  1. Beliefs about illness and their relationship with hopelessness, depression, insight and suicide attempts in schizophrenia.

    PubMed

    Acosta, Francisco J; Aguilar, Eduardo J; Cejas, Maria R; Gracia, Ramón

    2013-03-01

    Although the negative appraisals of the illness may be related to suicidal thinking and behaviours in schizophrenia, this has been insufficiently studied. The aim of this study was to analyze the relationship between schizophrenic patients' cognitions about their illness and past suicidal behaviours. The relationship between patients' beliefs about their illness with potential mediators of suicidal behaviours such as depressive symptoms, hopelessness and insight was also investigated. A group of 60 patients diagnosed with schizophrenia according to ICD-10 criteria belonging to a follow-up study were assessed one year after their last psychiatric admission. Psychopathological variables were assessed by the Calgary Depression Scale, Beck Hopelessness Scale and the first three items of the Scale to Assess Unawareness of Mental Disorder. The appraisals of the illness were assessed by the Personal Beliefs about Illness Questionnaire. Negative appraisals were associated with hopelessness and depressive symptoms. Negative expectations and stigma showed the strongest associations. Contrary to our expectations, this scale was not able to differentiate between patients with and without past suicidal behaviour. Negative appraisals of the illness in patients with schizophrenia seem to have psychopathological consequences such as greater hopelessness and depression. Since these psychopathological features are linked to suicidal risk, the psychotherapeutic approach counteracting negative beliefs about the illness may reduce the risk of suicide.

  2. Sleep-wake profiles predict longitudinal changes in manic symptoms and memory in young people with mood disorders.

    PubMed

    Robillard, Rébecca; Hermens, Daniel F; Lee, Rico S C; Jones, Andrew; Carpenter, Joanne S; White, Django; Naismith, Sharon L; Southan, James; Whitwell, Bradley; Scott, Elizabeth M; Hickie, Ian B

    2016-10-01

    Mood disorders are characterized by disabling symptoms and cognitive difficulties which may vary in intensity throughout the course of the illness. Sleep-wake cycles and circadian rhythms influence emotional regulation and cognitive functions. However, the relationships between the sleep-wake disturbances experienced commonly by people with mood disorders and the longitudinal changes in their clinical and cognitive profile are not well characterized. This study investigated associations between initial sleep-wake patterns and longitudinal changes in mood symptoms and cognitive functions in 50 young people (aged 13-33 years) with depression or bipolar disorder. Data were based on actigraphy monitoring conducted over approximately 2 weeks and clinical and neuropsychological assessment. As part of a longitudinal cohort study, these assessments were repeated after a mean follow-up interval of 18.9 months. No significant differences in longitudinal clinical changes were found between the participants with depression and those with bipolar disorder. Lower sleep efficiency was predictive of longitudinal worsening in manic symptoms (P = 0.007). Shorter total sleep time (P = 0.043) and poorer circadian rhythmicity (P = 0.045) were predictive of worsening in verbal memory. These findings suggest that some sleep-wake and circadian disturbances in young people with mood disorders may be associated with less favourable longitudinal outcomes, notably for subsequent manic symptoms and memory difficulties. © 2016 European Sleep Research Society.

  3. The relationship between meaning of illness, anxiety depression, and quality of life for cancer patients.

    PubMed

    Karakas, Sibel Asi; Okanli, Ayse

    2014-09-01

    The aim of this descriptive study was to determine the relationship between meaning of illness, anxiety, depression, and quality of life of patients receiving chemotherapy. Inclusion of the study consists of 110 patients with cancer who applied to the inpatient unit of a medical oncology clinic from 01 December 2005 to 31 May 2006 to receive inpatient chemotherapy. The research sampling comprises of 110 patients who were hospitalized at the medical oncology clinic of the university hospital and who received chemotherapy for at least 6 months. Hospital Anxiety and Depression Scale (HAD), Meaning of Illness Questionnaire (MIQ) and Quality of Life Scale were utilized to collect data. The results of the correlation analysis revealed a statistically significant relationship between meaning ofillness, anxiety, depression, and quality of life (p < 0.01). Positive meaning of the illness increases the quality of life score average and reduces anxiety and depression. The results indicated that meaning of illness affects anxiety, depression, and quality of life. Nurses should offer op- portunities for patients to search the positive meaning in the cancer illness.

  4. The relationship between meaning of illness, anxiety, depression, and quality of life for cancer patients.

    PubMed

    Karakas, Sibel Asi; Okanli, Ayse

    2014-09-01

    The aim of this descriptive study was to determine the relationship between meaning of illness, anxiety, depression, and quality of life of patients receiving chemotherapy. Inclusion of the study consists of 110 patients with cancer who applied to the inpatient unit of a medical oncology clinic from 01 December 2005 to 31 May 2006 to receive inpatient chemotherapy. The research sampling comprises of 110 patients who were hospitalized at the medical oncology clinic of the university hospital and who received chemotherapy for at least 6 months. Hospital Anxiety and Depression Scale (HAD), Meaning of Illness Questionnaire (MIQ) and Quality of Life Scale were utilized to collect data. The results of the correlation analysis revealed a statistically significant relationship between meaning ofillness, anxiety, depression, and quality of life (p < 0.01). Positive meaning of the illness increases the quality of life score average and reduces anxiety and depression. The results indicated that meaning of illness affects anxiety, depression, and quality of life. Nurses should offer op- portunities for patients to search the positive meaning in the cancer illness.

  5. Effects of emotional stimuli on time perception in manic and euthymic patients with bipolar disorder.

    PubMed

    Ryu, Vin; Kook, Sodahm; Lee, Su Jin; Ha, Kyooseob; Cho, Hyun-Sang

    2015-01-02

    Time perception, which plays a fundamental role in decision-making and the evaluation of the environment, is also influenced by emotions. Patients with bipolar disorder have impairments in emotional processing as well as interval timing. We investigated the effects of emotional stimuli on time estimation and reproduction in manic and euthymic bipolar patients compared with healthy controls. We recruited 22 manic bipolar patients, 24 euthymic bipolar patients and 24 healthy controls. Each subject performed time estimation and reproduction tasks using standardized affective pictures that were classified into 4 stimulus groups according to valence and level of arousal and presented for durations of 2, 4, and 6s. We analyzed temporal performance on these tasks using transformed data expressed as a proportion of the target period. The interactions between arousal and valence were different in manic patients compared with euthymic patients and healthy controls in both time estimation and reproduction tasks. Manic patients showed no effect of positive valence low arousal stimuli in the time estimation task compared to euthymic patients and healthy controls. In the time reproduction task, the effect of emotional stimuli was reversed in manic patients compared to euthymic patients and healthy controls. Significant correlations between the severity of manic symptoms or illness severity and average temporal performance scores were found in manic patients. Our results suggest that altered emotion-related time judgments may be a state-dependent phenomenon observed in manic patients only. This difference in time perception for emotional stimuli may be related to the underlying neurobiological mechanisms of the manic state. Copyright © 2014 Elsevier Inc. All rights reserved.

  6. Gender and depressive symptoms in 711 patients with bipolar disorder evaluated prospectively in the Stanley Foundation bipolar treatment outcome network.

    PubMed

    Altshuler, Lori L; Kupka, Ralph W; Hellemann, Gerhard; Frye, Mark A; Sugar, Catherine A; McElroy, Susan L; Nolen, Willem A; Grunze, Heinz; Leverich, Gabriele S; Keck, Paul E; Zermeno, Melanie; Post, Robert M; Suppes, Trisha

    2010-06-01

    The authors assessed gender differences in the proportion of clinical visits spent depressed, manic, or euthymic in patients with bipolar disorder. Data were analyzed from 711 patients with bipolar I or II disorder who were followed prospectively over 7 years (13,191 visits). The main outcome measures were the presence of symptoms of depression or of hypomania or mania, measured by the Inventory of Depressive Symptomatology and the Young Mania Rating Scale. Data were analyzed using three separate repeated-measures regressions with a logistic link function to model the probability that an individual was depressed, manic, or euthymic. The models controlled for bipolar I or bipolar II diagnosis, rapid cycling, age, time in the study, comorbid anxiety disorders, and comorbid substance use disorders. In approximately half of visits, patients had depressive, manic, or hypomanic symptoms. The likelihood of having depressive symptoms was significantly greater for women than for men. This was accounted for by higher rates in women of rapid cycling and anxiety disorders, each of which was associated with increased rates of depression. All patient groups showed an increase in number of euthymic visits and a decrease in number of visits with depressive and manic symptoms with increased time in study. Bipolar patients spend a substantial proportion of their time ill. Significant gender differences exist, with women spending a greater proportion of their visits in the depressive pole. This finding appears to be related to the corresponding differences in rates of rapid cycling and anxiety disorders.

  7. "Depression is who I am": Mental illness identity, stigma and wellbeing.

    PubMed

    Cruwys, Tegan; Gunaseelan, Sathiavaani

    2016-01-01

    Previous research has found that in the face of discrimination, people tend to identify more strongly with stigmatized groups. Social identification can, in turn, buffer wellbeing against the negative consequences of discrimination. However, this rejection identification model has never been tested in the context of mental illness identity. A survey was conducted with 250 people with diagnosed depression or current symptoms of at least moderate clinical severity. Experiencing mental illness stigma was associated with poorer wellbeing. Furthermore, people who had experienced such stigma were more likely to identify as a depressed person. Social identification as depressed magnified, rather than buffered, the relationship between stigma and reduced wellbeing. This relationship was moderated by perceived social norms of the depressed group for engaging in depressive thoughts and behaviors. These findings suggest that mental illness stigma is a double-edged sword: as well as the direct harms for wellbeing, by increasing identification with other mental illness sufferers, stigma might expose sufferers to harmful social influence processes. Crown Copyright © 2015. Published by Elsevier B.V. All rights reserved.

  8. Manic Depressive Disorder in Mental Handicap.

    ERIC Educational Resources Information Center

    Berney, T. P.; Jones, P. M.

    1988-01-01

    Eight cases of early onset bipolar affective disorder in adolescents with mental impairment are described, focusing on age of onset; common characteristics such as rapid cycling, mixed affective states, and lithium resistance; and the likelihood that cerebral dysfunction might cause a secondary form of bipolar disorder. (JDD)

  9. Manic Depressive Disorder in Mental Handicap.

    ERIC Educational Resources Information Center

    Berney, T. P.; Jones, P. M.

    1988-01-01

    Eight cases of early onset bipolar affective disorder in adolescents with mental impairment are described, focusing on age of onset; common characteristics such as rapid cycling, mixed affective states, and lithium resistance; and the likelihood that cerebral dysfunction might cause a secondary form of bipolar disorder. (JDD)

  10. Depression and Cardiovascular Disease: An Update on How Course of Illness May Influence Risk

    PubMed Central

    Fiedorowicz, Jess G.

    2014-01-01

    Depression constitutes a novel and independent risk factor for cardiovascular disease, which despite extensive support in the literature has been underappreciated. While much of the evidence for depression as a risk factor for cardiovascular disease is based on studies following myocardial infarction, the elevated vascular risk conveyed by depression is not confined to periods following acute coronary syndromes. For that matter, the risk appears across mood disorders with evidence for even greater risk in bipolar disorder. This review summarizes the literature linking depressive disorders to cardiovascular mortality with a focus on how the course of illness of mood disorders may influence this risk. Mood disorders may influence risk over decades of illness in a dose-response to symptom burden, or the persistence of affective symptomatology. This may be mediated through changes in the activity of the autonomic nervous system, the hypothalamic-pituitary-adrenal axis, and inflammatory cytokines. Whether treatment of depression can mitigate this risk is not established although there are suggestions to support this contention, which could be better studied with more effective treatments of depression and larger standardized samples. Directions for future study of mechanisms and treatment are discussed. Regardless of causal mechanisms, persons with depressive disorders and other risk factors for vascular disease represent a neglected, high-risk group for cardiovascular events. In addition to the appropriate treatment for depression, screening and optimized management of traditional risk factors for cardiovascular diseases is necessary. PMID:25163592

  11. Assessment of Automatic Thoughts in Patients with Depressive Illness at a Tertiary Hospital in Nepal.

    PubMed

    Rana, M; Sthapit, S; Sharma, V D

    2017-01-01

    Cognitive functions have significant influence on psycho-social and general wellbeing. The quality, content and processing of negative thoughts initiate depressive symptoms; i.e. low mood, decreased self-worth and diminished interest in pleasurable activities. The study assessed the automatic thoughts of patients having depressive illness and evaluated and compared the changes after therapy; i.e. Psychotherapy and pharmacotherapy. Diagnosed cases of depressive illness (n=135), according to ICD-10 and study criteria, attending the out-patient clinic of Department of Psychiatry and Mental Health, Tribhuvan University Teaching Hospital, were included. Beck Depression Inventory was used to screen level of depressive symptoms. Automatic thoughts were assessed by the Automatic Thought Questionnaire-Revised before initiating therapy and after completion of therapy for comparison. Depressive patients received either of the three treatment procedures after randomization of the study sample into three different treatment groups; i.e. Cognitive behavior therapy, pharmacotherapy or combined therapy receiving both cognitive behavior therapy and pharmacotherapy. Among the total 135 patients, 53 (39.3%) had moderate, 47 (34.8%) had severe depressive and 35 (25.9%) had mild depressive symptoms before therapeutic interventions. Negative automatic thoughts were significantly present in depressed patients and reduced after all three interventions. Negative automatic thoughts of hopelessness, anxiety and inability coping were significantly reduced after therapy. Automatic negative thoughts were significantly correlated with depressive disorder. Combined therapy CBT with pharmacotherapy or CBT alone was found to be more effective in modifying automatic negative thoughts than pharmacotherapy alone, ultimately reducing depressive symptoms to a significant degree.

  12. Gilles de la Tourette Syndrome, Depression, Depressive Illness, and Correlates in a Child and Adolescent Population.

    PubMed

    Rizzo, Renata; Gulisano, Mariangela; Martino, Davide; Robertson, Mary May

    2017-04-01

    Gilles de la Tourette syndrome (GTS) and depression are both common disorders. It has been suggested that depression occurs in 13%-76% GTS patients. Despite this, there are few studies into the specific relationships and correlates between the two disorders. There is only some consensus as to the precise relationship between the two disorders. We undertook the study to investigate the relationship between depressive symptomatology and the core clinical features of GTS in a well-characterized clinical population of youth with this disorder. Our aim was to verify the association between depression and comorbid obsessive-compulsive disorder and explore further other potential associations highlighted in some, but not all, of the studies focused on this topic. Our results demonstrated that (1) the GTS patients were significantly older than the controls, (2) the GTS patients were significantly more depressed than controls, (3) depression was associated with tic severity, (4) the Diagnostic Confidence Index scores were higher in GTS patients without depression, (5) anxiety, attention-deficit/hyperactivity disorder (ADHD), conduct disorder (CD), and behavioral problems were significantly associated with depression, and (6) finally, patients with GTS and depression have a positive family history of depression. However, obsessionality (CY-BOCS) did not differentiate between depressed and not depressed GTS patients. Depression is common in patients with GTS and occurs significantly more in GTS than in controls. Depression is significantly associated with GTS factors such as tic severity, comorbidity with ADHD, and the presence of coexistent anxiety, CDs, and behavior problems. Depression is importantly significantly associated with a positive family history of depression. Intriguingly, depression in our sample was not related to obsessionality.

  13. Influence of Intensity and Duration of Yoga on Anxiety and Depression Scores Associated with Chronic Illness

    PubMed Central

    Telles, S; Pathak, S; Kumar, A; Mishra, P; Balkrishna, A

    2015-01-01

    Background: Chronic illness is commonly associated with anxiety and depression. Both anxiety and depression respond to yoga. However, there is no report on the association between the intensity and duration of yoga practice with the benefits seen. Aim: The present study was intended to determine whether the daily duration of yoga practice and the duration of experience in months would predict anxiety and depression, associated with chronic illness. Subjects and Methods: Seven hundred and sixty-three volunteers with ages between 14 and 86 years (group mean age standard deviation, 50.2 [14.2]) who attended a 7 day residential yoga camp in the north of India were included in this cross-sectional study. All participants had chronic illnesses, which were under control with treatment, and which were categorized and are detailed. Participants were assessed for state anxiety scores using State-Trait Anxiety Inventory and for anxiety with hospital anxiety and depression scale (HADS-A), and depression was assessed using HADS-D scores of the HADS. Linear multiple regression analyses were performed using PASW SPSS version 18.0 (Armonk, New York, U.S.) to determine how the daily and monthly duration of yoga practice could influence state anxiety, hospital anxiety and depression of the participants. Results: Yoga practice in months and the time spent practicing yoga each day significantly predict the level of state anxiety (P < 0.001, P = 0.03) and HAD-A (P < 0.01, P < 0.01). The duration of yoga practice in months alone was a significant predictor of the HAD-D (P < 0.01). Conclusions: The results suggest that the duration of yoga practice in months and daily practice in minutes predict anxiety associated with chronic illness. In contrast the duration of yoga practice in months alone, predicted depression scores. PMID:26229714

  14. Association Between Cardiovascular Risk and Depressive Symptoms Among People With Serious Mental Illness.

    PubMed

    Naslund, John A; Aschbrenner, Kelly A; Pratt, Sarah I; Lohman, Matthew C; Scherer, Emily A; McHugo, Gregory J; Marsch, Lisa A; Unützer, Jürgen; Bartels, Stephen J

    2017-08-01

    Depressive symptoms have debilitating effects on the physical health and functioning of people with serious mental illness. We examined change in depressive symptoms among overweight and obese adults with serious mental illness (n = 343) using data combined from two randomized trials comparing the 12-month In SHAPE program to a gym membership control condition. In SHAPE consists of a gym membership, weekly individual meetings with a fitness trainer, and instruction on healthy eating and nutrition. Depressive symptoms were measured at baseline, 3, 6, and 12 months. Change in depressive symptoms did not differ between groups, but depressive symptoms decreased over time across the entire sample (p = 0.045). At 12 months, reduced depressive symptoms were associated with clinically significant improved cardiorespiratory fitness (p = 0.030), 10% or more weight loss (p = 0.044), and cardiovascular risk reduction (p = 0.028) across both groups. Our findings suggest that participation in health promotion programs resulting in cardiovascular risk reduction may be associated with reduced depressive symptoms.

  15. ROLE OF MATERNAL CHILDHOOD TRAUMA ON PARENTING AMONG DEPRESSED MOTHERS OF PSYCHIATRICALLY ILL CHILDREN

    PubMed Central

    Zalewski, Maureen; Cyranowski, Jill M.; Cheng, Yu; Swartz, Holly A.

    2015-01-01

    Background Independently, maternal depression and maternal history of childhood abuse confer risk for impaired parenting. These associations may be compounded when depressed mothers with histories of childhood abuse are faced with the challenge of parenting offspring who themselves struggle with mental health problems. This study examined the relationships among maternal history of childhood abuse, maternal depression, and parenting style in the context of parenting a psychiatrically ill child, with an emphasis on examining maternal emotional abuse and neglect. We hypothesized that maternal childhood emotional abuse would be associated with maladaptive parenting strategies (lower levels of maternal acceptance and higher levels of psychological control), independent of maternal depression severity and other psychosocial risk factors. Method Ninety-five mother-child dyads (children ages 7–18) were recruited from child mental health centers where children were receiving treatment for at least one internalizing disorder. Participating mothers met DSM-IV criteria for major depressive disorder. Mothers reported on their own childhood abuse histories and children reported on their mothers’ parenting. Results Regression analyses demonstrated that maternal childhood emotional abuse was associated with child reports of lower maternal acceptance and greater psychological control, controlling for maternal depression severity, and other psychosocial risk factors. Conclusions When treating psychiatrically ill children, it is important for a child’s clinician to consider mothers’ childhood abuse histories in addition to their history of depression. These mothers appear to have additional barriers to effective parenting. PMID:23649503

  16. Role of maternal childhood trauma on parenting among depressed mothers of psychiatrically ill children.

    PubMed

    Zalewski, Maureen; Cyranowski, Jill M; Cheng, Yu; Swartz, Holly A

    2013-09-01

    Independently, maternal depression and maternal history of childhood abuse confer risk for impaired parenting. These associations may be compounded when depressed mothers with histories of childhood abuse are faced with the challenge of parenting offspring who themselves struggle with mental health problems. This study examined the relationships among maternal history of childhood abuse, maternal depression, and parenting style in the context of parenting a psychiatrically ill child, with an emphasis on examining maternal emotional abuse and neglect. We hypothesized that maternal childhood emotional abuse would be associated with maladaptive parenting strategies (lower levels of maternal acceptance and higher levels of psychological control), independent of maternal depression severity and other psychosocial risk factors. Ninety-five mother-child dyads (children ages 7-18) were recruited from child mental health centers where children were receiving treatment for at least one internalizing disorder. Participating mothers met DSM-IV criteria for major depressive disorder. Mothers reported on their own childhood abuse histories and children reported on their mothers' parenting. Regression analyses demonstrated that maternal childhood emotional abuse was associated with child reports of lower maternal acceptance and greater psychological control, controlling for maternal depression severity, and other psychosocial risk factors. When treating psychiatrically ill children, it is important for a child's clinician to consider mothers' childhood abuse histories in addition to their history of depression. These mothers appear to have additional barriers to effective parenting. © 2013 Wiley Periodicals, Inc.

  17. Cognitive Improvement Associated with Tricyclic Antidepressant Treatment of Childhood Major Depressive Illness.

    ERIC Educational Resources Information Center

    Staton, R. Dennis; And Others

    1981-01-01

    Describes the results of detailed neuropsychological testing done before and during drug-induced remission of depressive illness in 11 children (ages 6-13 years), demonstrating significant improvement in cognitive function, especially that of the right hemisphere and frontal lobes. (Author/SJL)

  18. Internalized stigma of mental illness and depressive and psychotic symptoms in homeless veterans over 6 months.

    PubMed

    Boyd, Jennifer E; Hayward, H'Sien; Bassett, Elena D; Hoff, Rani

    2016-06-30

    We investigated the relationship between internalized stigma of mental illness at baseline and depressive and psychotic symptoms 3 and 6 months later, controlling for baseline symptoms. Data on homeless veterans with severe mental illness (SMI) were provided by the Northeast Program Evaluation Center (NEPEC) Special Needs-Chronic Mental Illness (SN-CMI) study (Kasprow and Rosenheck, 2008). The study used the Internalized Stigma of Mental Illness (ISMI) scale to measure internalized stigma at baseline and the Symptom Checklist-90-R (SCL-90-R) to measure depressive and psychotic symptoms at baseline and 3 and 6 month follow-ups. Higher levels of internalized stigma were associated with greater levels of depressive and psychotic symptoms 3 and 6 months later, even controlling for symptoms at baseline. Alienation and Discrimination Experience were the subscales most strongly associated with symptoms. Exploratory analyses of individual items yielded further insight into characteristics of potentially successful interventions that could be studied. Overall, our findings show that homeless veterans with SMI experiencing higher levels of internalized stigma are likely to experience more depression and psychosis over time. This quasi-experimental study replicates and extends findings of other studies and has implications for future controlled research into the potential long-term effects of anti-stigma interventions on mental health recovery.

  19. Cognitive Improvement Associated with Tricyclic Antidepressant Treatment of Childhood Major Depressive Illness.

    ERIC Educational Resources Information Center

    Staton, R. Dennis; And Others

    1981-01-01

    Describes the results of detailed neuropsychological testing done before and during drug-induced remission of depressive illness in 11 children (ages 6-13 years), demonstrating significant improvement in cognitive function, especially that of the right hemisphere and frontal lobes. (Author/SJL)

  20. The Relation of Illness Perceptions to Stress, Depression, and Fatigue in Patients with Chronic Lymphocytic Leukemia

    PubMed Central

    Maddocks, Kami; Andersen, Barbara L.

    2016-01-01

    Objective Chronic lymphocytic leukemia (CLL) is the most prevalent adult leukemia and is incurable. The course and treatment of CLL is unique and characterized by repeated cycles of treatment, stable disease, and relapse. Utilizing a Self-Regulatory Model framework (Leventhal et al., 1980), we examined the relationship between patients’ illness perceptions and cancer-specific stress, depression, and fatigue. Our aim was to test illness perceptions as predictors of these outcomes when variance due to disease and treatment variables was controlled. Design Data were collected on 147 patients with relapsed/refractory CLL as they entered a phase-II clinical trial of an investigational medication at a university affiliated, National Cancer Institute designated comprehensive cancer center. Main outcome measures Cancer-specific stress, depressive symptoms, and fatigue interference. Results Hierarchical multiple regression was used. Consequences and emotional representation were related to all outcomes (ps <.01). Illness concern was related to cancer-specific stress (p <.01), and identity was related to fatigue interference (p <.01). All relationships were observed while controlling for number of previous CLL therapies received. Conclusion Illness perceptions are related to cancer-specific stress, depressive symptoms, and fatigue interference in relapsed/refractory CLL. Interventions targeted at restructuring maladaptive illness perceptions may have clinical benefit in this population. PMID:26982998

  1. Defining the boundaries of atypical depression: evidence from the HPA axis supports course of illness distinctions.

    PubMed

    Stewart, Jonathan W; Quitkin, Frederic M; McGrath, Patrick J; Klein, Donald F

    2005-06-01

    Treatment outcome and brain laterality differ between early onset (<20 years) chronically (no well-being >2 months) depressed patients with atypical features (early/chronic atypical) and those with either later onset or less chronic illness (late/nonchronic atypical). Because hypothalamic-pituitary-adrenal (HPA) axis abnormalities have been hypothesized to distinguish atypical depression from melancholia, we examined whether HPA measures would also differentiate these two groups of depressed patients with atypical features. Three-hour afternoon cortisol levels, stimulation of cortisol by afternoon dextroamphetamine, and suppression of cortisol by dexamethasone were investigated in 85 depressed patients with atypical features. The latter group was divided into early/chronic atypical and late/nonchronic atypical based on chart review of course of illness. Patients with early/chronic atypical had significantly lower mean 3 h afternoon cortisol levels (N=21) and 4:00 p.m. post-dexamethasone cortisol levels (N=20) than did those with late/nonchronic atypical (N=43 with afternoon cortisol; N=26 with post-dexamethasone cortisol). Post-dextroamphetamine cortisol levels were numerically higher in the early/chronic atypical group (N=15 vs. 19), but this failed to reach conventional significance (0.05illness limit the generalizability of these findings. These HPA data are consistent with earlier treatment and brain laterality findings that course of illness distinguishes biologically distinct groups within depressed patients with atypical features. The DSM should consider adding course of illness requirements to its criteria for atypical features.

  2. Illness Cognitions and Coping Self-Efficacy in Depression Among Persons With Low Vision.

    PubMed

    Sturrock, Bonnie A; Xie, Jing; Holloway, Edith E; Hegel, Mark; Casten, Robin; Mellor, David; Fenwick, Eva; Rees, Gwyneth

    2016-06-01

    To investigate the mediating role of coping self-efficacy (CSE) between two types of illness cognitions (i.e., acceptance and helplessness) and depressive symptoms in persons with low vision. This was a single-group, cross-sectional study. Patients with visual acuity < 6/12 in the better eye and at least minimal depressive symptoms (≥5 on the Patient Health Questionnaire-9 [PHQ-9]) were recruited from vision rehabilitation services and participated in telephone-administered structured interviews at one time point. Measures were the PHQ-9, CSE Scale, and Illness Cognition Questionnaire. Structural equation modeling (SEM) devised the causal flow of illness cognitions and their observed indirect effects on depressive symptoms via the CSE mediators: problem focused, emotion focused, and social support. The study comprised 163 patients (mean age 62 years; 61% female), most with age-related macular degeneration (26%) and moderate vision impairment (44%, <6/18-6/60). Structural equation modeling indices indicated a perfect fit (χ2 < 0.001, P = 1.00), accounting for 55% of the variance in depressive symptoms. Lower levels of acceptance and higher levels of helplessness illness cognitions were associated with lower self-efficacy in problem-focused coping (β = 0.38, P < 0.001, β = -0.28, P < 0.01, respectively), which in turn was associated with greater depressive symptom severity (β = -0.54, P < 0.001). Lack of acceptance and greater helplessness relating to low vision led to a lack of perceived capability to engage in problem-focused coping, which in turn promoted depressive symptoms. Third-wave cognitive-behavioral treatments that focus on acceptance may be efficacious in this population.

  3. Life events at the onset of bipolar affective illness.

    PubMed

    Dunner, D L; Patrick, V; Fieve, R R

    1979-04-01

    The authors assessed the occurrence of stressful life events before the initial or subsequent episodes of affective illness in a group of 79 bipolar I manic-depressive patients who were attending a lithium clinic. About half of the patients recalled a life event in the 3-month interval before their initial episode; postpartum onset was prominent among these events. Few patients recalled life events for subsequent episodes. Finally, history data did not differentiate patients who recalled life events and those who did not. These data may be useful in assessing environmental antecedents of populations at risk for bipolar illness.

  4. [Knowledge and attitude of the general public regarding symptoms, etiology and possible treatments of depressive illnesses].

    PubMed

    Althaus, D; Stefanek, J; Hasford, J; Hegerl, U

    2002-07-01

    Within the German research network on depression, the Nuremberg Alliance against Depression aims at informing the public about depressive illness and preventing suicidality by carrying out a city-wide information campaign. Before the prevention program started, public attitudes and knowledge had been assessed in a public opinion survey in Nuremberg and in a control region. A total of 1426 randomly chosen inhabitants of Nuremberg and Würzburg completed a computer-assisted telephone interview during November and December 2000. They were asked about their knowledge and attitudes towards symptoms, causes, and treatment of depression. No relevant differences between Nuremberg and Würzburg were found. Depression is regarded as a serious illness. People seemed to be more knowledgeable as compared to the results of earlier surveys, but there are still important information deficits. This is especially true for males over 60, who show unfavorable attitudes. Eighty percent of the population consider antidepressants to be addictive, and 69% were convinced that the use of antidepressants would lead to personality changes. Future information campaigns should aim at describing depression as an often chronic disease similar to hypertonia or diabetes. Public knowledge about antidepressants must be improved.

  5. What are depressive symptoms in acutely ill patients with schizophrenia spectrum disorder?

    PubMed

    Schennach, R; Riedel, M; Obermeier, M; Seemüller, F; Jäger, M; Schmauss, M; Laux, G; Pfeiffer, H; Naber, D; Schmidt, L G; Gaebel, W; Klosterkötter, J; Heuser, I; Maier, W; Lemke, M R; Rüther, E; Klingberg, S; Gastpar, M; Möller, H-J

    2015-01-01

    Aim was to examine depressive symptoms in acutely ill schizophrenia patients on a single symptom basis and to evaluate their relationship with positive, negative and general psychopathological symptoms. Two hundred and seventy-eight patients suffering from a schizophrenia spectrum disorder were analysed within a naturalistic study by the German Research Network on Schizophrenia. Using the Calgary Depression Scale for Schizophrenia (CDSS) depressive symptoms were examined and the Positive and Negative Syndrome Scale (PANSS) was applied to assess positive, negative and general symptoms. Correlation and factor analyses were calculated to detect the underlying structure and relationship of the patient's symptoms. The most prevalent depressive symptoms identified were depressed mood (80%), observed depression (62%) and hopelessness (54%). Thirty-nine percent of the patients suffered from depressive symptoms when applying the recommended cut-off of a CDSS total score of >6 points at admission. Negligible correlations were found between depressive and positive symptoms as well as most PANSS negative and global symptoms despite items on depression, guilt and social withdrawal. The factor analysis revealed that the factor loading with the PANSS negative items accounted for most of the data variance followed by a factor with positive symptoms and three depression-associated factors. The naturalistic study design does not allow a sufficient control of study results for the effect of different pharmacological treatments possibly influencing the appearance of depressive symptoms. Results suggest that depressive symptoms measured with the CDSS are a discrete symptom domain with only partial overlap with positive or negative symptoms. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  6. Illness Conceptualizations among Older Rural Mexican-Americans with Anxiety and Depression

    PubMed Central

    Letamendi, Andrea M.; Ayers, Catherine R.; Ruberg, Joshua L.; Singley, Daniel B.; Wilson, Jacqueline; Chavira, Denise; Palinkas, Lawrence; Wetherell, Julie Loebach

    2014-01-01

    Background Research on barriers and utilization of mental health services in older ethnic minorities has been productive. However, little is known about the characterization and beliefs about anxiety and depression symptoms among older Mexican-Americans. Exploration of these conceptualizations will lead to better detection and provision of care to this large, yet underserved group. Method The present study used a mixed methods approach to explore conceptualizations of anxiety and depression in a group of rural older Mexican-Americans. Twenty-five Spanish-speaking participants (mean age 71.2) responded to flyers that solicited individuals who felt “tense or depressed.” Participants completed a structured diagnostic interview as well as self-report questionnaires about medical health, anxiety and depressive symptoms, and cognitive functioning. Qualitative interviews included questions about how participants describe, conceptualize, and cope with anxiety and depression symptoms. Results Sixty-eight percent of the sample met criteria for at least one anxiety or mood disorder with high comorbidity rates. Self-reported symptoms of depression, anxiety, and somatization were below clinical ranges for all participants. Medical illness, cognitive impairment, age, education, and acculturation were not associated with distress. Qualitative analyses revealed that nearly half of the terms used by the sample to describe distress phenomena deviated from Western labels traditionally used to indicate anxious and depressive symptomatology. Discussion Multiple methods of symptom endorsement demonstrated that older Mexican-Americans may report distress differently than detected by traditional self-report measures or common Western terminology. Understanding these additional illness conceptualizations may have implications for improving the detection of mental illness and increasing service use among this growing population. PMID:24077906

  7. Loneliness, depression, social support, and quality of life in older chronically ill Appalachians.

    PubMed

    Theeke, Laurie A; Goins, R Turner; Moore, Julia; Campbell, Heather

    2012-01-01

    This study's purpose was to describe loneliness and to examine the relationships between loneliness, depression, social support, and QOL in chronically ill, older Appalachians. In-person interviews were conducted with a convenience sample of 60 older, chronically ill, community-dwelling, and rural adults. Those with dementia or active grief were excluded. The UCLA Loneliness Scale (Russell, Peplau, & Cutrona, 1985), Geriatric Depression Scale (Shiekh & Yesavage, 1986), Katz ADL scale (Katz, Down, & Cash, 1970), MOS Social Support Scale (Sherbourne & Stewart, 1991), and a visual analog scale for Quality of Life (Spitzer et al., 1981) scale were used. Diagnoses were obtained through chart reviews. SPSS was used for data analyses. The majority of the 65% female sample (M age = 75 years) were married and impoverished. Participants' number of chronic illnesses averaged more than 3. Over 88% of participants reported at least 1 area of functional impairment. Loneliness was prevalent with UCLA loneliness scores indicating moderate to high loneliness, ranging from 39 to 62 (possible scores were 20-80). Higher loneliness scores correlated with depression, lower Qol, and lower social support, particularly lower emotional support. This study provides evidence that loneliness is a significant problem for older chronically ill Appalachian adults and that it may be related to low emotional support. Further, it provides evidence that this population may be significantly lonely and may not self-identify as lonely. Screening for loneliness and designing interventions that target the emotional aspects of loneliness could be important in this population.

  8. Predicting depression from illness severity in cardiovascular disease patients: self-efficacy beliefs, illness perception, and perceived social support as mediators.

    PubMed

    Greco, A; Steca, P; Pozzi, R; Monzani, D; D'Addario, M; Villani, A; Rella, V; Giglio, A; Malfatto, G; Parati, G

    2014-04-01

    Many studies have investigated the relationships between cardiovascular diseases and patients' depression; nevertheless, few is still known as regard the impact of illness severity on depression and whether psychosocial variables mediate this association. The aim of this study is to investigate the putative mediating role of illness representations, self-efficacy beliefs, and perceived social support on the relationship between illness severity and depression. A total of 75 consecutive patients with cardiovascular disease (80 % men; mean age = 65.44, SD = 10.20) were enrolled in an Italian hospital. Illness severity was measured in terms of left ventricular ejection fraction, whereas psychological factors were assessed using self-report questionnaires. The relationship between left ventricular ejection fraction and depression was mediated by identity illness perception, self-efficacy beliefs in managing cardiac risk factors, and perceived social support. The treatment of depression in cardiovascular disease patients may therefore benefit from a psychological intervention focused on patients' illness representations, self-efficacy beliefs, and their perceived social support.

  9. Identifying illness perception schemata and their association with depression and quality of life in cardiac patients.

    PubMed

    Le Grande, Michael R; Elliott, Peter C; Worcester, Marian U C; Murphy, Barbara M; Goble, Alan J; Kugathasan, Vanessa; Sinha, Karan

    2012-01-01

    The purpose of this paper is to identify groups of cardiac patients who share similar perceptions about their illness and to examine the relationships between these schemata and psychosocial outcomes such as quality of life and depression. A total of 190 cardiac patients with diagnoses of myocardial infarction, stable angina pectoris or chronic heart failure, completed a battery of psychosocial questionnaires within four weeks of their admission to hospital. These included the Brief Illness Perceptions Questionnaire (BIPQ), Beck Depression Inventory II (BDI II) and The MacNew Health-related Quality of Life instrument (MacNew). BIPQ items were subjected to latent class analysis (LCA) and the resulting groups were compared according to their BDI II and MacNew scores. LCA identified a five-class model of illness perception which comprised the following: (1) Consequence focused and mild emotional impact, n = 55, 29%; (2) Low illness perceptions and low emotional impact, n = 45, 24%; (3) Control focused and mild emotional impact, n = 10, 5%; (4) Consequence focused and high emotional impact, n = 60, 32%; and (5) Consequence focused and severe emotional impact, n = 20, 10%. Gender and diagnosis did not appear to reflect class membership except that class 2 had a significantly higher proportion of AMI patients than did class 5. There were numerous significant differences between classes in regards to depression and health-related quality of life. Notably, classes 4 and 5 are distinguished by relatively high BDI II scores and low MacNew scores. Identifying classes of cardiac patients based on their illness perception schemata, in hospital or shortly afterwards, may identify those at risk of developing depressive symptoms and poor quality of life.

  10. Examining Whether Offspring Psychopathology Influences Illness Course in Mothers With Recurrent Depression Using a High-Risk Longitudinal Sample

    PubMed Central

    2016-01-01

    Depression is known to be influenced by psychosocial stressors. For mothers with recurrent depressive illness, the presence of psychopathology in their children may have important effects on their own mental health. Although the impact of maternal depression on child mental health is well-established, no study to date, as far as we are aware, has examined the extent to which offspring psychopathology influences the course of depression in mothers with a history of recurrent depressive illness, what types of child psychopathology impact maternal mental health, or whether risks vary by child gender. Aims were to (a) Use a longitudinal design to examine whether adolescent psychopathology (depression, disruptive behavior disorder; DBD) predicts recurrence of a depressive episode and depression symptom course in women with a history of recurrent depression; and (b) To test if observed effects vary by child gender. 299 mothers with recurrent major depressive disorder and their adolescent offspring were assessed on 2 occasions, 29 months apart. Maternal depression and offspring psychopathology were assessed using semistructured interview measures. Cross-generational links across time were assessed using structural equation modeling. Analyses were adjusted for past severity of maternal depression. Offspring depression symptoms but not DBD symptoms at baseline predicted future episode recurrence in mothers. Depression symptoms in daughters (β = .16, p = .039) but not sons (β = −.07, p = .461), predicted an increase in maternal depression symptoms across time. Psychopathology in daughters is associated with long-term depressive symptoms in women (mothers) with a history of recurrent depression. Findings highlight the importance of careful assessment and management of mental health problems in adolescents for more effective management of maternal depression. This study suggests that offspring symptoms of depression may be important for the recurrence of maternal

  11. Interplay between pro-inflammatory cytokines and growth factors in depressive illnesses

    PubMed Central

    Audet, Marie-Claude; Anisman, Hymie

    2013-01-01

    The development of depressive disorders had long been attributed to monoamine variations, and pharmacological treatment strategies likewise focused on methods of altering monoamine availability. However, the limited success achieved by treatments that altered these processes spurred the search for alternative mechanisms and treatments. Here we provide a brief overview concerning a possible role for pro-inflammatory cytokines and growth factors in major depression, as well as the possibility of targeting these factors in treating this disorder. The data suggest that focusing on one or another cytokine or growth factor might be counterproductive, especially as these factors may act sequentially or in parallel in affecting depressive disorders. It is also suggested that cytokines and growth factors might be useful biomarkers for individualized treatments of depressive illnesses. PMID:23675319

  12. [Acedia or the depressed between sin and illness].

    PubMed

    Alliez, J; Huber, J P

    1987-05-01

    Acedia is a term of the classical greek vocabulary that a christian author of the IVth century, Evagre the Pontic, uses in a special sense, to describe a mental state characterized among other things, by disgust and dejection, and which, according to him, falls into what became the first list of deadly sins. The word was conveyed to us by another monk of the egyptian deserts, Jean Cassien, with a change of meaning which made it very difficult to distinguish from sadness: his audience being very different from his predecessor's, as he wrote for Latins, little inclined to anachoretic life but among which developed the first great coenobitic institutions of the Occident. One century later, Pope Gregory the great removes acedia from the list of deadly sins, either because he does not distinguish it from sadness (and laziness) or because he considers it a morbid state and, as such, depending on medical care. The word has nevertheless survived until Thomas Aquinas and later, and its study provides valuable data on the mental states prefiguring our modern depressions.

  13. People with symptoms of Ménière's disease: the relationship between illness intrusiveness, illness uncertainty, dizziness handicap, and depression.

    PubMed

    Arroll, Megan; Dancey, Christine P; Attree, Elizabeth A; Smith, Sharon; James, Trevor

    2012-07-01

    The goal of this study was to assess the impact of dizziness handicap, illness intrusiveness (in relation to vertigo, tinnitus, and hearing problems), and illness uncertainty on depression in people with the symptoms of Ménière's disease. Ménière's disease is a progressive disease of the inner ear, the symptoms of which are vertigo, tinnitus, hearing loss, and aural fullness. Although pharmacologic treatments may reduce acute vertigo spells and dizziness, they rarely disappear entirely. Previous research shows that Ménière's disease is unpredictable and has a negative impact on patients' quality of life. Questionnaires measuring Dizziness Handicap, Illness Intrusiveness, Illness Uncertainty, and Depression were completed by 74 people with self-reported symptoms of Ménière's disease. Bivariate correlations, repeated-measures analysis of variance, and multiple regression analyses were used to assess the contribution of dizziness handicap, illness intrusiveness, and illness uncertainty to depression. Vertigo was more intrusive than tinnitus, hearing problems, and most other comparator illnesses. The intrusiveness of the symptoms of Ménière's disease accounted for 32% of the variance in depression scores, which were high; illness uncertainty did not account for additional variance. Dizziness handicap accounted for 31% of the variation in depression. Although the symptoms of Ménière's disease may not be alleviated by psychological methods, programs that target cognitions in relation to the embarrassment in front of others, and the feeling of being handicapped, may lessen the psychosocial impact of the symptoms of Ménière's disease, which may reduce some of the depression felt in this group.

  14. The impact of chronic physical illness, maternal depressive symptoms, family functioning, and self-esteem on symptoms of anxiety and depression in children.

    PubMed

    Ferro, Mark A; Boyle, Michael H

    2015-01-01

    The present study extends earlier research identifying an increased risk of anxiety among children with chronic physical illness (CwCPI) by examining a more complete model that explains how physical illness leads to increased symptoms of anxiety and depression. We tested a stress-generation model linking chronic physical illness to symptoms of anxiety and depression in a population-based sample of children aged 10 to 15 years. We hypothesized that having a chronic physical illness would be associated with more symptoms of anxiety and depression, increased levels of maternal depressive symptoms, more family dysfunction, and lower self-esteem; and, that maternal depressive symptoms, family dysfunction, and child self-esteem would mediate the influence of chronic physical illness on symptoms of anxiety and depression. Data came from the National Longitudinal Survey of Children and Youth (N = 10,646). Mediating processes were analyzed using latent growth curve modeling. Childhood chronic physical illness was associated with increases in symptoms of anxiety and depression, β = 0.20, p < 0.001. Mediating effects were also observed such that chronic physical illness resulted in increases in symptoms of maternal depression and family dysfunction, leading to declines in child self-esteem, and in turn, increases in symptoms of anxiety and depression. CwCPI are at-risk for symptoms of anxiety and depression. Some of this elevated risk appears to work through family processes and child self-esteem. This study supports the use of family-centered care approaches among CwCPI to minimize burden on families and promote healthy psychological development for children.

  15. Models of care for late-life depression of the medically ill: examples from chronic obstructive pulmonary disease and stroke.

    PubMed

    Avari, Jimmy N; Alexopoulos, George S

    2015-05-01

    Depression worsens most treatment outcomes in medically ill older adults. Chronic medical illnesses weaken and demoralize patients and compromise their ability to adhere to treatments requiring consistency and effort. Acute medical illnesses create a psychosocial storm that finds patients and their ecosystem unprepared. We describe two intervention models that can be used to target and personalize treatment in depressed, chronically, or acutely medically ill older adults. The Personalized Adherence Intervention for Depression and COPD (PID-C) is a model intervention for depressed patients with chronic medical illnesses. It targets patient-specific barriers to treatment engagement and aims to shift the balance in favor of treatment participation. PID-C led to higher remission rates of depression, reduction in depressive symptoms, and reduction in dyspnea-related disability. The addition of problem-solving training enables patients to use resources available to them and hopefully improve their outcomes. Ecosystem-focused therapy (EFT) is a model intervention for depression developing in the context of an acute medical event. It was developed for patients with poststroke depression (PSD) and targets five areas, part of the "psychosocial storm" originating from the patient's sudden disability and the resulting change in the patient's needs and family's life. A preliminary study suggests that EFT is feasible and efficacious in reducing depressive symptoms and signs and disability in PSD.

  16. Quality of depression treatment in Black Americans with major depression and comorbid medical illness

    PubMed Central

    Agyemang, Amma A.; Mezuk, Briana; Perrin, Paul; Rybarczyk, Bruce

    2014-01-01

    Objective To evaluate how comorbid type 2 diabetes (T2DM) and hypertension (HT) influence depression treatment and to assess whether these effects operate differently in a nationally-representative community-based sample of Black Americans. Methods Data came from the National Survey of American Life (N=3,673), and analysis is limited to respondents who met lifetime criteria for major depression (MD) (N=402). Depression care was defined according to American Psychiatric Association (APA) guidelines and included psychotherapy, pharmacotherapy, and satisfaction with services. Logistic regression was used to examine the effects of T2DM and HT on quality of depression care. Results Only 19.2% of Black Americans with MD alone, 7.8% with comorbid T2DM, and 22.3% with comorbid HT reported APA guideline-concordant psychotherapy or antidepressant treatment. Compared to respondents with MD alone, respondents with MD + T2DM/HT were no more or less likely to receive depression care. Respondents with MD + HT + T2DM were more likely to report any guideline-concordant care (OR=3.32 95% CI [1.07, 10.31]). Conclusions Although individuals with MD and comorbid T2DM + HT were more likely to receive depression care, guideline-concordant depression care is low among Black Americans, including those with comorbid medical conditions. PMID:24793895

  17. Antecedents of Manic versus Other First-Psychotic Episodes in 263 Bipolar-I Disorder Patients

    PubMed Central

    Salvatore, Paola; Baldessarini, Ross J.; Khalsa, Hari-Mandir K.; Vázquez, Gustavo; Perez, Jesus; Faedda, Gianni L.; Amore, Mario; Maggini, Carlo; Tohen, Mauricio

    2013-01-01

    Objective Since initial episode-type can predict later morbidity in bipolar disorder, we tested the hypothesis that clinical antecedents might predict initial episode-types. Method We studied 263 first-episode, adult, DSM-IV-TR type-I bipolar disorder (BD-I) subjects within the McLean-Harvard-International First-Episode Project. Based on blinded assessments of antecedents from SCID examinations and clinical records, we compared first-lifetime Manic vs. Other (mixed, depressive, or nonaffective) major psychotic-episodes. Results We identified 32 antecedents arising at early, intermediate or later times, starting 12.3±10.7 years prior to first-lifetime major psychotic-episodes. Based on multivariate modeling, antecedents associated significantly and independently with Other (n=113) more than Manic (n=150) first-lifetime major psychotic-episodes ranked by Odds Ratio: more early attentional disturbances, more late depression, more early perplexity, more detoxification, more early unstable-mixed affects, more antidepressants, more early dysphoria, more intermediate depression, more early impulsivity, more late anhedonia, longer early-to-intermediate intervals, more intermediate substance abuse, more family history of major depression, and younger at earliest antecedents. Antecedents selectively preceding Manic more than Other first-psychotic episodes included more late behavioral problems and more risk of familial BD-I. Conclusion Clinical antecedents in adult, BD-I patients, beginning a decade before first major-episodes and progressing through sequential stages were dissimilar in Manic versus Other first-psychotic-episodes. PMID:23837831

  18. Decreased serum zinc concentration during depressive episode in patients with bipolar disorder.

    PubMed

    Siwek, Marcin; Sowa-Kućma, Magdalena; Styczeń, Krzysztof; Szewczyk, Bernadeta; Reczyński, Witold; Misztak, Paulina; Topór-Mądry, Roman; Nowak, Gabriel; Dudek, Dominika; Rybakowski, Janusz K

    2016-01-15

    Zinc may be involved in the pathophysiology and treatment of depressive disorder. However, data on this issue in bipolar disorder (BD) are limited. The aim of the study was to assess zinc concentrations in the blood serum of patients at various phases and stages of bipolar disorder. The study included 129 patients with a diagnosis of bipolar disorder type I (n=69) or type II (n=60). Fifty-eight were in a depressive episode, 23 in a manic episode and 48 in remission. Fifty healthy volunteers made a control group. Zinc concentration was measured using flame atomic absorption spectrometry. Serum zinc level in patients diagnosed with BD type I in the depressive phase was significantly reduced as compared with mania, remission and healthy subjects. In the BD type II, serum zinc level in hypomania, depression or remission phase was not significantly different from the control group. In the whole group, lower level of zinc in depression compared to remission and control subjects was found during late stage of the illness but not in the early stage. Zinc concentration was not dependent on the severity of manic or depressive symptoms and subtype of depression but correlated positively with the number of manic/hypomanic relapses in the past year. Lack of prospective model, heterogeneity of pharmacological treatment, small number of subgroups presenting specified clinical features. Decreased serum zinc concentration occurs in depression in BD type I and probably in depression in the late stage of BD. Copyright © 2015 Elsevier B.V. All rights reserved.

  19. Depressive symptoms and decision-making preferences in patients with comorbid illnesses.

    PubMed

    Moise, Nathalie; Ye, Siqin; Alcántara, Carmela; Davidson, Karina W; Kronish, Ian

    2017-01-01

    Shared decision-making (SDM) is increasingly promoted in the primary care setting, but depressive symptoms, which are associated with cognitive changes, may influence decision-making preferences. We sought to assess whether elevated depressive symptoms are associated with decision-making preference in patients with comorbid chronic illness. We enrolled 195 patients ≥18years old with uncontrolled hypertension from two urban, academic primary care clinics. Depressive symptoms were assessed using the 8-item Patient Health Questionnaire. Clinician-directed decision-making preference was assessed according to the Control Preference Scale. The impact of depressive symptoms on decision-making preference was assessed using generalized linear mixed models adjusted for age, gender, race, ethnicity, education, Medicaid status, Charlson Comorbidity Index, partner status, and clustering within clinicians. The mean age was 64.2years; 72% were women, 77% Hispanic, 38% Black, and 33% had elevated depressive symptoms. Overall, 35% of patients preferred clinician-directed decision-making, 19% mostly clinician-directed, 39% shared, and 7% some or little clinician-input. Patients with (vs. without) elevated depressive symptoms were more likely to prefer clinician-directed decision-making (46% versus 29%; p=0.02; AOR 2.51, 95% CI 1.30-4.85, p=0.005). Remitted depressive symptoms (vs. never depressed) were not associated with preference. Elevated depressive symptoms are associated with preference for clinician-directed decision-making. We suggest that clinicians should be aware of this effect when incorporating preference into their communication styles and take an active role in eliciting patient values and exchanging information about treatment choice, all important components of shared decision-making, particularly when patients are depressed. Copyright © 2015 Elsevier Inc. All rights reserved.

  20. Using Mixed Methods to Examine the Role of Veterans' Illness Perceptions on Depression Treatment Utilization and HEDIS Concordance.

    PubMed

    Elwy, A Rani; Glickman, Mark E; Bokhour, Barbara G; Dell, Natalie S; Mueller, Nora M; Zhao, Shibei; Osei-Bonsu, Princess E; Rodrigues, Stephanie; Coldwell, Craig M; Ngo, Tu A; Schlosser, James; Vielhauer, Melanie J; Pirraglia, Paul A; Eisen, Susan V

    2016-06-01

    Although depression screening occurs annually in the Department of Veterans Affairs (VA) primary care, many veterans may not be receiving guideline-concordant depression treatment. To determine whether veterans' illness perceptions of depression may be serving as barriers to guideline-concordant treatment. We used a prospective, observational design involving a mailed questionnaire and chart review data collection to assess depression treatment utilization and concordance with Healthcare Effectiveness Data and Information Set guidelines adopted by the VA. The Self-Regulation Model of Illness Behavior guided the study. Veterans who screened positive for a new episode of depression at 3 VA primary care clinics in the US northeast. The Illness Perceptions Questionnaire-Revised, measuring patients' perceptions of their symptoms, cause, timeline, consequences, cure or controllability, and coherence of depression and its symptoms, was our primary measure to calculate veterans' illness perceptions. Treatment utilization was assessed 3 months after the positive depression screen through chart review. Healthcare Effectiveness Data and Information Set (HEDIS) guideline-concordant treatment was determined according to a checklist created for the study. A total of 839 veterans screened positive for a new episode of depression from May 2009-June 2011; 275 (32.8%) completed the survey. Ninety-two (33.9%) received HEDIS guideline-concordant depression treatment. Veterans' illness perceptions of their symptoms, cause, timeline, and controllability of depression predicted receiving guideline-concordant treatment. Many veterans are not receiving guideline-concordant treatment for depression. HEDIS guideline measures may not be assessing all aspects of quality depression care. Conversations about veterans' illness perceptions and their specific needs are encouraged to ensure that appropriate treatment is achieved.

  1. Using mixed methods to examine the role of Veterans’ illness perceptions on depression treatment utilization and HEDIS concordance

    PubMed Central

    Glickman, Mark E.; Bokhour, Barbara G.; Dell, Natalie S.; Mueller, Nora M.; Zhao, Shibei; Osei-Bonsu, Princess E.; Rodrigues, Stephanie; Coldwell, Craig M.; Ngo, Tu A.; Schlosser, James; Vielhauer, Melanie J.; Pirraglia, Paul A.; Eisen, Susan V.

    2014-01-01

    Background Although depression screening occurs annually in Department of Veterans Affairs (VA) primary care, many Veterans may not be receiving guideline-concordant depression treatment. Objectives To determine whether Veterans’ illness perceptions of depression may be serving as barriers to guideline-concordant treatment. Research Design We used a prospective, observational design involving a mailed questionnaire and chart review data collection to assess depression treatment utilization and concordance with Healthcare Effectiveness Data and Information Set guidelines adopted by the VA. The Self-Regulation Model of Illness Behavior guided the study. Subjects Veterans who screened positive for a new episode of depression at three VA primary care clinics in the U.S. Northeast. Measures The Illness Perceptions Questionnaire-Revised, measuring patients’ perceptions of their symptoms, cause, timeline, consequences, cure or controllability and coherence of depression and its symptoms, was our primary measure to calculate Veterans’ illness perceptions. Treatment utilization was assessed three months after the positive depression screen through chart review. HEDIS guideline-concordant treatment was determined according to a checklist created for the study. Results 839 Veterans screened positive for a new episode of depression from May 2009–June 2011; 275 (32.8%) completed the survey. 92 (33.9%) received HEDIS guideline-concordant depression treatment. Veterans’ illness perceptions of their symptoms, cause, timeline, and controllability of depression predicted receiving guideline-concordant treatment. Conclusions Many Veterans are not receiving guideline-concordant treatment for depression. HEDIS guideline measures may not be assessing all aspects of quality depression care. Conversations about Veterans’ illness perceptions and their specific needs are encouraged to ensure that appropriate treatment is achieved. PMID:24374425

  2. [Representations of insanity, mental illness and depression in general population in France].

    PubMed

    Roelandt, J-L; Caria, A; Defromont, L; Vandeborre, A; Daumerie, N

    2010-01-01

    The aim of this study was to describe the representations of insane, mentally ill and depressive persons, in a representative sample from the French General Population. Data were derived from the multicentric survey "Mental Health in the General Population: images and realities", carried out in 47 French public sites between 1999 and 2003. A face-to-face questionnaire was used to interview a representative sample of French metropolitan subjects, aged 18 and over, non-institutionalized and homeless. These subjects were recruited using quota sampling for age, sex, socioprofessional and education levels, according to data from the 1999 national French population census. Representations of insane, mentally ill and depressive persons were explored by a specific questionnaire with open and semi-open questions. Psychiatric diagnoses were identified using the Mini International Neuropsychiatric Interview (MINI). A national database was then constituted by pooling data from all sites, weighted for age, sex, level of education, socioprofessional level and work status to be representative of the French general population. Of the 36,000 individuals included in this study, over 75% associated the words "insane" and "mentally ill" with violent and dangerous behaviours and the term "depressive" with sadness, isolation and suicide. Young people, those with higher education and higher income level more frequently associated dangerous behaviours with mental illness rather than with insanity. The study shows that the general population draws a clear line between the representation of insane and mentally ill on one hand, and depressive on the other hand. Insane and mentally people are described as abnormal, irresponsible, unconscious, socially excluded, far from being curable, and to be cured against their will by psychotropic drugs and psychiatric hospitalisation. Whereas the depressive is perceived as a more familiar character, suffering, curable, who can be cured with psychotropic

  3. Self-reference in psychosis and depression: a language marker of illness.

    PubMed

    Fineberg, S K; Leavitt, J; Deutsch-Link, S; Dealy, S; Landry, C D; Pirruccio, K; Shea, S; Trent, S; Cecchi, G; Corlett, P R

    2016-09-01

    Language use is of increasing interest in the study of mental illness. Analytical approaches range from phenomenological and qualitative to formal computational quantitative methods. Practically, the approach may have utility in predicting clinical outcomes. We harnessed a real-world sample (blog entries) from groups with psychosis, strong beliefs, odd beliefs, illness, mental illness and/or social isolation to validate and extend laboratory findings about lexical differences between psychosis and control subjects. We describe the results of two experiments using Linguistic Inquiry and Word Count software to assess word category frequencies. In experiment 1, we compared word use in psychosis and control subjects in the laboratory (23 per group), and related results to subject symptoms. In experiment 2, we examined lexical patterns in blog entries written by people with psychosis and eight comparison groups. In addition to between-group comparisons, we used factor analysis followed by clustering to discern the contributions of strong belief, odd belief and illness identity to lexical patterns. Consistent with others' work, we found that first-person pronouns, biological process words and negative emotion words were more frequent in psychosis language. We tested lexical differences between bloggers with psychosis and multiple relevant comparison groups. Clustering analysis revealed that word use frequencies did not group individuals with strong or odd beliefs, but instead grouped individuals with any illness (mental or physical). Pairing of laboratory and real-world samples reveals that lexical markers previously identified as specific language changes in depression and psychosis are probably markers of illness in general.

  4. Assessment of implicit self-esteem in bipolar manic and euthymic patients using the implicit association test.

    PubMed

    Park, Jin Young; Ryu, Vin; Ha, Ra Yeon; Lee, Su Jin; Choi, Won-Jung; Ha, Kyooseob; Cho, Hyun-Sang

    2014-04-01

    Although self-esteem is thought to be an important psychological factor in bipolar disorder, little is known about implicit and explicit self-esteem in manic patients. In this study, we investigated differences in implicit and explicit self-esteem among bipolar manic patients, bipolar euthymic patients, and healthy controls using the Implicit Association Test (IAT). Participants included 19 manic patients, 27 euthymic patients, and 27 healthy controls. Participants completed a self-esteem scale to evaluate explicit self-esteem and performed the self-esteem IAT to evaluate implicit self-esteem. There were no differences among groups in explicit self-esteem. However, there were significant differences among groups in implicit self-esteem. Manic patients had higher IAT scores than euthymic patients and a trend toward higher IAT scores than healthy controls. Our findings suggest that, on the latent level, a manic state is not simply the opposite of a depressed state. Furthermore, there may be a discontinuity of implicit self-esteem between manic and euthymic states. These unexpected results may be due to characteristics of the study participants or the methods used to assess implicit self-esteem. Nevertheless, they provide greater insights on the psychological status of manic patients. © 2014.

  5. Measuring Latinos’ Perceptions of Depression: A Confirmatory Factor Analysis of the Illness Perception Questionnaire

    PubMed Central

    Cabassa, Leopoldo J.; Lagomasino, Isabel T.; Dwight-Johnson, Megan; Hansen, Marissa C.; Xie, Bin

    2010-01-01

    This study examined the psychometric properties of the Revised Illness Perception Questionnaire adapted for a clinical sample of low-income Latinos suffering from depression. Participants (N = 339) were recruited from public primary care centers. Their average age was 49.73 years and the majority was foreign born females of either Mexican or Central American descent. Confirmatory factor analysis was used to test the factor structure of this measure. Construct and discriminant validity and internal consistency were evaluated. After the elimination of three items because of low factor loadings (< .40) and the specification of seven error covariances, a revised model composed of 24 items had adequate goodness-of-fit indices and factor loadings, supporting construct validity. Each of the subscales reported satisfactory internal consistency. Intercorrelations between the 5 illness perception factors provided initial support for the discriminant validity of these factors in the context of depression. The establishment of the psychometric properties of this adapted measure will pave the way for future studies examining the role illness perceptions play in the help seeking and management of depression among Latinos. PMID:18954174

  6. Measuring Latinos' perceptions of depression: a confirmatory factor analysis of the Illness Perception Questionnaire.

    PubMed

    Cabassa, Leopoldo J; Lagomasino, Isabel T; Dwight-Johnson, Megan; Hansen, Marissa C; Xie, Bin

    2008-10-01

    This study examined the psychometric properties of the Revised Illness Perception Questionnaire adapted for a clinical sample of low-income Latinos suffering from depression. Participants (N = 339) were recruited from public primary care centers. Their average age was 49.73 years and the majority was foreign born females of either Mexican or Central American descent. Confirmatory factor analysis was used to test the factor structure of this measure. Construct and discriminant validity and internal consistency were evaluated. After the elimination of three items because of low factor loadings (< .40) and the specification of seven error covariances, a revised model composed of 24 items had adequate goodness-of-fit indices and factor loadings, supporting construct validity. Each of the subscales reported satisfactory internal consistency. Intercorrelations between the 5 illness perception factors provided initial support for the discriminant validity of these factors in the context of depression. The establishment of the psychometric properties of this adapted measure will pave the way for future studies examining the role illness perceptions play in the help seeking and management of depression among Latinos.

  7. Alagille Syndrome: A Case Report Highlighting Dysmorphic Facies, Chronic Illness, and Depression

    PubMed Central

    Winthrop, Zachary A.; Salman, Rabia; Majeed, Salman

    2016-01-01

    Alagille syndrome is a rare multisystem disorder affecting the liver, heart, vertebrae, eyes, and face. Alagille syndrome shares multiple phenotypic variants of other congenital or chronic childhood illnesses such as DiGeorge syndrome, Down syndrome, spina bifida, type 1 diabetes mellitus, and cystic fibrosis. All of these chronic illnesses have well-established links to psychiatric conditions. There are few community resources for Alagille patients, as it is an extremely rare condition. Despite the overlap with other chronic childhood illnesses, the psychiatric manifestations of Alagille syndrome have not been previously discussed in literature. The current study is a case report of a twelve-year-old female hospitalized in our pediatric psychiatric hospital for suicidal ideation with intent and plan. The patient had major depressive disorder, anxiety, other specified feeding and eating disorder, and attention-deficit/hyperactive disorder. PMID:28018696

  8. The influence of quality of life and depressed mood on smoking cessation among medically ill smokers.

    PubMed

    Hayes, Rashelle B; Dunsiger, Shira; Borrelli, Belinda

    2010-06-01

    Disease diagnosis and poor quality of life has been suggested as a "teachable moment" that facilitates smoking cessation, yet many patients continue to smoke. One reason for this inconsistency may be the potential moderating role of depressed mood. This study prospectively examined the role of depressed mood on the relationship between physical quality of life (PQoL) and smoking cessation among medically ill smokers. We hypothesized that poorer PQoL will be associated with smoking cessation, but only among those with little to no depressed mood. Nurses delivered smoking cessation counseling to medically ill patients (N = 273) who continued to smoke despite past hospitalization. Participants were assessed at baseline and at 2, 6, and 12-months later. The interaction between PQoL and depressed mood significantly predicted 1) 7-day point prevalence abstinence rates at both 2 and 12 months post-treatment [2 months: adjusted OR = 1.005, 95%CI 1.001-1.009, p < .05; 12 months: adjusted OR = 1.007, 95%CI 1.002-1.011, p < .005)] and 2) continuous abstinence rates at both 2 and 12 months post-treatment [2 months: adjusted OR = 1.011, 95%CI 1.004-1.019, p < .005; 12 months: adjusted OR = 1.006, 95%CI 1.001-1.011, p < .05] even after controlling for important covariates. The odds of quitting smoking increased for every one-unit decrease in PQoL, but only among those with little to no depressed mood. Medically ill smokers with poor quality of life may need more intensive smoking cessation interventions that include mood management to help them quit smoking.

  9. How does illness severity influence depression, health satisfaction and life satisfaction in patients with cardiovascular disease? The mediating role of illness perception and self-efficacy beliefs.

    PubMed

    Steca, P; Greco, A; Monzani, D; Politi, A; Gestra, R; Ferrari, G; Malfatto, G; Parati, G

    2013-01-01

    Numerous empirical studies have investigated the relationships between cardiovascular diseases (CVD) and patients' psychological well-being, with a focus almost exclusively on its dark side. Very little is known on the impact of illness severity on both negative and positive indicators of patients' well-being, as well as on the psychosocial variables that may mediate this association. Aim of the study was to investigate the impact of illness severity on depression as well as on health satisfaction and life satisfaction of patients undergoing a cardiovascular rehabilitation. It also aimed at testing the mediation of illness perception and self-efficacy beliefs in managing cardiac risk factors. The study involved 172 patients (mean age = 66.43 years; SD = 9.99 years; 76.2% men). Illness severity was measured in terms of left ventricular ejection fraction at discharge from the cardiology department, whereas all psychological dimensions were assessed one week later. Results showed significant relationships among illness severity, depression and health satisfaction that were fully mediated by illness perception and self-efficacy beliefs, but not significant relation between disease severity and life satisfaction (χ2 (1) = 2.30, p = n.s.). Overall, findings underline the importance of working on illness perception and self-efficacy beliefs to contrast depression and to improve health and life satisfaction in patients with CVD.

  10. Daylight saving time transitions and hospital treatments due to accidents or manic episodes

    PubMed Central

    Lahti, Tuuli A; Haukka, Jari; Lönnqvist, Jouko; Partonen, Timo

    2008-01-01

    Background Daylight saving time affects millions of people annually but its impacts are still widely unknown. Sleep deprivation and the change of circadian rhythm can trigger mental illness and cause higher accident rates. Transitions into and out of daylight saving time changes the circadian rhythm and may cause sleep deprivation. Thus it seems plausible that the prevalence of accidents and/or manic episodes may be higher after transition into and out of daylight saving time. The aim of this study was to explore the effects of transitions into and out of daylight saving time on the incidence of accidents and manic episodes in the Finnish population during the years of 1987 to 2003. Methods The nationwide data were derived from the Finnish Hospital Discharge Register. From the register we obtained the information about the hospital-treated accidents and manic episodes during two weeks before and two weeks after the transitions in 1987–2003. Results The results were negative, as the transitions into or out of daylight saving time had no significant effect on the incidence of accidents or manic episodes. Conclusion One-hour transitions do not increase the incidence of manic episodes or accidents which require hospital treatment. PMID:18302734

  11. Daylight saving time transitions and hospital treatments due to accidents or manic episodes.

    PubMed

    Lahti, Tuuli A; Haukka, Jari; Lönnqvist, Jouko; Partonen, Timo

    2008-02-26

    Daylight saving time affects millions of people annually but its impacts are still widely unknown. Sleep deprivation and the change of circadian rhythm can trigger mental illness and cause higher accident rates. Transitions into and out of daylight saving time changes the circadian rhythm and may cause sleep deprivation. Thus it seems plausible that the prevalence of accidents and/or manic episodes may be higher after transition into and out of daylight saving time. The aim of this study was to explore the effects of transitions into and out of daylight saving time on the incidence of accidents and manic episodes in the Finnish population during the years of 1987 to 2003. The nationwide data were derived from the Finnish Hospital Discharge Register. From the register we obtained the information about the hospital-treated accidents and manic episodes during two weeks before and two weeks after the transitions in 1987-2003. The results were negative, as the transitions into or out of daylight saving time had no significant effect on the incidence of accidents or manic episodes. One-hour transitions do not increase the incidence of manic episodes or accidents which require hospital treatment.

  12. Unrecognised bipolar disorder in primary care patients with depression.

    PubMed

    Smith, Daniel J; Griffiths, Emily; Kelly, Mark; Hood, Kerry; Craddock, Nick; Simpson, Sharon A

    2011-07-01

    Bipolar disorder is complex and can be difficult to diagnose. It is often misdiagnosed as recurrent major depressive disorder. We had three main aims. To estimate the proportion of primary care patients with a working diagnosis of unipolar depression who satisfy DSM-IV criteria for bipolar disorder. To test two screening instruments for bipolar disorder (the Hypomania Checklist (HCL-32) and Bipolar Spectrum Diagnostic Scale (BSDS)) within a primary care sample. To assess whether individuals with major depressive disorder with subthreshold manic symptoms differ from those individuals with major depressive disorder but with no or little history of manic symptoms in terms of clinical course, psychosocial functioning and quality of life. Two-phase screening study in primary care. Three estimates of the prevalence of undiagnosed bipolar disorder were obtained: 21.6%, 9.6% and 3.3%. The HCL-32 and BSDS questionnaires had quite low positive predictive values (50.0 and 30.1% respectively). Participants with major depressive disorder and with a history of subthreshold manic symptoms differed from those participants with no or little history of manic symptoms on several clinical features and on measures of both psychosocial functioning and quality of life. Between 3.3 and 21.6% of primary care patients with unipolar depression may have an undiagnosed bipolar disorder. The HCL-32 and BSDS screening questionnaires may be more useful for detecting broader definitions of bipolar disorder than DSM-IV-defined bipolar disorder. Subdiagnostic features of bipolar disorder are relatively common in primary care patients with unipolar depression and are associated with a more morbid course of illness. Future classifications of recurrent depression should include dimensional measures of bipolar symptoms.

  13. A regressional analysis of maladaptive rumination, illness perception and negative emotional outcomes in Asian patients suffering from depressive disorder.

    PubMed

    Lu, Yanxia; Tang, Catherine; Liow, Chiew Shan; Ng, Winnie Wei Ni; Ho, Cyrus Su Hui; Ho, Roger Chun Mun

    2014-12-01

    Although illness perception has been shown to be associated with illness outcomes in various chronic physical diseases, the association of illness perception and rumination are not well elucidated in mental disorders. This study aims to investigate the mediational effects of adaptive and maladaptive rumination in the relationship between illness perception and negative emotions (depression, anxiety and stress) in male and female patients (N=110) suffering from depressive disorders. The results showed that maladaptive rumination mediated the relationship between illness perception and negative emotions in both male and female depressive patients. However, no mediating effects of adaptive rumination were found in the relationship between illness perception and negative emotion. Maladaptive rumination mediated the relationship between perceived identity, chronicity of illness, consequences of illness and emotional representation of illness and negative emotions in males. It also mediated the relationship between perceived identity and emotional representation of illness and negative emotions in females. The results, possible clinical implications and limitations of this study are also discussed. Copyright © 2014 Elsevier B.V. All rights reserved.

  14. Novel Therapeutic Approaches for the Treatment of Depression and Cognitive Deficits in a Rodent Model of Gulf War Veterans Illness

    DTIC Science & Technology

    2015-10-01

    1 AWARD NUMBER: W81XWH-14-1-0478 TITLE: Novel Therapeutic Approaches for the Treatment of Depression and Cognitive Deficits in a Rodent Model...the Treatment of Depression and Cognitive Deficits in a Rodent Model of Gulf War Veterans’ Illness 5b. GRANT NUMBER W81XWH-14-1-0478 5c...of GWI neurological symptoms and screen effective treatment of GWIs. 15. SUBJECT TERMS Gulf War Illness, Organophosphate, diisopropyl fluorophosphate

  15. Daily electronic monitoring of subjective and objective measures of illness activity in bipolar disorder using smartphones--the MONARCA II trial protocol: a randomized controlled single-blind parallel-group trial.

    PubMed

    Faurholt-Jepsen, Maria; Vinberg, Maj; Frost, Mads; Christensen, Ellen Margrethe; Bardram, Jakob; Kessing, Lars Vedel

    2014-11-25

    Patients with bipolar disorder often show decreased adherence with mood stabilizers and frequently interventions on prodromal depressive and manic symptoms are delayed. Recently, the MONARCA I randomized controlled trial investigated the effect of electronic self-monitoring using smartphones on depressive and manic symptoms. The findings suggested that patients using the MONARCA system had more sustained depressive symptoms than patients using a smartphone for normal communicative purposes, but had fewer manic symptoms during the trial. It is likely that the ability of these self-monitored measures to detect prodromal symptoms of depression and mania may be insufficient compared to automatically generated objective data on measures of illness activity such as phone usage, social activity, physical activity, and mobility. The Monsenso system, for smartphones integrating subjective and objective measures of illness activity was developed and will be tested in the present trial. The MONARCA II trial uses a randomized controlled single-blind parallel-group design. Patients with bipolar disorder according to ICD-10 who previously have been treated at the Copenhagen Clinic for Affective Disorder, Denmark are included and randomized to either daily use of the Monsenso system including an feedback loop between patients and clinicians (the intervention group) or to the use of a smartphone for normal communicative purposes (the control group) for a 9-month trial period. The trial was started in September 2014 and recruitment is ongoing. The outcomes are: differences in depressive and manic symptoms; rate of depressive and manic episodes (primary); automatically generated objective data on measures of illness activity; number of days hospitalized; psychosocial functioning (secondary); perceived stress; quality of life; self-rated depressive symptoms; self-rated manic symptoms; recovery; empowerment and adherence to medication (tertiary) between the intervention group and the

  16. Symposium on Age Differentiation in Depressive Illness. Depression in the Elderly

    ERIC Educational Resources Information Center

    Epstein, Leon J.

    1976-01-01

    It is important that the clinician who treats older patients be aware that depression is the psychiatric symptom often encountered in the elderly and that it is as distressing in this age group as it is in younger persons. It often is reversible with prompt and appropriate treatment. (Author)

  17. Assessment of illness acceptance by patients with COPD and the prevalence of depression and anxiety in COPD

    PubMed Central

    Uchmanowicz, Izabella; Jankowska-Polanska, Beata; Motowidlo, Urszula; Uchmanowicz, Bartosz; Chabowski, Mariusz

    2016-01-01

    Background COPD is a civilization disease. It affects up to 8%–10% of population >30 years of age. Coexistence of depression occurs in 20%–40% of patients with COPD. Depression and anxiety reduce compliance and worsen prognosis. Objective The aims of this study were to determine the degree of illness acceptance among patients with COPD, to examine the relation between disease acceptance and perceived anxiety and depression, and to verify which of the sociodemographic and clinical factors are associated with illness acceptance, anxiety, and depression. Materials and methods The study included 102 patients with COPD (mean age 65.8 years), hospitalized due to exacerbations. Acceptance of Illness Scale and Hospital Anxiety and Depression Scale were used. For statistical analysis, Student’s t-test and Pearson’s r correlation coefficient were carried out. Results The overall illness acceptance level was moderate with a tendency toward lack of acceptance (mean 20.6, standard deviation [SD] 7.62). The overall scores were 10.2 (SD 3.32) for anxiety and 10.8 (SD 4.14) for depression, which indicate borderline or high intensity of these symptoms. Acceptance of illness was negatively correlated with the intensity of depression symptoms (r=−0.46, P<0.05). Intensity of depression was significantly associated with intensity of smoking, duration of the disease, severity of dyspnea, and living in a rural area. Conclusion Early identification and assessment of depression and anxiety symptoms allow health care providers to offer patients at risk of depression a special medical supervision. Rapid start of antidepressant therapy may increase illness acceptance and improve prognosis among patients with COPD. PMID:27274217

  18. Assessment of illness acceptance by patients with COPD and the prevalence of depression and anxiety in COPD.

    PubMed

    Uchmanowicz, Izabella; Jankowska-Polanska, Beata; Motowidlo, Urszula; Uchmanowicz, Bartosz; Chabowski, Mariusz

    2016-01-01

    COPD is a civilization disease. It affects up to 8%-10% of population >30 years of age. Coexistence of depression occurs in 20%-40% of patients with COPD. Depression and anxiety reduce compliance and worsen prognosis. The aims of this study were to determine the degree of illness acceptance among patients with COPD, to examine the relation between disease acceptance and perceived anxiety and depression, and to verify which of the sociodemographic and clinical factors are associated with illness acceptance, anxiety, and depression. The study included 102 patients with COPD (mean age 65.8 years), hospitalized due to exacerbations. Acceptance of Illness Scale and Hospital Anxiety and Depression Scale were used. For statistical analysis, Student's t-test and Pearson's r correlation coefficient were carried out. The overall illness acceptance level was moderate with a tendency toward lack of acceptance (mean 20.6, standard deviation [SD] 7.62). The overall scores were 10.2 (SD 3.32) for anxiety and 10.8 (SD 4.14) for depression, which indicate borderline or high intensity of these symptoms. Acceptance of illness was negatively correlated with the intensity of depression symptoms (r=-0.46, P<0.05). Intensity of depression was significantly associated with intensity of smoking, duration of the disease, severity of dyspnea, and living in a rural area. Early identification and assessment of depression and anxiety symptoms allow health care providers to offer patients at risk of depression a special medical supervision. Rapid start of antidepressant therapy may increase illness acceptance and improve prognosis among patients with COPD.

  19. Illness Progression, Recent Stress and Morphometry of Hippocampal Subfields and Medial Prefrontal Cortex in Major Depression

    PubMed Central

    Treadway, Michael T.; Waskom, Michael L.; Dillon, Daniel G.; Holmes, Avram J.; Park, Min Tae M.; Chakravarty, M. Mallar; Dutra, Sunny J.; Polli, Frida E.; Iosifescu, Dan V.; Fava, Maurizio; Gabrieli, John D.E.; Pizzagalli, Diego A.

    2014-01-01

    Background Longitudinal studies of illness progression in Major Depressive Disorder (MDD) indicate that the onset of subsequent depressive episodes becomes increasingly decoupled from external stressors. A possible mechanism underlying this phenomenon is that multiple episodes induce long-lasting neurobiological changes that confer increased risk for recurrence. Prior morphometric studies have frequently reported volumetric reductions in MDD—especially in medial prefrontal cortex (mPFC) and the hippocampus— but few studies have investigated whether these changes are exacerbated by prior episodes. Methods We used structural magnetic resonance imaging (sMRI) to examine relationships between number of prior episodes, current stress, and brain volume and cortical thickness in a sample of 103 medication-free depressed patients and never-depressed controls. Volumetric analyses of the hippocampus were performed using a recently-validated subfield segmentation approach, while cortical thickness estimates were obtained using Vertex-Based Cortical Thickness (VBCT). Participants were grouped on the basis of the number of prior depressive episodes as well as current depressive state. Results Number of prior episodes was associated with both lower reported stress levels as well as reduced volume in the dentate gyrus. Cortical thinning of the left medial prefrontal cortex (mPFC) was associated with a greater number of prior depressive episodes, but not current depressive state. Conclusions Collectively, these findings are consistent with preclinical models suggesting that the dentate gyrus and mPFC are especially vulnerable to stress exposure, and provide evidence for morphometric changes that are consistent with stress-sensitization models of recurrence in MDD. PMID:25109665

  20. Depression predicts future emergency hospital admissions in primary care patients with chronic physical illness.

    PubMed

    Guthrie, Elspeth A; Dickens, Chris; Blakemore, Amy; Watson, Jennifer; Chew-Graham, Carolyn; Lovell, Karina; Afzal, Cara; Kapur, Navneet; Tomenson, Barbara

    2016-03-01

    More than 15 million people currently suffer from a chronic physical illness in England. The objective of this study was to determine whether depression is independently associated with prospective emergency hospital admission in patients with chronic physical illness. 1860 primary care patients in socially deprived areas of Manchester with at least one of four exemplar chronic physical conditions completed a questionnaire about physical and mental health, including a measure of depression. Emergency hospital admissions were recorded using GP records for the year before and the year following completion of the questionnaire. The numbers of patients who had at least one emergency admission in the year before and the year after completion of the questionnaire were 221/1411 (15.7%) and 234/1398 (16.7%) respectively. The following factors were independently associated with an increased risk of prospective emergency admission to hospital: having no partner (OR 1.49, 95% CI 1.04 to 2.15); having ischaemic heart disease (OR 1.60, 95% CI 1.04 to 2.46); having a threatening experience (OR 1.16, 95% CI 1.04 to 1.29); depression (OR 1.58, 95% CI 1.04 to 2.40); and emergency hospital admission in the year prior to questionnaire completion (OR 3.41, 95% CI 1.98 to 5.86). To prevent potentially avoidable emergency hospital admissions, greater efforts should be made to detect and treat co-morbid depression in people with chronic physical illness in primary care, with a particular focus on patients who have no partner, have experienced threatening life events, and have had a recent emergency hospital admission. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

  1. Depression predicts future emergency hospital admissions in primary care patients with chronic physical illness

    PubMed Central

    Guthrie, Elspeth A.; Dickens, Chris; Blakemore, Amy; Watson, Jennifer; Chew-Graham, Carolyn; Lovell, Karina; Afzal, Cara; Kapur, Navneet; Tomenson, Barbara

    2016-01-01

    Objective More than 15 million people currently suffer from a chronic physical illness in England. The objective of this study was to determine whether depression is independently associated with prospective emergency hospital admission in patients with chronic physical illness. Method 1860 primary care patients in socially deprived areas of Manchester with at least one of four exemplar chronic physical conditions completed a questionnaire about physical and mental health, including a measure of depression. Emergency hospital admissions were recorded using GP records for the year before and the year following completion of the questionnaire. Results The numbers of patients who had at least one emergency admission in the year before and the year after completion of the questionnaire were 221/1411 (15.7%) and 234/1398 (16.7%) respectively. The following factors were independently associated with an increased risk of prospective emergency admission to hospital: having no partner (OR 1.49, 95% CI 1.04 to 2.15); having ischaemic heart disease (OR 1.60, 95% CI 1.04 to 2.46); having a threatening experience (OR 1.16, 95% CI 1.04 to 1.29); depression (OR 1.58, 95% CI 1.04 to 2.40); and emergency hospital admission in the year prior to questionnaire completion (OR 3.41, 95% CI 1.98 to 5.86). Conclusion To prevent potentially avoidable emergency hospital admissions, greater efforts should be made to detect and treat co-morbid depression in people with chronic physical illness in primary care, with a particular focus on patients who have no partner, have experienced threatening life events, and have had a recent emergency hospital admission. PMID:26919799

  2. Central Diabetes Insipidus presenting with manic symptoms.

    PubMed

    Sachdeva, Jasmine Kaur; Chalana, Harsh

    2011-09-01

    Central Diabetes Insipidus mostly presents with polydipsia and polyuria but may also present with confusion, psychosis, seizure or coma. We present a case of Central Diabetes Insipidus presenting with manic symptoms. A 21 year old Indian male had Central Diabetes Insipidus, which was confirmed by water deprivation test. He presented to our hospital with full blown manic symptoms meeting the ICD 10 criteria. He was managed with intranasal Desmopressin, water restriction and Olanzapine. In contrary to routine psychiatric patients which may present with psychogenic polydipsia or Central Diabetes Insipidus patients presenting in delirium or psychosis, our case presents a unique example of Central Diabetes Insipidus presenting with manic symptoms. It hints about a relationship between a common pathway for Central Diabetes Insipidus and mood disorders which needs further research. Diencephalon has already been the focus of attention for several researchers but no concrete evidence is available yet. Copyright © 2011 Elsevier B.V. All rights reserved.

  3. Depression.

    ERIC Educational Resources Information Center

    Strock, Margaret

    Approximately ten percent of the population suffers from a depressive illness each year. Although the economic cost is high, the cost in human suffering is immeasurable. To help educate the population about this disorder, this paper presents a definition of depression and its common manifestations. The symptoms that people often experience are…

  4. The Impact of Group-as-a-Whole Work on Anxiety and Depression in a Severely Mentally Ill Population

    ERIC Educational Resources Information Center

    Semmelhack, Diana J.; Hazell, Clive; Hoffman, William

    2008-01-01

    This study explored the impact of a group-as-a-whole processing group on 11 severely mentally ill adult clients residing in a long term care facility over 30 weeks. Participants were evaluated for the effect of the group on anxiety and depression, using the Beck Depression Index (BDI-II) and the Beck Anxiety Index (BAI). This longitudinal study…

  5. Altered empathic responding in major depressive disorder: relation to symptom severity, illness burden, and psychosocial outcome.

    PubMed

    Cusi, Andrée M; Macqueen, Glenda M; Spreng, R Nathan; McKinnon, Margaret C

    2011-07-30

    Individuals with major depressive disorder (MDD) demonstrate deficits in multiple social cognitive domains; however, systematic investigations of empathic responding have not been performed. Twenty patients with MDD completed two measures of empathy, the Interpersonal Reactivity Index (IRI: Davis, 1980, 1983) and the Toronto Empathy Questionnaire (TEQ: Spreng et al., 2009). Relative to matched controls, patients with MDD reported significantly reduced levels of empathy measured broadly on the TEQ and specifically in cognitive ('Perspective Taking') and affective ('Empathic Concern') domains captured by the IRI. A higher illness burden (i.e., greater number of past depressive episodes) was associated with greater reductions in perspective taking ability. This study provides early evidence of impaired empathic abilities in patients with MDD that may worsen with illness progression. Alternatively, reductions in perspective taking ability may contribute to a more severe course of illness in this population. Further longitudinal work is needed to characterize the relation between social cognitive performance and social functioning in this population. Copyright © 2011. Published by Elsevier Ireland Ltd.

  6. May duration of untreated illness influence the long-term course of major depressive disorder?

    PubMed

    Altamura, A Carlo; Dell'osso, Bernardo; Vismara, Serena; Mundo, Emanuela

    2008-03-01

    The aim of this naturalistic study was to investigate the possible influence of the duration of untreated illness (DUI) on the long-term course of Major Depressive Disorder (MDD). One hundred and thirteen patients with recurrent MDD, according to DSM-IV-TR criteria, followed up for 5 years, were selected, interviewed and their clinical charts were reviewed. The DUI was defined as the interval between the onset of the first depressive episode and the first adequate antidepressant treatment. The sample was divided into two groups according to the DUI: one group with a DUI12 months (n=38). The main demographic and clinical course variables were compared between the two groups using Student's t-tests or chi-square tests. Patients with a longer DUI showed an earlier age at onset (t=2.82, p=0.006) and a longer duration of illness (t=3.20, p=0.002) compared to patients with a shorter DUI. In addition, the total number of depressive episodes occurring before the first antidepressant treatment was higher in the group with a longer DUI (t=-2.223, p<0.03). Even though limited by the retrospective nature of the study, these preliminary findings would suggest that a longer DUI may negatively influence the course of MDD. Larger prospective studies are warranted to further investigate the role of the DUI within MDD.

  7. Time and life perception in the terminally ill: its utility in screening for depression.

    PubMed

    Julião, Miguel; Oliveira, Fátima; Nunes, Baltazar; Barbosa, António

    2013-11-01

    The objective was to explore the utility of a new three-item depression screening tool concerning time and life perception (TLP-3), compared with the DSM-IV criteria. This was a cross-sectional study of 63 Portuguese terminally ill patients, from May 2010 to November 2012. Patients were eligible if they fulfilled the following inclusion criteria: age ≥18 years old; having a life-threatening disease with prognosis of 6 months or less; no evidence of dementia or delirium, based on documentation within the medical chart or by clinical consensus; Mini Mental State score ≥20; being able to read and speak Portuguese; and provision of written informed consent. Participants were assessed for depression using DSM-IV criteria and the newly developed TLP-3. Screening performance for depression using the TLP-3 compared with DSM-IV was calculated using measures of sensitivity, specificity, positive and negative predictive values. Logistic regression was calculated with the aim of identifying variables with the best predictive ability for diagnosing depression. After logistic regression analysis was made to all three items composing TLP-3, only two items were maintained (OR=2.9, 95% CI [0.9-8.7]; OR=7.6, 95% CI [0.9-65.3], respectively). This final regression model composed of two questions (TLP-2) was able to diagnose correctly 70% of the depressed patients with a sensitivity of 63% and a specificity of 74%. The area under the ROC curve was 72% (95% CI [59-85]). TLP-3 is a novel and clinically applicable approach to assessing depression among palliative care patients. Further investigation is needed on the psychological significance of time and life perception distortions, and its possible application to screen for depression among patients nearing end of life.

  8. Psychosocial Risk Factors for Upper Respiratory Infection: Depression as a Mediator of Associations between Neuroticism and Upper Respiratory Illness

    DTIC Science & Technology

    1989-03-31

    8217•,Ij F11LE Copy • PSYCHOSOCIAL RISK FACTORS FOR UPPER RESPIRATORY INFECTION: DEPRESSION AS A MEDIATOR OF ASSOCIATIONS C14 BETWEEN NEUROTlClSM AND S... Factors for Upper Respiratory Infection: DEPRESSION AS A MEDIATOR OF ASSOCIATIONS BETWEEN NEUROTICISM AND UPPER RESPIRATORY ILLNESS I jlI Ross R...indicators of situational depression . Factor analyses of the CES-D in samples of the general U. S. civilian pcpulation typically identify 3 or 4 basic

  9. Prevalence of depression and its associated factors among primary caregivers of patients with severe mental illness in southwest, Ethiopia.

    PubMed

    Derajew, Habtamu; Tolessa, Daniel; Feyissa, Garumma Tolu; Addisu, Fikir; Soboka, Matiwos

    2017-03-09

    Depression is a serious mental illness that affects patients' treatment outcome and caregiver's day to day life. The prevalence of depression among caregivers of patients with severe mental illness is greater than the general population. Little is known about depression among primary caregivers of patients with severe mental illness in Ethiopia. This study is aimed at assessing prevalence of depression and associated factors among primary caregivers of patients with mental illness. A cross-sectional study was conducted among primary caregivers of patients with severe mental illness in Jimma University Teaching Hospital. Patient health questionnaire (PHQ-9) was used to assess depression. A multidimensional scale of perceived social support (MSPSS) was used to assess perceived social support; Cut down, Annoyed, Guilty, Eye opener (CAGE) scale was used to assess alcohol use disorder. After conducting descriptive analyses, logistic regression analysis was finally used for bivariate and multivariable analysis. The overall prevalence of depression among primary caregivers of patients with mental illness was 12 (19%). Out of those caregivers with depressions, 11.3, 3.5 and 4.2% had moderate, moderately severe and severe types of depression respectively. The prevalence of depression among female primary caregivers was 25% (n = 40). Being single (aOR 2.62, 95% CI = 1.07, 6.41), giving care more than six hours per day (aOR 3.75, 95% CI = 1.51, 9.33) and caring for a patient who had more than once episodes of suicidal attempts (aOR 1.48, 95% CI = 1.07, 3.42) were positively associated with depression among caregivers of patients with mental illness. We found that the prevalence of depression among primary caregivers was high. Depression among caregivers was associated with giving care more than six hours per day and caring for a patient who had two or more episodes of suicidal attempts. The prevalence of depression among female caregivers was higher than that

  10. Substance use disorders in schizophrenia, bipolar disorder, and depressive illness: a registry-based study.

    PubMed

    Nesvåg, Ragnar; Knudsen, Gun Peggy; Bakken, Inger Johanne; Høye, Anne; Ystrom, Eivind; Surén, Pål; Reneflot, Anne; Stoltenberg, Camilla; Reichborn-Kjennerud, Ted

    2015-08-01

    To compare the prevalence and pattern of comorbid substance use disorders (SUD) between patients with schizophrenia, bipolar disorder, and depressive illness. Data on presence of alcohol use disorder (AUD) and non-alcohol drug use disorder (DUD) were retrieved from the Norwegian Patient Register for individuals born between 1950 and 1989 who in the period 2009-2013 were diagnosed with schizophrenia, bipolar disorder or depressive illness according to the 10th version of the WHO International Classification of Diseases. The prevalence of AUD only, DUD only, or both was compared between men and women across age and diagnostic groups. The prevalence of SUD was 25.1 % in schizophrenia (AUD: 4.6 %, DUD: 15.6 %, AUD and DUD: 4.9 %), 20.1 % in bipolar disorder (AUD: 8.1 %, DUD: 7.6 %, AUD and DUD: 4.4 %), and 10.9 % in depressive illness (AUD: 4.4 %, DUD: 4.3 %, AUD and DUD: 2.2 %). Middle-aged men with bipolar disorder had the highest prevalence of AUD (19.1 %) and young men with schizophrenia had the highest prevalence of DUD (29.6 %). Of the specific DUDs, all but sedative use disorder were more prevalent in schizophrenia than the other groups. Cannabis and stimulant use disorder was found among 8.8 and 8.9 %, respectively, of the men with schizophrenia. The alarmingly high prevalence of DUD among young patients with severe mental disorders should encourage preventive efforts to reduce illicit drug use in the adolescent population.

  11. Neurocognitive impairment in adolescent major depressive disorder: state vs. trait illness markers.

    PubMed

    Maalouf, Fadi T; Brent, David; Clark, Luke; Tavitian, Lucy; McHugh, Rebecca Munnell; Sahakian, Barbara J; Phillips, Mary L

    2011-10-01

    Current treatment outcomes of Major Depressive Disorder (MDD) in adolescents remain suboptimal. Discriminating between state and trait markers of MDD in adolescents would help identify markers that may guide choice of appropriate interventions and help improve longer-term outcome for individuals with the illness. We compared neurocognitive performance in executive function, sustained attention and short-term memory in 20 adolescents with MDD in acute episode (MDDa), 20 previously depressed adolescents in remission (MDDr) and 17 healthy control participants (HC). There was a group difference that emerged for executive function with increasing task difficulty (p=0.033). MDDa showed impaired executive function, as measured by using more moves to solve 4-move problems on a forward planning task, relative to MDDr and HC (p=0.01, d=0.94 and p=0.015, d=0.77 respectively). MDDa showed more impulsivity as measured by lower response bias (B″) on a sustained attention task than both MDDr and HC (p=0.01, d=0.85 and p=0.008, d=0.49 respectively). Higher impulsivity was associated with more severe depression (r=-0.365, p=0.022) and earlier age of onset of depression (r=0.402, p=0.012) and there was a trend for a correlation between more executive dysfunction and more severe depression (r=0.301 p=0.059) in MDDa and MDDr combined. The three groups did not differ significantly on short-term memory or target detection on the sustained attention task. These results need to be replicated in the future with a larger sample size. Executive dysfunction and impulsivity appear to be state-specific markers of MDD in adolescents that are related to depression severity and not present in remission. Copyright © 2011 Elsevier B.V. All rights reserved.

  12. Coping Style and Depressive Symptoms in Family Decision Makers of the Chronically Critically Ill

    PubMed Central

    Hickman, Ronald L.; Daly, Barbara J.; Douglas, Sara L.; Clochesy, John M.

    2011-01-01

    BACKGROUND Overwhelmed family decision makers (FDMs) of the chronically critically ill (CCI) must receive and comprehend vital information to make complex treatment decisions that are consistent with the patient’s preferences. Exploration of informational coping styles (ICS) of FDMs may result in evidence for tailored communication practices supporting psychological and informational needs of these vulnerable family members. OBJECTIVES The aims of this study were to describe patterns of FDM demographic characteristics and ICS, to assess differences in informational satisfaction, role stress, and depressive symptoms between FDMs classified as monitors and blunters, and to describe the predictive associations between ICS, informational satisfaction, and role stress on depressive symptoms in FDMs. METHODS A secondary data analysis of 210 FDMs of cognitively impaired patients who required ≥ 3 days of mechanical ventilation. On enrollment FDMs completed the abbreviated Miller Behavioral Style Scale to assess ICS, the Critical Care Family Satisfaction Survey’s informational sub-scale to assess informational satisfaction, a single-item measure of role stress, and the Center for Epidemiological Studies Depression (CES-D) scale to assess depressive symptoms. RESULTS No associations emerged between FDM demographic characteristics and ICS. FDMs classified as monitors had higher CES-D scores compared to blunters. Both information coping style and informational satisfaction had influence on depressive symptoms, however role stress was the most significant predictor. CONCLUSIONS FDMs who were classified as monitors were at higher risk for depression than those who appear to avoid information. Targeting FDMs who are monitors with additional psychological and informational support may mitigate their psychological impairment. PMID:20810416

  13. 'It was all intertwined': Illness representations and self-management in patients with cancer and anxiety/depression.

    PubMed

    Richardson, Emma M; Scott, Jennifer L; Schüz, Natalie; Sanderson, Kristy; Schüz, Benjamin

    2017-09-01

    Cancer and anxiety/depression frequently co-occur, leading to poorer outcomes for these illnesses. However, the majority of existing research investigates how participants view single illnesses alone. This study aimed to explore the content of individuals' multimorbid representations and how these relate to their coping behaviours and self-management strategies for cancer and anxiety/depression. A semi-structured qualitative research design with theoretical thematic analysis. Multimorbid illness representations, coping behaviours, and self-management strategies. In interviews with 21 participants multimorbid representations varied, three participants viewed cancer and anxiety/depression as unrelated, five participants were uncertain about the relationship between cancer and anxiety/depression, and the majority of participants perceived cancer and anxiety/depression as related. This third group of participants often described relationships as causal, with representations having both positive and negative influences on coping behaviours and self-management strategies. Representations were shown to change over the course of the cancer experience, with fear of cancer recurrence and the influence of participants' most challenging illness also discussed. People hold multimorbid illness representations that can influence self-management. An awareness of these representations by researchers, health professionals, and patients is important for the creation of future interventions that aim to improve and maintain patient wellbeing.

  14. Gratitude uniquely predicts lower depression in chronic illness populations: A longitudinal study of inflammatory bowel disease and arthritis.

    PubMed

    Sirois, Fuschia M; Wood, Alex M

    2017-02-01

    Although gratitude has been identified as a key clinically relevant trait for improving well-being, it is understudied within medical populations. The current study addressed this gap and extended previous and limited cross-sectional research by examining the longitudinal associations of gratitude to depression in 2 chronic illness samples, arthritis and inflammatory bowel disease (IBD). Two chronic illness samples, arthritis (N = 423) and IBD (N = 427), completed online surveys at Time 1 (T1). One hundred sixty-three people with arthritis and 144 people with IBD completed the 6-month follow-up survey (T2). Depression, gratitude, illness cognitions, perceived stress, social support, and disease-related variables were assessed at T1 and T2. At T2, 57.2% of the arthritis sample and 53.4% of the IBD sample met the cut off scores for significant depression. T1 gratitude was negatively associated with depressive symptoms at T1 and T2 in both samples (rs from -.43 to -.50). Regression analyses revealed that T1 gratitude remained a significant and unique predictor of lower T2 depression after controlling for T1 depression, relevant demographic variables, illness cognitions, changes in illness-relevant variables, and another positive psychological construct, thriving, in both samples. As the first investigation of the longitudinal associations of gratitude to psychological well-being in the context of chronic illness, the current study provides important evidence for the relevance of gratitude for health-related clinical populations. Further intervention-based research is warranted to more fully understand the potential benefits of gratitude for adjustment to chronic illness. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

  15. Older Persons' Experiences of Depressive Ill-Health and Family Support

    PubMed Central

    Lyberg, Anne; Holm, Anne Lise; Lassenius, Erna; Berggren, Ingela; Severinsson, Elisabeth

    2013-01-01

    The aim of this study was to explore experiences of the meaning of family support among older persons with depressive ill-health. Data were collected from twenty-nine participants through semistructured interviews and analysed using interpretative hermeneutic and reflective methodology. The findings revealed a main theme, hovering between feelings of belongingness and aloneness in relationships with family members, based on two themes: a sense of being worthy and a sense of being unworthy. Experiences of support and lack of support from family members were not opposites but connected in internal relationships and can be pictured as a movement on a continuum of ambiguity. Family support promotes the emotional needs of older persons with depressive ill-health to be confirmed. The family plays a vital role, not always by direct assistance, but indirectly by supporting the older person's own “guiding principles” for managing her/his situation. The feelings of aloneness as well as shame and guilt at poor or absent family responsiveness should be adequately addressed. Innovative nursing care can lead to improvement by focusing on acquiescence to the older person's life situation. PMID:24078871

  16. Extreme Attributions Predict Transition from Depression to Mania or Hypomania in Bipolar Disorder

    PubMed Central

    Stange, Jonathan P.; Sylvia, Louisa G.; Magalhães, Pedro Vieira da Silva; Frank, Ellen; Otto, Michael W.; Miklowitz, David J.; Berk, Michael; Nierenberg, Andrew A.; Deckersbach, Thilo

    2013-01-01

    Background Relatively little is known about psychological predictors of the onset of mania among individuals with bipolar disorder, particularly during episodes of depression. In the present study we investigated attributional style as a predictor of onset of hypomanic, manic or mixed episodes among bipolar adults receiving psychosocial treatment for depression. We hypothesized that “extreme” (i.e., excessively pessimistic or optimistic) attributions would predict a greater likelihood of developing an episode of mood elevation. Method Outpatients with DSM-IV bipolar I or II disorder (N=105) enrolled in the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) were randomly allocated to one of three types of intensive psychotherapy for depression or a brief psychoeducational intervention. Patients completed a measure of attributional style at baseline and were followed prospectively for up to one year. All analyses were by intent to treat. Results Logistic regressions and Cox proportional hazards models indicated that extreme (both positively- and negatively-valenced) attributions predicted a higher likelihood of (and shorter time until) transition from depression to a (hypo)manic or mixed episode (ps < .04), independent of the effects of manic or depressive symptom severity at baseline. Extreme attributions were also retrospectively associated with more lifetime episodes of (hypo)mania and depression (ps < .05). Conclusions Evaluating extreme attributions may help clinicians to identify patients who are at risk for experiencing a more severe course of bipolar illness, and who may benefit from treatments that introduce greater cognitive flexibility. PMID:23791456

  17. Extreme attributions predict transition from depression to mania or hypomania in bipolar disorder.

    PubMed

    Stange, Jonathan P; Sylvia, Louisa G; Magalhães, Pedro Vieira da Silva; Frank, Ellen; Otto, Michael W; Miklowitz, David J; Berk, Michael; Nierenberg, Andrew A; Deckersbach, Thilo

    2013-10-01

    Relatively little is known about psychological predictors of the onset of mania among individuals with bipolar disorder, particularly during episodes of depression. In the present study we investigated attributional style as a predictor of onset of hypomanic, manic or mixed episodes among bipolar adults receiving psychosocial treatment for depression. We hypothesized that "extreme" (i.e., excessively pessimistic or optimistic) attributions would predict a greater likelihood of developing an episode of mood elevation. Outpatients with DSM-IV bipolar I or II disorder (N = 105) enrolled in the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) were randomly allocated to one of three types of intensive psychotherapy for depression or a brief psychoeducational intervention. Patients completed a measure of attributional style at baseline and were followed prospectively for up to one year. All analyses were by intent to treat. Logistic regressions and Cox proportional hazards models indicated that extreme (both positively- and negatively-valenced) attributions predicted a higher likelihood of (and shorter time until) transition from depression to a (hypo)manic or mixed episode (ps < .04), independent of the effects of manic or depressive symptom severity at baseline. Extreme attributions were also retrospectively associated with more lifetime episodes of (hypo)mania and depression (ps < .05). Evaluating extreme attributions may help clinicians to identify patients who are at risk for experiencing a more severe course of bipolar illness, and who may benefit from treatments that introduce greater cognitive flexibility. Copyright © 2013 Elsevier Ltd. All rights reserved.

  18. The manic phase of Bipolar disorder significantly impairs theory of mind decoding.

    PubMed

    Hawken, Emily R; Harkness, Kate L; Lazowski, Lauren K; Summers, David; Khoja, Nida; Gregory, James Gardner; Milev, Roumen

    2016-05-30

    Bipolar disorder is associated with significant deficits in the decoding of others' mental states in comparison to healthy participants. However, differences in theory of mind decoding ability among patients in manic, depressed, and euthymic phases of bipolar disorder is currently unknown. Fifty-nine patients with bipolar I or II disorder (13 manic, 25 depressed, 20 euthymic) completed the "Reading the Mind in the Eyes" Task (Eyes task) and the Animals Task developed to control for non-mentalistic response demands of the Eyes Task. Patients also completed self-report and clinician-rated measures of depression, mania, and anxiety symptoms. Patients in the manic phase were significantly less accurate than those in the depressed and euthymic phases at decoding mental states in the Eyes task, and this effect was strongest for eyes of a positive or neutral valence. Further Eyes task performance was negatively correlated with the symptoms of language/thought disorder, pressured speech, and disorganized thoughts and appearance. These effects held when controlling for accuracy on the Animals task, response times, and relevant demographic and clinical covariates. Results suggest that the state of mania, and particularly psychotic symptoms that may overlap with the schizophrenia spectrum, are most strongly related to social cognitive deficits in bipolar disorder.

  19. Anxiety disorders, physical illnesses, and health care utilization in older male veterans with Parkinson disease and comorbid depression.

    PubMed

    Qureshi, Salah U; Amspoker, Amber B; Calleo, Jessica S; Kunik, Mark E; Marsh, Laura

    2012-12-01

    This study examined the rates of anxiety and depressive disorders, physical illnesses, and health service use in male patients 55 years or older with a diagnosis of Parkinson disease who were seen at least twice at the 10 medical centers in the Veterans Affairs Healthcare Network of the South Central region of the United States. Of the 273 male patients diagnosed between October 1, 1997, and September 30, 2009, 62 (22.7%) had a depressive disorder. The overall prevalence of anxiety disorders was 12.8%; patients with comorbid depression had a 5-fold greater prevalence of anxiety disorders than those without depression (35.5% vs 6.2%, P<.0001). Patients with comorbid depression also had increased prevalence of all physical illnesses examined and more outpatient clinic and mental health visits. Patients with Parkinson disease and comorbid depression are more likely to have anxiety disorders and several physical illnesses, to be using antipsychotic and dementia medicines, and to have increased health service utilization than those without depression.

  20. Mixed-state bipolar I and II depression: time to remission and clinical characteristics.

    PubMed

    Shim, In Hee; Woo, Young Sup; Jun, Tae-Youn; Bahk, Won-Myong

    2014-01-01

    We compared the time to achieve remission and the clinical characteristics of patients with bipolar depressive mixed state and those with bipolar depressive non-mixed state. The subjects (N=131) were inpatients diagnosed between 2006 and 2012 with bipolar I or II disorder, depression and were classified into the following three groups: "pure depressive state" (PD, n=70), "sub-threshold mixed state" (SMX, n=38), and "depressive mixed state" (DMX, n=23). Diagnosis of a DMX was in accordance with Benazzi's definition: three or more manic symptoms in a depressive episode. The subjects' charts were retrospectively reviewed to ascertain the time to achieve remission from the index episode and to identify other factors, such as demographic and clinical characteristics, specific manic symptoms, and pharmacological treatment, that may have contributed to remission. The time to achieve remission was significantly longer in the DMX (p=0.022) and SMX (p=0.035) groups than in the PD group. Adjustment for covariates using a Cox proportional hazards model did not change these results. Clinically, subjects with a DMX were more likely to have manic symptoms in the index episode, especially inflated self-esteem and psychomotor agitation than those in the PD. We investigated only inpatients and therefore could not comment on outpatients. These findings showed that sub-syndromal manic symptoms in bipolar depression had different clinical characteristics and a more severe illness course, including a longer time to achieve remission, than did a pure depressive state. © 2013 Elsevier B.V. All rights reserved.

  1. Open comparative randomised study of moclobemide versus amitriptyline in major depressive illness (DSM IIIR) in Nigeria.

    PubMed

    Ononye, F; Sijuola, O A; Chukwuani, C M; Mume, O C; Makanjuola, R O

    2000-01-01

    In a multi-centre study, 60 patients (20 males and 40 females aged 43 +/- 15 and 37 +/- 15 years respectively) with a DSM-IIIR diagnosis of major depressive disorders were randomly assigned to treatment with either Moclobemide (maximum dose 600 mg per day) or Amitriptyline (maximum dose 150 mg per day) for eight weeks. Patients were evaluated pretreatment and over the 8 weeks treatment period using Hamilton Depression Rating Scale (HDRS) and the clinical global impressions (CGI). The Adverse Drug Effects Schedule, clinical, haematological and biochemical status were also evaluated pre, during and post treatment. Of the 60 patients enrolled for the study 54 were found evaluable for efficacy whilst all 60 were evaluated for safety (Adverse Event). On the HDRS and CGI scale there was no significant difference in the therapeutic outcome between the two treatment groups. In the overall clinical assessment rating at the end of treatment 94.1% of patients in the Moclobemide group were rated 'very good to good' and 94.4% with Amitriptyline. Moclobemide appeared to have a slightly better safety profile, the incidence of adverse event was 9.0% compared to 19.0% with Amitriptyline. The drop out rate was 16.7% and 26.7% for moclobemide and amitriptyline respectively. These differences were however not statistically significant. It was therefore concluded that moclobemide is an effective and safe alternative to amitriptyline, with attractive potential for out patients management of depressive illness.

  2. Brief Report: Naturalistically Observed Swearing, Emotional Support and Depressive Symptoms in Women Coping with Illness

    PubMed Central

    Robbins, Megan L.; Focella, Elizabeth S.; Kasle, Shelley; López, Ana María; Weihs, Karen L.; Mehl, Matthias R.

    2011-01-01

    Objective The goal of this study was to explore the intra- and interpersonal consequences of swearing. Specifically, it investigated what implications swearing has for coping with and adjustment to illness. Methods The present project combined data from two pilot studies of 13 women with rheumatoid arthritis and 21 women with breast cancer. Participants wore the Electronically Activated Recorder (EAR), an unobtrusive observation sampling method that periodically records snippets of ambient sounds, on weekends to track spontaneous swearing in their daily interactions, and completed self-reported measures of depressive symptoms and emotional support. Results Naturalistically-observed swearing in the presence of others, but not alone, was related to decreases in reported emotional support and increases in depressive symptoms over the study period. Further, decreases in emotional support mediated the effect of swearing on disease-severity adjusted changes in depressive symptoms. Conclusion These exploratory results are consistent with the notion that swearing can sometimes repel emotional support at the expense of psychological adjustment. This is one of the first studies to examine the role of swearing, a ubiquitous but understudied psychological phenomenon, in a medical context. PMID:21574707

  3. Depression, anxiety and positive affect in people diagnosed with low-grade tumours: the role of illness perceptions.

    PubMed

    Keeling, Melanie; Bambrough, Jacki; Simpson, Jane

    2013-06-01

    People with low-grade brain tumour experience a range of emotional, behavioural and psychosocial consequences. Using Leventhal's self-regulation model to explore biopsychosocial factors associated with distress, we examine the relationships between illness perceptions, coping and depression, anxiety and positive affect. A cross-sectional, self-report study in which 74 people (54% women) diagnosed with a low-grade brain tumour completed the Illness Perceptions Questionnaire-Revised was conducted. Mean time since diagnosis was 27.69 months (SD = 19.79). Mean age was 38.30 years (SD = 10.67). The Illness Perceptions Questionnaire-Revised, in addition to clinical, demographic and coping variables previously associated with psychological distress, was used to predict three psychological outcomes: depression, anxiety and positive affect. Hierarchical multiple regression analyses demonstrated that a biopsychosocial causal attribution was a significant predictor of anxiety and depression. Illness identity also emerged as a significant predictor of depression scores. Coping through self-blame was the only coping variable to emerge as a significant predictor of anxiety scores. A combination of coping through venting, acceptance, positive reframing, denial, behavioural disengagement and self-blame contributed to the variance in all three psychological outcome scores. No illness perception variables significantly predicted positive affect. Illness perceptions play a significant role in emotional distress experienced by people with low-grade brain tumours. Illness perceptions did not play a significant role in positive affect. Coping variables were shown to significantly contribute to the scores on all three psychological outcomes. Results suggest interventions targeted at modifying illness perceptions and enhancing problem-focused coping strategies may reduce psychological distress. Copyright © 2012 John Wiley & Sons, Ltd.

  4. Developing a brief depression screen and identifying associations with comorbid physical and psychological illness in Australian Gulf War veterans.

    PubMed

    McKenzie, Dean P; Sim, Malcolm R; Clarke, David M; Forbes, Andrew B; Ikin, Jillian F; Kelsall, Helen L

    2015-12-01

    Major depression occurs frequently in veterans, and is associated with comorbid psychological and physical disorders and poorer quality of life. Depression can be difficult to detect in primary care, while lengthy assessment instruments can deter use. Our study aimed to develop a brief depression screen that could be used by veterans and caregivers, and then to compare the association between the brief screen and comorbidities and quality of life with that of a longer instrument. Our dataset comprised 1204 male Royal Australian Navy veterans of the 1990/91 Gulf War. Depressive symptoms were assessed using the General Health Questionnaire (GHQ-12), health-related quality of life by the Short-Form Health Survey (SF-12), major depression and comorbid psychiatric diagnoses such as posttraumatic disorder (PTSD) using Diagnostic and Statistical Manual (DSM-IV) criteria. Comorbid physical illnesses including musculoskeletal disorders, chronic fatigue and diabetes were examined. A brief depression screen of three key self-reported symptoms was identified. Veterans with major depression present according to the screen were over four times more likely to have multisymptom illness or PTSD, and almost twice as likely to have musculoskeletal disorders. Having depression according to the brief screen and having at least one other physical or psychological condition was associated with poorer quality of life. Similar results were obtained for a longer screen based on all GHQ-12 items. A 3 item depression screen performed as well as a 12 item one in identifying major depression, comorbid physical and psychological illness and poorer quality of life in veterans. Copyright © 2015 The Authors. Published by Elsevier Inc. All rights reserved.

  5. The effects of dehydroepiandrosterone (DHEA) in the treatment of depression and depressive symptoms in other psychiatric and medical illnesses: a systematic review.

    PubMed

    Peixoto, Clayton; Devicari Cheda, Julio Nelson; Nardi, Antonio Egidio; Veras, Andre Barciela; Cardoso, Adriana

    2014-01-01

    International interest on the benefits of using the steroid hormone Dehydroepiandrosterone (DHEA) on various aspects of human health, including the regulation of mood, is increasing. This study aimed to review the scientific literature on the use of DHEA in the treatment of depression and depressive symptoms in other psychiatric and medical illnesses. PubMed, ISI Web of Knowledge and Virtual Health Library (VHL) databases were independently searched by two researchers using the following terms: depression, treatment, DHEA, and mood. Clinical studies were considered eligible when subjects were treated with DHEA and psychological assessments of depression were conducted. No time limits or language for this research were imposed. One 183 references were identified, and 22 references were selected to compose this review. Significant improvements related to the use of DHEA in patients with depression were observed, in addition to improvements in depressive symptoms in patients with schizophrenia, anorexia nervosa, HIV and adrenal insufficiency. No significant improvements were observed regarding depressive symptoms in patients with fibromyalgia; the results observed in patients with autoimmune diseases and healthy individuals remain contradictory. Although the selected studies demonstrated good methodological applications, most studies consisted of small samples, and only 3 studies were conducted in a young population. Therefore, we concluded that the studies published to date indicate promising results regarding the use of DHEA in the treatment of depression and depressive symptoms, especially in depression that is mild or resistant to conventional therapy.

  6. Course and predictors of depressive symptoms among family caregivers of terminally ill cancer patients until their death.

    PubMed

    Tang, Siew Tzuh; Chang, Wen-Cheng; Chen, Jen-Shi; Wang, Hung-Ming; Shen, Wen Chi; Li, Chung-Yi; Liao, Yen-Chi

    2013-06-01

    Few studies have investigated the impact of providing end-of-life care on family caregivers' depressive symptoms over time, especially until the patient's death. The purpose of this study was to identify the course and predictors of depressive symptoms in caregivers of terminally ill cancer patients until they died. For this prospective, longitudinal study of 193 caregivers, data were collected using the Center for Epidemiological Studies Depression Scale, Symptom Distress Scale, Medical Outcomes Study Social Support Survey, and Caregiver Reaction Assessment scale. The course and predictors of depressive symptoms were analyzed using the generalized estimating equation model. Caregivers' depressive symptoms increased as the patient's death approached. Spousal or adult child family caregivers suffered more depressive symptoms if they self-identified as lacking social support and confidence in offering substantial assistance for younger terminally ill cancer patients with higher levels of symptom distress. Caregivers were susceptible to higher levels of depressive symptoms if they were heavily burdened by caregiving, that is, experienced more disruptions in schedules, greater health deterioration, stronger sense of family abandonment, and lower caregiver esteem. Psychological well-being of caregivers of terminally ill cancer patients deteriorated in response to progression of the patient's disease and impending death. Effective interventions should be developed and provided to high-risk caregivers as identified in our study. Increasing caregivers' strength of perceived social support, facilitating their confidence in caregiving, and alleviating their subjective burden may lessen the development of depressive symptoms in caregivers of terminally ill cancer patients throughout the dying process. Copyright © 2012 John Wiley & Sons, Ltd.

  7. Does BDNF genotype influence creative output in bipolar I manic patients?

    PubMed

    Soeiro-de-Souza, Márcio Gerhardt; Post, Robert M; de Sousa, Mario Lucio; Missio, Giovani; do Prado, Carolina Martins; Gattaz, Wagner F; Moreno, Ricardo A; Machado-Vieira, Rodrigo

    2012-07-01

    Creativity is a complex human ability influenced by affective and cognitive components but little is known about its underlying neurobiology. Bipolar Disorder (BD) is highly prevalent among creative individuals. Brain-derived neurotrophic factor (BDNF) is the most widely distributed neurotrophic factor, and has been implicated in the pathophysiology of BD. In contrast to the better functioning of the BDNF polymorphism (Val(66)Met) Val allele, the Met allele decreases BDNF transport and has been associated with worsened performance on several cognitive domains in euthymic BD subjects and controls. We hypothesized that the Val allele is associated with increased creativity in bipolar disorder. Sixty-six subjects with BD (41 in manic and 25 in depressive episodes) and 78 healthy volunteers were genotyped for BDNF Val(66)Met and tested for creativity using the Barrow Welsh Art Scale (BWAS) and neuropsychological tests. Manic patients with the Val allele (Met-) had higher BWAS scores than Met+ carriers. This relationship was not observed among patients in depressive episodes or among control subjects. BDNF Met allele status showed no association with cognitive function in any of the groups. As postulated, these findings suggest that the better functioning allele of BDNF may selectively facilitate creative thinking in subjects with manic episodes, but not in controls or depressives. Further studies exploring the role of BDNF in the neurobiology of creativity in BD and in euthymic phases are warranted. Copyright © 2012 Elsevier B.V. All rights reserved.

  8. Depressive Illness in a General Practice. A Demographic Study and a Controlled Trial of Imipramine

    PubMed Central

    Porter, A. M. W.

    1970-01-01

    The distribution of 93 consecutive cases of depressive illness in a Surrey general practice was found to be non-random. Married women were at risk, while men and unmarried women were largely spared. Married women were prone to the disorder at any time in their lives, and relapse was frequent. There was some suggestion that divorced wives and wives of low social class were particularly predisposed to the disorder. Sixty of the patients took part in a double-blind controlled trial of imipramine. There was no evidence that the drug was superior to a placebo in inducing a remission. It is suggested that imipramine has become established in clinical practice on inadequate evidence and that there is a need for further trials. PMID:4910188

  9. What goes up must come down: The burden of bipolar depression in youth

    PubMed Central

    Van Meter, Anna R.; Henry, David B.; West, Amy E.

    2013-01-01

    Background In the pediatric bipolar disorder literature, mania has eclipsed depression as the mood state of most interest. Though depressive episodes tend to be more prevalent and persisting than manic episodes, research about the associated consequences is limited. The goal of the present study was to compare the influences of depressive and manic symptoms on domains of functioning in which youth with bipolar disorder often demonstrate deficits. Method Youth meeting DSM-IV-TR criteria for bipolar spectrum disorders (I, II, and NOS) between the ages of seven and 13 were recruited from a clinic in a large Midwestern city (N=54). Both parent and clinician report of manic and depressive symptoms were used in regression analyses to determine how each set of symptoms was related to child functioning. Results Parent-rated child depression symptoms were associated with problem behaviors (p<.05), and lower quality of life (p<.001). Clinician-rated child depression was associated with greater psychiatric illness (p<.05), lower child self-concept (p<.001), lower quality of life (p<.05), hopelessness (p<.05, and suicidal ideation (p<.05). Parent-rated mania was associated with better self-esteem (p<.05) and physical wellbeing (p<.05). Clinician-rated mania was associated with greater psychiatric illness (p<.05) and physical wellbeing (p<.05). Limitations The specific outcomes predicted by parent and clinician-rated symptoms vary. Though the overall story told – that bipolar depression is associated with significant impairment in youth – is consistent, further research is necessary to more fully understand the impact of each mood state. Conclusion Mania is undoubtedly destructive, but this study provides evidence to suggest that depression may be more deleterious to youths’ psychosocial functioning and quality of life; more attention to understanding and ameliorating the effects of bipolar depression on youth is warranted. PMID:23768529

  10. What goes up must come down: the burden of bipolar depression in youth.

    PubMed

    Van Meter, Anna R; Henry, David B; West, Amy E

    2013-09-25

    In the pediatric bipolar disorder literature, mania has eclipsed depression as the mood state of most interest. Though depressive episodes tend to be more prevalent and persisting than manic episodes, research about the associated consequences is limited. The goal of the present study was to compare the influences of depressive and manic symptoms on domains of functioning in which youth with bipolar disorder often demonstrate deficits. Youth meeting DSM-IV-TR criteria for bipolar spectrum disorders (I, II, and NOS) between the ages of seven and 13 were recruited from a clinic in a large Midwestern city (N=54). Both parent and clinician report of manic and depressive symptoms were used in regression analyses to determine how each set of symptoms was related to child functioning. Parent-rated child depression symptoms were associated with problem behaviors (p<0.05), and lower quality of life (p<0.001). Clinician-rated child depression was associated with greater psychiatric illness (p<0.05), lower child self-concept (p<0.001), lower quality of life (p<0.05), hopelessness (p<0.05), and suicidal ideation (p<0.05). Parent-rated mania was associated with better self-esteem (p<0.05) and physical wellbeing (p<0.05). Clinician-rated mania was associated with greater psychiatric illness (p<0.05) and physical wellbeing (p<0.05). The specific outcomes predicted by parent and clinician-rated symptoms vary. Though the overall story told--that bipolar depression is associated with significant impairment in youth--is consistent, further research is necessary to more fully understand the impact of each mood state. Mania is undoubtedly destructive, but this study provides evidence to suggest that depression may be more deleterious to youths' psychosocial functioning and quality of life; more attention to understanding and ameliorating the effects of bipolar depression on youth is warranted. © 2013 Elsevier B.V. All rights reserved.

  11. Possible structural abnormality of the brainstem in unipolar depressive illness: a transcranial ultrasound and diffusion tensor magnetic resonance imaging study.

    PubMed

    Steele, J D; Bastin, M E; Wardlaw, J M; Ebmeier, K P

    2005-11-01

    Most empirically derived antidepressants increase monoamine levels. The nuclei of cells synthesising these monoamines are located in the brainstem, and projection tracts such as the medial forebrain bundle reach virtually all other brain areas. Two studies of unipolar depressive illness using transcranial ultrasound have reported reduced echogenicity of the brainstem midline in unipolar depressed patients. This may be consistent with disruption of white matter tracts, including the medial forebrain bundle, and it has been suggested that the effect of such disruption could be reversed by antidepressants. To replicate these findings in a group of unipolar depressed patients and controls. Fifteen unipolar depressed patients and 15 controls were studied using transcranial ultrasound imaging and diffusion tensor magnetic resonance imaging (DT-MRI). No difference in echogenicity of the brainstem midline of unipolar depressed patients was found. A possible trend (Cohen's d = 0.39) in the direction of previous studies was found. Although the echogenicity of the brainstem midline of the control group was found to be similar to previous reports, there was no reduction in the patient group. Additionally, no structural abnormality of the brainstem was identified using DT-MRI. While these data do not replicate the findings of previous studies reporting a significant reduction in the echogenicity of the brainstem midline in unipolar depressed patients, the ultrasound investigation indicated that there may be a trend in this direction. Given the importance of identifying the causes of depressive illness, it is important that other groups attempt similar studies.

  12. Web-based interventions for comorbid depression and chronic illness: a systematic review.

    PubMed

    Charova, Ekaterina; Dorstyn, Diana; Tully, Phillip; Mittag, Oskar

    2015-06-01

    Web-based interventions offer potential benefits for managing and treating depression in the context of chronic physical illness, however their use with this population has yet to be quantitatively assessed. The present systematic review examined the biopsychosocial data from 11 independent studies (N = 1348 participants), including randomised controlled and quasi-experimental designs most commonly performed with diabetes and multiple sclerosis. Study quality was evaluated using the Downs and Black (1998) index, with most studies being statistically underpowered although internal validity was demonstrated. Treatment outcomes were quantified using Cohen's d effect sizes. Results indicated significant short-term improvements in depression severity (d w = 0.36, CI = 0.20-0.52, p < 0.01), in addition to quality of life, problem-solving skills, functional ability, anxiety and pain-related cognitions (d range = 0.23 to 1.10). Longer-term outcomes could not be determined based on the limited data. Further robust studies are required before wider adoption of web techniques takes place. © The Author(s) 2015 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  13. Chronic Illnesses and Depressive Symptoms Among Older People: Functional Limitations as a Mediator and Self-Perceptions of Aging as a Moderator.

    PubMed

    Han, Jina

    2017-05-01

    This research examined the mediation of functional limitations in the relationship between chronic illnesses and depressive symptoms among older Americans along with tests for the moderation of self-perceptions of aging. Data from the Health and Retirement Study (2008, 2010, and 2012) were used. Longitudinal mediation models were tested using a sample of 3,382 Americans who responded to psychosocial questions and were over 65 years old in 2008. Functional limitations mediated the linkage between chronic illnesses and depressive symptoms. Negative self-perceptions of aging exacerbated the effects of chronic illnesses on depressive symptoms. Health care professionals should be aware of depressive symptoms in older adults reporting chronic illnesses and particularly in those reporting functional limitations. To decrease the risk of depressive symptoms caused by chronic illnesses, negative self-perceptions of aging may need to be challenged.

  14. Manic Symptoms in Youth: Dimensions, Latent Classes, and Associations With Parental Psychopathology

    PubMed Central

    Pan, Pedro Mario; Salum, Giovanni Abrahão; Gadelha, Ary; Moriyama, Tais; Cogo-Moreira, Hugo; Graeff-Martins, Ana Soledade; Rosario, Maria Conceição; Polanczyk, Guilherme Vanoni; Brietzke, Elisa; Rohde, Luis Augusto; Stringaris, Argyris; Goodman, Robert; Leibenluft, Ellen; Bressan, Rodrigo Affonseca

    2015-01-01

    Objective The purpose of the study was to define the latent structure of parent-reported manic symptoms and their association with functional impairment and familial risk in a community sample of Brazilian children. Method We screened for manic symptoms in a community sample of 2,512 children 6 to 12 years of age. Parents of children with “episodes of going abnormally high” completed a detailed mania section (n = 479; 19.1%). Confirmatory factor analysis (CFA) tested a solution with “Under-Control (UC)” and “Exuberant (EX)” dimensions, investigating the severity (threshold) and factor loading of each symptom. We also used latent class analysis (LCA) to evaluate the latent categorical structure of manic symptoms. Associations of these latent constructs with psychiatric comorbidity, psychosocial impairment, and family history of psychopathology were tested. Results The 2-dimensional model fit the data well. Only the UC dimension was associated with psychiatric morbidity, psychosocial impairment, and a family history of mania, depression, or suicide attempts. Both UC and EX items discriminated subjects with “episodes of going abnormally high,” but EX items lay at the mild end of the severity spectrum, whereas UC items lay at the severe end. The LCA yielded a small group of children with high levels of manic symptoms and a distinct profile of psychiatric comorbidity and impairment (“high-symptom group”). Conclusion In a large, community-based sample, we found a 2-dimensional latent structure for parent-reported manic symptoms in youth, and demonstrated familial associations between the UC dimension and affective disorders. Both UC and EX items are clinically useful, but their contributions vary with symptom severity. PMID:24839881

  15. Challenges in the management of bipolar depression.

    PubMed

    Suppes, Trisha; Kelly, Dorothy I; Perla, Jessica M

    2005-01-01

    Bipolar depression has started to receive more attention in clinical trials only relatively recently, despite the fact that patients spend more time in the depressed phase than in the manic phase of bipolar disorder. The diagnosis and management of bipolar depression are challenging, and many patients are undiagnosed or misdiagnosed due to symptom similarities with unipolar depression or other illnesses and/or comorbidities. Untreated or inappropriately treated bipolar depression adds to the burden of illness and is associated with a greater risk of suicide. Treatment options include lithium, lamotrigine, atypical antipsychotics, and traditional antidepressants, such as the selective serotonin reuptake inhibitors. However, traditional antidepressants are recommended with caution due to their potential risk of switching patients into mania. Some atypical antipsychotics have shown efficacy in bipolar depression, although longer-term studies are warranted. The choice of treatment for different subgroups of patients with bipolar depression, including those with comorbid anxiety, may vary and also needs further study. Other important issues that require further investigation include the recognition of the core features of bipolar depression and the threshold symptoms for treatment, as well as the optimal treatment choices for monotherapy or combination therapy, and acute versus long-term management of bipolar depression.

  16. Religiously Integrated Cognitive Behavioral Therapy: A New Method of Treatment for Major Depression in Patients With Chronic Medical Illness

    PubMed Central

    Pearce, Michelle J.; Koenig, Harold G.; Robins, Clive J.; Nelson, Bruce; Shaw, Sally F.; Cohen, Harvey J.; King, Michael B.

    2015-01-01

    Intervention studies have found that psychotherapeutic interventions that explicitly integrate clients’ spiritual and religious beliefs in therapy are as effective, if not more so, in reducing depression than those that do not for religious clients. However, few empirical studies have examined the effectiveness of religiously (vs. spiritually) integrated psychotherapy, and no manualized mental health intervention had been developed for the medically ill with religious beliefs. To address this gap, we developed and implemented a novel religiously integrated adaptation of cognitive–behavioral therapy (CBT) for the treatment of depression in individuals with chronic medical illness. This article describes the development and implementation of the intervention. First, we provide a brief overview of CBT. Next, we describe how religious beliefs and behaviors can be integrated into a CBT framework. Finally, we describe Religiously Integrated Cognitive Behavioral Therapy (RCBT), a manualized therapeutic approach designed to assist depressed individuals to develop depression-reducing thoughts and behaviors informed by their own religious beliefs, practices, and resources. This treatment approach has been developed for 5 major world religions (Christianity, Judaism, Islam, Buddhism, and Hinduism), increasing its potential to aid the depressed medically ill from a variety of religious backgrounds. PMID:25365155

  17. Triggers of mania and depression in young adults with bipolar disorder.

    PubMed

    Proudfoot, Judith; Whitton, Alexis; Parker, Gordon; Doran, Justin; Manicavasagar, Vijaya; Delmas, Kristy

    2012-12-20

    Early intervention significantly decreases the impact of bipolar disorder. However, there is little research investigating triggers that may be unique precipitants of manic/hypomanic episodes, and how these may differ from triggers specific to bipolar depression, in young adults with the disorder. Individuals aged 18 to 30 years who had been diagnosed with bipolar disorder (n=198) completed an online survey to identify triggers unique to mania/hypomania and depression, as well as triggers which were common to both. Respondents rated how frequently a series of situations and behaviours had precipitated either a manic/hypomanic episode or a depressive episode in the past. Survey data was supplemented by in-depth face-to-face interviews (n=11). Triggers specifically associated with the onset of manic/hypomanic episodes included falling in love, recreational stimulant use, starting a creative project, late night partying, going on vacation and listening to loud music. Triggers associated with depressive episodes included stressful life events, general stress, fatigue, sleep deprivation, physical injury or illness, menstruation and decreases in physical exercise. A further set of triggers were identified as being common to both manic/hypomanic and depressive episodes. Consistent themes arose from the analysis of face-to-face interviews, which extended and illuminated the findings of the survey data. Identification of a unique set of triggers for mania/hypomania and a unique set for depression in young adults with bipolar disorder may allow for earlier identification of episodes, thus increasing opportunities for early intervention. Copyright © 2012 Elsevier B.V. All rights reserved.

  18. Differential diagnosis of depression: relevance of positron emission tomography

    SciTech Connect

    Schwartz, J.M.; Baxter, L.R. Jr.; Mazziotta, J.C.; Gerner, R.H.; Phelps, M.E.

    1987-09-11

    The proper differential diagnosis of depression is important. A large body of research supports the division of depressive illness into bipolar and unipolar subtypes with respect to demographics, genetics, treatment response, and neurochemical mechanisms. Optimal treatment is different for unipolar and bipolar depressions. Treating a patient with bipolar depression as one would a unipolar patient may precipitate a serious manic episode or possibly even permanent rapid cycling disorder. The clinical distinction between these disorders, while sometimes difficult, can often be achieved through an increased diagnostic suspicion concerning a personal or family history of mania. Positron emission tomography and the FDG method, which allow in vivo study of the glucose metabolic rates for discrete cerebral structures, provide new evidence that bipolar and unipolar depression are two different disorders.

  19. The impact of repeated manic episodes and executive dysfunction on work adjustment in bipolar disorder.

    PubMed

    Bonnín, C M; Torrent, C; Goikolea, J M; Reinares, M; Solé, B; Valentí, M; Sánchez-Moreno, J; Hidalgo, D; Tabarés-Seisdedos, R; Martínez-Arán, A; Vieta, E

    2014-04-01

    The aim of this study was to study the clinical and neurocognitive variables that best explain poor work adjustment in a sample of bipolar I euthymic patients. Eighty-five euthymic patients at the Hospital Clinic of Barcelona were assessed for this study by means of a comprehensive neuropsychological battery and a work-focused interview to determine work adjustment. Clinical and sociodemographic variables were also collected. Direct logistic regression was performed to assess the impact of demographic, clinical and neuropsychological variables on the likelihood of presenting poor work adjustment. The model that best fitted contained five variables (Hamilton Depression Rating scores, number of manic episodes, number of perseverative errors in the Wisconsin Card Sorting Test (WCST), number of depressive episodes and Trail Making Test-part B). However, only two out of these variables made a unique statistically significant contribution to the model, which were number of manic episodes (OR 1.401; CI 1.05-1.86; p = 0.021) and number of perseverative errors in the WCST (OR 1.062; CI 1.00-1.12; p = 0.044). The model explained up to 36 % of the variance in work adjustment. This study highlights the role of manic relapses and neurocognitive impairment, specifically the role of executive function, in work adjustment.

  20. Explaining heterogeneity in disability associated with current major depressive disorder: effects of illness characteristics and comorbid mental disorders.

    PubMed

    van der Werff, E; Verboom, C E; Penninx, B W J H; Nolen, W A; Ormel, J

    2010-12-01

    Although major depressive disorder (MDD) is associated with disability, some persons do function well despite their illness. Aim of the present study was to examine the effect of illness characteristics and comorbid mental disorders on various aspects of disability among persons with a current MDD episode. Data were derived from 607 participants with a current MDD based on the Composite International Diagnostic Interview (CIDI). Severity was assessed via the Inventory of Depressive Symptoms self-report (IDS-SR). For disability three outcome measures were used: World Health Organization Disability Assessment Schedule II (WHODAS) disability and its 7 dimensions, days out of role, and work absence. Using multiple regression analysis the effects of MDD characteristics and comorbid mental disorders were estimated. The IDS-SR score was the best predictor of all disability outcomes. Of the comorbid mental disorders, agoraphobia was significantly associated with overall disability. Collectively, all illness characteristics accounted for 43% of variance in WHODAS disability, 13% in days out of role and 10% in work absence, suggesting substantial unexplained variance. Only self-report measures of disability were used. There were no assessments of other diagnoses than depressive, anxiety and alcohol use disorders. Although heterogeneity in disability of persons with current MDD is partially explained by illness characteristics of MDD (especially symptom severity) and comorbid mental disorders, most of the variance is not accounted for. Copyright © 2010 Elsevier B.V. All rights reserved.

  1. Psychosocial conditions on and off the job and psychological ill health: depressive symptoms, impaired psychological wellbeing, heavy consumption of alcohol

    PubMed Central

    Michelsen, H; Bildt, C

    2003-01-01

    Background: Psychiatric epidemiology has revealed a number of associations between gender, socioeconomic status, and psychiatric disorders. Aims: To examine psychosocial conditions on and off the job in relation to psychological ill health. Methods: Longitudinal design with 24 year follow up of employed persons (190 women, 177 men). Interview and questionnaire data on work and leisure conditions were collected in 1969 and 1993. Risk analyses were performed in relation to three outcomes in 1993: depression within the preceding 12 months, impaired psychological wellbeing, and heavy alcohol use. Results: Thirteen per cent of the women and 11% of the men showed symptoms of depression, 21% and 22% had impaired psychological wellbeing, and 7% and 15% respectively were heavy alcohol users. Dissatisfaction with the quality (women) or quantity (men) of social contacts 24 years earlier was a significant risk factor for depression. Dissatisfaction with the quality of social contacts was also associated with impaired psychological wellbeing (among women), and dissatisfaction with leisure time activities was associated with heavy alcohol use (among men). Frequent overtime work 24 years earlier was associated with heavy alcohol use among women. Cross sectional analyses also showed associations between psychological ill health and some work related factors (mentally demanding work and lack of job pride). Conclusions: Perceived inadequacies in social contacts, and practical obstacles to social relationships are viewed as risk factors for depression. In this longitudinal study, work related factors, including mental demands and time pressure, do not appear sufficiently associated with psychological ill health. PMID:12819282

  2. Cabergoline-induced manic episode: case report

    PubMed Central

    Yüksel, Rabia Nazik; Elyas Kaya, Zeynep; Dilbaz, Nesrin; Cingi Yirün, Merve

    2016-01-01

    Cabergoline is an orally administered synthetic dopamine agonist that is used for the treatment of hyperprolactinemia, Parkinson’s disease and antipsychotic-induced prolactin elevation. One of the main characteristics of cabergoline is its long duration of effect. It is highly effective in suppressing prolactin levels up to 21 days after a single 1 mg oral dose. The prolonged elimination half-life offers an advantage of once-daily dosing, but it might be a handicap in terms of washout of adverse effects such as psychosis. Cabergoline has been associated with adverse reactions consistent with other dopaminergic agonists including cardiovascular, gastrointestinal and neuropsychiatric effects. It is known that dopaminergic treatment is a remarkable risk factor for psychosis. A number of reports implicate dopamine agonists in the development of psychosis, but there is no knowledge in the literature of dopamine agonist-induced mania. In this case, we report the first manic episode occurring after cabergoline use for hyperprolactinemia treatment. In susceptible individuals, cabergoline can cause manic episodes and cabergoline should be used more carefully considering the risk–benefit ratio. PMID:27354910

  3. Cabergoline-induced manic episode: case report.

    PubMed

    Yüksel, Rabia Nazik; Elyas Kaya, Zeynep; Dilbaz, Nesrin; Cingi Yirün, Merve

    2016-06-01

    Cabergoline is an orally administered synthetic dopamine agonist that is used for the treatment of hyperprolactinemia, Parkinson's disease and antipsychotic-induced prolactin elevation. One of the main characteristics of cabergoline is its long duration of effect. It is highly effective in suppressing prolactin levels up to 21 days after a single 1 mg oral dose. The prolonged elimination half-life offers an advantage of once-daily dosing, but it might be a handicap in terms of washout of adverse effects such as psychosis. Cabergoline has been associated with adverse reactions consistent with other dopaminergic agonists including cardiovascular, gastrointestinal and neuropsychiatric effects. It is known that dopaminergic treatment is a remarkable risk factor for psychosis. A number of reports implicate dopamine agonists in the development of psychosis, but there is no knowledge in the literature of dopamine agonist-induced mania. In this case, we report the first manic episode occurring after cabergoline use for hyperprolactinemia treatment. In susceptible individuals, cabergoline can cause manic episodes and cabergoline should be used more carefully considering the risk-benefit ratio.

  4. Efficacy of illness perception focused intervention on quality of life, anxiety, and depression in patients with myocardial infarction

    PubMed Central

    Sararoudi, Reza Bagherian; Motmaen, Maryam; Maracy, Mohammad Reza; Pishghadam, Elnaz; Kheirabadi, Gholam Reza

    2016-01-01

    Background: Myocardial infarction (MI) is one of the major causes of death and disability worldwide, which can reduces quality of life in patients. Some disabilities are depression and anxiety which delay returning to work. The aim of this study was to evaluate the effect of illness perception focused intervention on quality of life, anxiety, and depression in MI patients. Materials and Methods: A randomized controlled trial study of 48 recently hospitalized MI patients was conducted (24 in intervention group and 24 in control group). Intervention group was trained to understand the disease by a mental health counselor in three half-an-hour sessions for three consecutive days. Data were collected from three questionnaires: hospital anxiety and depression scale, the World Health Organization Quality of Life Questionnaire (short form), and Illness Perceptions Questionnaire Brief at admission, 1.5, and 3 months postdischarge. Data were analyzed with ANOVA repeated measure. Results: The mean duration of returning to work was 28.7 ± 8.1 days in intervention groups and 46 ± 7.6 days in control group which was statistically significant (P < 0.001). Moreover, anxiety, depression, and illness perceptions score were significantly decreased in intervention groups which were 8.3 ± 3.3, 6.8 ± 3.5, and 36.5 ± 5 in intervention groups and 15.8 ± 2.1(P < 0.001), 17.1 ± 2.3 (P < 0.001), and 41.9 ± 4 (P < 0.001) in control group, respectively. Mean of quality of life subscales scores just physical health subscale showed a significant reduction after 3 months in the control group. Conclusion: Training MI patients to understand the disease in three half-an-hour sessions for 3 consecutive days can decrease the duration of returning to work, anxiety and depression, and increase illness perceptions which can make a better outcome. PMID:28331511

  5. Onset of Manic Episode during Chemotherapy with 5-Fluorouracil

    PubMed Central

    Ha, Jee Hyun; Hwang, Dae-Yong; Park, Doo-Heum; Ryu, Seung-Ho

    2011-01-01

    The authors report a case of 5-Fluorouracil (5-FU) induced manic episode in an elderly female without any previous psychiatric history. The patient presented manic symptoms after 4th cycle of 5-FU chemotherapy after surgery of rectal cancer. After cessation of chemotherapy and administration of olanzapine and divalproex sodium, symptoms were subsided within 10 days. PMID:21519541

  6. Providing Support to Relatives and Friends Managing Both Chronic Physical Illness and Depression: the Views of a National Sample of U.S. Adults

    PubMed Central

    Janevic, Mary; Rosland, Ann-Marie; Wiitala, Wyndy; Connell, Cathleen M; Piette, John D.

    2012-01-01

    Objective To describe how comorbid depression in chronically ill adults affects the willingness of their family and friends to provide them with illness management support. Methods We identified a national sample of U.S. adults (n=1027), all of whom had a close relative or friend with a chronic physical illness. We examined whether respondents were less willing to help their relatives/friends with disease management when they reported that these relatives/friends were also diagnosed with depression. Results In multivariate models, the odds of respondents being willing to provide disease-management support doubled when the relative/friend was depressed (adjusted odds ratio (AOR) = 1.99; 95% C.I=1.31, 3.02). Respondents were willing to perform an equal number of illness support tasks for relatives/friends with and without depression. However, respondents reported 30% more difficulties discussing health issues (incidence rate ratio (IRR)=1.30; 95% C.I=1.11,1.53), and 44% more barriers to providing support (IRR=1.44; 95% C.I=1.18, 1.75) to depressed relatives/friends. Conclusion U.S. adults are more willing to provide disease-management support for chronically ill relatives/friends with depression. However, helping depressed relatives/friends is also more challenging. Practice implications By providing resources for potential supporters, health providers could mobilize an important source of disease-management support for patients with chronic illness and depression. PMID:22748757

  7. Is the Higher Number of Suicide Attempts in Bipolar Disorder vs. Major Depressive Disorder Attributable to Illness Severity?

    PubMed

    Michaels, Matthew S; Balthrop, Tia; Pulido, Alejandro; Rudd, M David; Joiner, Thomas E

    2017-04-19

    The present study represents an early stage investigation into the phenomenon whereby those with bipolar disorder attempt suicide more frequently than those with unipolar depression, but do not tend to attempt suicide during mania. Data for this study were obtained from baseline measurements collected in a randomized treatment study at a major southwestern United States military medical center. We demonstrated the rarity of suicide attempts during mania, the higher frequency of suicide attempts in those with bipolar disorder compared to those with depression, and the persistence of effects after accounting for severity of illness. These results provide the impetus for the development and testing of theoretical explanations.

  8. Course of illness in comorbid bipolar disorder and obsessive-compulsive disorder patients.

    PubMed

    Amerio, A; Tonna, M; Odone, A; Stubbs, B; Ghaemi, S N

    2016-04-01

    Psychiatric comorbidity is extremely common. One of the most common and difficult to manage comorbid conditions is the co-occurrence of bipolar disorder (BD) and obsessive compulsive disorder (OCD). We updated our recent systematic review searching the electronic databases MEDLINE, Embase, and PsycINFO to investigate course of illness in BD-OCD patients. We identified a total of 13 relevant papers which found that the majority of comorbid OCD cases appeared to be related to mood episodes. OC symptoms in comorbid patients appeared more often during depressive episodes, and comorbid BD and OCD cycled together, with OC symptoms often remitting during manic/hypomanic episodes.

  9. Collaborative Depression Treatment in Older and Younger Adults with Physical Illness: Pooled Comparative Analysis of Three Randomized Clinical Trials

    PubMed Central

    Ell, Kathleen; Aranda, María P.; Xie, Bin; Lee, Pey-Jiuan; Chou, Chih-Ping

    2010-01-01

    Objective There have been few comparisons of the effectiveness of collaborative depression care between older versus younger adults with co-morbid illness, particularly among low-income populations. Design Intent-to-treat analyses are conducted on pooled data from three randomized controlled trials that tested collaborative care aimed at improving depression, quality of life and treatment receipt. Settings Trials were conducted in oncology and primary care safety net clinics and diverse home health care programs. Participants 1,081 patients with major depressive symptoms and cancer, diabetes or other co-morbid illness. Intervention Similar intervention protocols included patient, provider, socio-cultural and organizational adaptations. Measurements The PHQ-9 depression, SF-12/20 quality-of-life, self-reported hospitalization, ER, ICU utilization, and antidepressant, psychotherapy treatment receipt are assessed at baseline, 6, 12 months. Results There are no significant differences in reducing depression symptoms (P ranged 0.18-0.58), improving quality-of-life (t=1.86, df=669, P=0.07 for physical functioning at 12 months; and P ranged 0.23-0.99 for all others) between patients ≥60 versus 18-59. Both age group intervention patients have significantly higher rates of a 50% PHQ-9 reduction (older: Wald χ2[df=1]=4.82, p=0.03; younger: Wald χ2[df=1]=6.47, p=0.02), greater reduction in major depression rates (older: Wald χ2[df=1]=7.72, p=0.01; younger: Wald χ2[df=1]=4.0, p=0.05) than enhanced-usual-care patients at 6 months, and are no significant age group differences in treatment type or intensity. Conclusion Collaborative depression care in individuals with co-morbid illness is as effective in reducing depression in older patients as younger patients, including among low-income, minority patients. Patient, provider, and organizational adaptations of depression care management models may contribute to positive outcomes. PMID:20220588

  10. Temperament and prodromal symptoms prior to first manic/hypomanic episodes: results from a pilot study.

    PubMed

    Zeschel, Eike; Bingmann, Tiffany; Bechdolf, Andreas; Krüger-Oezguerdal, Seza; Correll, Christoph U; Leopold, Karolina; Pfennig, Andrea; Bauer, Michael; Juckel, Georg

    2015-03-01

    Prodromal symptoms prior to first episode mania/hypomania have been reported. However, the relationship between temperament and manic/hypomanic prodromal symptoms has not been investigated. We hypothesized that subjects scoring higher on cyclothymic and irritable temperament scales show more manic/hypomanic prodromal symptoms. Euthymic patients diagnosed with bipolar-I or -II disorder within 8 years underwent retrospective assessments with the Temperament Evaluation of Memphis, Pisa, Paris and San Diego-autoquestionnaire (TEMPS-A) and the Bipolar Prodrome Symptom Scale-Retrospective (BPSS-R). Among 39 subjects (36.1 ± 9.9 years, females = 59%, bipolar-I = 62%) 100% and 92.3% reported subthreshold mania (mean = 7.4 ± 2.9) or subthreshold depressive symptoms (mean = 2.4 ± 1.5), and 87.2% and 43.6% reported general psychopathology (mean = 3.2 ± 2.0) or subthreshold psychotic symptoms (mean = 0.7 ± 1.0) prior to their first hypo-/manic episode. Subjects with higher cyclothymic and irritable temperament scores showed more subthreshold symptoms prior to the first manic/hypomanic episode, mainly subthreshold hypo-/manic symptoms (cyclothymic temperament r = 0.430; p = 0.006; irritable temperament r = 0.330; p = 0.040), general psychopathology symptoms (cyclothymic temperament r = 0.316; p = 0.05; irritable temperament r = 0.349; p = 0.029) and subthreshold psychotic symptoms (cyclothymic temperament r = 0.413; p = 0.009). In regression analyses, cyclothymic temperament explained 16.1% and 12.5% of the variance of the BPSS-R total score (p = 0.045) and psychosis subscore (p = 0.029). Retrospective study, no control group, small sample size. We present data, which indicate a relationship between cyclothymic and irritable temperament and prodromal symptoms prior to the first manic/hypomanic episode. These findings support the notion that assessing cyclothymic temperament to identify people at-risk of developing bipolar-I and -II disorder may help to increase the

  11. Psychotherapy based on identity problems of depressives.

    PubMed

    Kraus, A

    1995-01-01

    I present here what I call my identity-theoretical concept of depression, discussing both bipolar disorders and major depressive disorders. The method is phenomenological in that through interviews with depressives we become aware of their being-in-the-world, their social roles and the various identities they form through identification and under the pressure of their environment. In contrast to the normal individual, whose identity is autonomous, flexible, and continuously changes throughout the life cycle, depressives have what I call an "overidentifying" identity formation. That is to say, they cannot stand back and be autonomous, they must overidentify or throw themselves excessively into whatever particular social expectations they encounter. This leads to an "overadjustment" to the norms of society, a rigidity, and an excessive dependence on others. Patients in the manic phase may show the opposite extreme in their effort to avoid the overidentification tendency. Furthermore, depressives cannot tolerate ambiguity, they cannot deal with the positive and negative characteristics in one or the same object or person. Depressive or manic episodes are precipitated by situations where ambiguity cannot be avoided, or where conflicting identities are demanded at the same time, for example when a high quantity of high quality work is demanded in too short a time for this to be possible. Any sort of changes or role losses that demand flexibility of one's identity or the capacity to step back a bit and suspend one's characteristic habits or identity manifestations will precipitate manic or depressive episodes in such predisposed melancholics. On the basis of my identity-theoretical concept certain guidelines for psychotherapy suggest themselves, and these are presented. I call this "identity therapy," and I distinguish it from cognitive therapy because it is not the cognitive schemes that are disturbed in these patients but rather their identity structure. I discuss

  12. The neural correlates of emotional face-processing in adolescent depression: a dimensional approach focusing on anhedonia and illness severity.

    PubMed

    Henderson, Sarah E; Vallejo, Ana I; Ely, Benjamin A; Kang, Guoxin; Krain Roy, Amy; Pine, Daniel S; Stern, Emily R; Gabbay, Vilma

    2014-12-30

    Deficits in emotion processing, a known clinical feature of major depressive disorder (MDD), have been widely investigated using emotional face paradigms and neuroimaging. However, most studies have not accounted for the high inter-subject variability of symptom severity. Similarly, only sparse research has focused on MDD in adolescence, early in the course of the illness. Here we sought to investigate neural responses to emotional faces using both categorical and dimensional analyses with a focus on anhedonia, a core symptom of MDD associated with poor outcomes. Nineteen medication-free depressed adolescents and 18 healthy controls (HC) were scanned during presentation of happy, sad, fearful, and neutral faces. ANCOVAs and regressions assessed group differences and relationships with illness and anhedonia severity, respectively. Findings included a group by valence interaction with depressed adolescents exhibiting decreased activity in the superior temporal gyrus (STG), putamen and premotor cortex. Post-hoc analyses confirmed decreased STG activity in MDD adolescents. Dimensional analyses revealed associations between illness severity and altered responses to negative faces in prefrontal, cingulate, striatal, and limbic regions. However, anhedonia severity was uniquely correlated with responses to happy faces in the prefrontal, cingulate, and insular regions. Our work highlights the need for studying specific symptoms dimensionally in psychiatric research.

  13. Evidence for Neuroplastic Compensation in the Cerebral Cortex of Persons with Depressive Illness

    PubMed Central

    Bansal, Ravi; Hellerstein, David J.; Peterson, Bradley S.

    2017-01-01

    We yoked anatomical brain Magnetic Resonance Imaging to a randomized, double-blind, placebo-controlled trial (RCT) of antidepressant medication for 10-week’s duration in patients with dysthymia. The RCT study design mitigated ascertainment bias by randomizing patients to receive either duloxetine or placebo, and it supported true causal inferences about treatment effects on the brain by controlling treatment assignment experimentally. We acquired 121 anatomical scans: at baseline and endpoint in 41 patients, and once in 39 healthy controls. At baseline, patients had diffusely thicker cortices than did healthy participants, and patients who had thicker cortices had proportionately less severe symptoms. During the trial, symptoms improved significantly more in medication- compared with placebo-treated patients; concurrently, thicknesses in medication-treated patients declined toward values in healthy controls, but they increased slightly, away from control values, in placebo-treated patients. Changes in symptom severity during the trial mediated the association of treatment assignment with the change in thickness, suggesting that the beneficial effects of medication on symptom severity were at least partially responsible for normalizing cortical thickness. Together our findings suggest that baseline cortical hypertrophy in medication-free patients likely represented a compensatory, neuroplastic response that attenuated symptom severity. Medication then reduced symptoms and lessened the need for compensation, thereby normalizing thickness. This is to the best of our knowledge the first study to report within an RCT a differential change in cortical morphology during medication treatment for depressive illness and the first to provide within an RCT in vivo evidence for the presence of neuroanatomical plasticity in humans. PMID:28265119

  14. Atypical Antipsychotics for Acute Manic and Mixed Episodes in Children and Adolescents with Bipolar Disorder

    PubMed Central

    Singh, Manpreet K.; Ketter, Terence A.; Chang, Kiki D.

    2010-01-01

    The diagnosis of bipolar disorder (BD) in children is increasing, and often requires a comprehensive treatment plan to address a complex array of symptoms and associated morbidities. Pharmacotherapy, in combination with psychotherapeutic interventions, is essential for the treatment and stabilization of disrupted mood. Current evidence collectively demonstrates, by randomized controlled design, that atypical antipsychotics have efficacy for the treatment of acute manic or mixed symptoms in children and adolescents with BD. Additional longitudinal and biological studies are warranted to characterize the effects of atypical antipsychotics on all phases and stages of bipolar illness development in children and adolescents. PMID:20205485

  15. Manic/hypomanic symptom burden and cardiovascular mortality in bipolar disorder.

    PubMed

    Fiedorowicz, Jess G; Solomon, David A; Endicott, Jean; Leon, Andrew C; Li, Chunshan; Rice, John P; Coryell, William H

    2009-07-01

    To compare the risk for cardiovascular mortality between bipolar I and bipolar II subtypes and determine correlates of cardiovascular mortality. Bipolar disorder conveys an increased risk of cardiovascular mortality. Participants with major affective disorders were recruited for the National Institute of Mental Health Collaborative Depression Study and followed prospectively for up to 25 years. A total of 435 participants met the diagnostic criteria for bipolar I (n = 288) or bipolar II (n = 147) disorder based on Research Diagnostic Criteria at intake and measures of psychiatric symptoms during follow-up. Diagnostic subtypes were contrasted by cardiovascular mortality risk using Cox proportional hazards regression. Affective symptom burden (the proportion of time with clinically significant manic/hypomanic or depressive symptoms) and treatment exposure were additionally included in the models. Thirty-three participants died from cardiovascular causes. Participants with bipolar I disorder had more than double the cardiovascular mortality risk of those with bipolar II disorder, after controlling for age and gender (hazard ratio = 2.35, 95% Confidence Interval = 1.04-5.33; p = .04). The observed difference in cardiovascular mortality between these subtypes was at least partially confounded by the burden of clinically significant manic/hypomanic symptoms which predicted cardiovascular mortality independent of diagnosis, treatment exposure, age, gender, and cardiovascular risk factors at intake. Selective serotonin uptake inhibitors seemed protective although they were introduced late in follow-up. Depressive symptom burden was not related to cardiovascular mortality. Participants with bipolar I disorder may face a greater risk of cardiovascular mortality than those with bipolar II disorder. This difference in cardiovascular mortality risk may reflect manic/hypomanic symptom burden.

  16. Relationships of Sexual Dysfunction with Depression and Acceptance of Illness in Women and Men with Type 2 Diabetes Mellitus.

    PubMed

    Bąk, Ewelina; Marcisz, Czeslaw; Krzemińska, Sylwia; Dobrzyn-Matusiak, Dorota; Foltyn, Agnieszka; Drosdzol-Cop, Agnieszka

    2017-09-16

    An increased prevalence of sexual disorders has been reported in patients with type 2 diabetes. The aim of this study is the assessment of the influence of the psychical condition, the concentration of glycated hemoglobin, the duration of diabetes, the body mass index, the age, and the subjective acceptance of the illness on sexual disorders occurring in women and men with type 2 diabetes. The study enrolled 215 patients (114 women and 101 men) with type 2 diabetes and 183 controls. Sexuality was determined in all of the studied subjects using: the Female Sexual Function Index (FSFI) in women and the International Index of Erectile Function (IIEF) in men. The occurrence of depression symptoms was determined using the Beck Depression Inventory (BDI), whereas the acceptance of the illness in diabetic patients using the Acceptance of Illness Scale (AIS). A sexual dysfunction was found in 68% of the studied diabetic women and 17% of controls. The point values of all the examined FSFI domains were significantly lower in women with diabetes than in controls (p < 0.001). Erectile disorders occurred in 82% of the studied men with diabetes and in 41% of the controls (p < 0.001). The point values of all the domains of FSFI and IIEF demonstrated a significantly negative correlation with the total BDI score, which was higher in patients with diabetes than in patients without diabetes, and a positive correlation with the total AIS score (p < 0.001). The occurrence of sexual dysfunction in patients with diabetes correlated with the age and the duration of diabetes. We conclude that sexual disorders in patients with type 2 diabetes demonstrate the correlation with the occurrence of depression and the acceptance of their illness. Sexual disorders in diabetic patients occur more frequently in older patients and in those with a longer duration of diabetes.

  17. How mental health literacy and experience of mental illness relate to stigmatizing attitudes and social distance towards people with depression or psychosis: A cross-sectional study.

    PubMed

    Svensson, Bengt; Hansson, Lars

    2016-01-01

    Background Evidence suggests that mental health literacy among the public is low, and stigmatizing attitudes are widespread. So far the effects of anti-stigma campaigns are small, and studies demonstrate that negative attitudes have been quite stable through recent decades. Aims To investigate the relationships between mental health literacy, experience of mental illness and stigmatizing attitudes/social distance towards people with depression or psychosis. Methods A cross-sectional study in which staff members from public services in Sweden (n = 1027) completed questionnaires covering demographic data, self-reported experience of mental illness, identification of a vignette for depression or psychosis, beliefs about helpful interventions for the illness presented in the vignette, and attitudes and social distance towards people with the illness. Results About 50% of participants could identify depression and less than 40% psychosis. A higher degree of mental health literacy was related to less stigma and social distance but mainly towards people with depression. A similar relationship was shown for having personal or family experience of mental illness and attitudes/social distance. Negative attitudes and social distance were significantly higher in all aspects measured towards a person with psychosis than a person with depression. Conclusions A higher degree of mental health literacy relates to more positive attitudes and less desire for social distance towards people with depression. The differences between depression and psychosis should be taken into account in anti-stigma interventions.

  18. Longitudinal mood monitoring in bipolar disorder: Course of illness as revealed through a short messaging service.

    PubMed

    McKnight, Rebecca F; Bilderbeck, Amy C; Miklowitz, David J; Hinds, Christopher; Goodwin, Guy M; Geddes, John R

    2017-12-01

    Online self-monitoring of mood can be used to investigate differences in course patterns across patient groups. This study explored the feasibility of remote symptom capture with True Colours, a self-rated online mood monitoring tool completed on a weekly basis. Participants with bipolar disorder (N = 297) completed weekly depression and mania questionnaires over an average of 27.5 months (range 1 -81 months). Subgroups defined by sex, age, and bipolar I vs. II status were compared on time in various mood states, number of episodes, and week-to-week mood variability. Compliance with weekly questionnaires was generally high (median, 92% of weeks). Mood symptoms occurred for an average of 55.4% of weeks across the follow-up period. Females spent more time with hypomanic/manic and depressive symptoms and had more depressive episodes compared to males. Younger participants were found to experience more hypomanic/manic episodes and showed greater variability in mood symptoms than older participants. No significant differences in mood symptoms or variability were observed between bipolar I and II patients. This was a naturalistic study with a heterogeneous cohort, and did not include a control group. True Colours does not identify mood fluctuations that may occur in the days between weekly assessments. Monitoring moods through an online tool is both feasible and informative regarding course of illness in patients with bipolar disorder. Interventions aiming to reduce mood variability and manic/hypomanic episodes in the early phases of bipolar disorder may enhance the long-term symptomatic course of the illness. Copyright © 2017 Elsevier B.V. All rights reserved.

  19. The Hamilton Rating Scale for Depression: The making of a "gold standard" and the unmaking of a chronic illness, 1960-1980.

    PubMed

    Worboys, Michael

    2013-09-01

    To show why and how the Hamilton Rating Scale for Depression became the 'Gold Standard' for assessing therapies from the mid-1960s and how it was used to frame depression as a short-term and curable illness rather than a chronic one. My approach is that of the social construction of knowledge, identifying the interests, institutional contexts and practices that produce knowledge claims and then mapping the social processes of their circulation, validation and acceptance. The circulation and validation of Hamilton Rating Scale for Depression was relatively slow and it became a 'Gold Standard' 'from below', from an emerging consensus amongst psychiatrists undertaking clinical trials for depression, which from the 1960s were principally with psychopharmaceuticals for short-term illness. Hamilton Rating Scale for Depression, drug trials and the construction of depression as non-chronic were mutually constituted. Hamilton Rating Scale for Depression framed depression and its sufferers in new ways, leading psychiatrists to understand illness as a treatable episode, rather than a life course condition. As such, Hamilton Rating Scale for Depression served the interests of psychiatrists and psychiatry in its new era of drug therapy outside the mental hospital. However, Hamilton Rating Scale for Depression was a strange kind of 'standard', being quite non-standard in the widely varying ways it was used and the meanings given to its findings.

  20. Diagnosis of mental illness in primary and secondary care with a focus on bipolar disorder.

    PubMed

    Rogers, Jonathan; Agius, Mark; Zaman, Rashid

    2012-09-01

    While most of the management of mental health in the UK is conducted in primary care, the diagnosis by GPs has been shown to deficient in some areas. Bipolar disorder in particular is known to under-diagnosed but there is confusion as to whether this is due to poor recognition or conversion from unipolar depression In April and May 2012 an audit was conducted in secondary psychiatric services in Bedford, UK among 146 representative patients and 112 bipolar patients, examining the course of their illness and diagnosis Bipolar disorder is under-diagnosed in the community and in secondary care. First manic or hypomanic symptoms usually follow first depressive symptoms by several years (μ=7.3, σ=7.9). A diagnosis of bipolar also commonly follows manic or hypomanic symptoms by years (μ=7.6, σ=8.3). Both psychiatrists and GPs under-diagnose bipolar, but this study shows it may be due to two factors: poor recognition by doctors and conversion from major depressive disorder. GPs and psychiatrists must be more aware of the under-diagnosis of bipolar and its tendency to convert from pure depressive symptoms.

  1. Effects of qigong exercise on fatigue, anxiety, and depressive symptoms of patients with chronic fatigue syndrome-like illness: a randomized controlled trial.

    PubMed

    Chan, Jessie S M; Ho, Rainbow T H; Wang, Chong-Wen; Yuen, Lai Ping; Sham, Jonathan S T; Chan, Cecilia L W

    2013-01-01

    Background. Anxiety/depressive symptoms are common in patients with chronic fatigue syndrome- (CFS-) like illness. Qigong as a modality of complementary and alternative therapy has been increasingly applied by patients with chronic illnesses, but little is known about the effect of Qigong on anxiety/depressive symptoms of the patients with CFS-like illness. Purpose. To investigate the effects of Qigong on fatigue, anxiety, and depressive symptoms in patients with CFS-illness. Methods. One hundred and thirty-seven participants who met the diagnostic criteria for CFS-like illness were randomly assigned to either an intervention group or a waitlist control group. Participants in the intervention group received 10 sessions of Qigong training twice a week for 5 consecutive weeks, followed by home-based practice for 12 weeks. Fatigue, anxiety, and depressive symptoms were assessed at baseline and postintervention. Results. Total fatigue score [F(1,135) = 13.888, P < 0.001], physical fatigue score [F(1,135) = 20.852, P < 0.001] and depression score [F(1,135) = 9.918, P = 0.002] were significantly improved and mental fatigue score [F(1,135) = 3.902, P = 0.050] was marginally significantly improved in the Qigong group compared to controls. The anxiety score was not significantly improved in the Qigong group. Conclusion. Qigong may not only reduce the fatigue symptoms, but also has antidepressive effect for patients with CFS-like illness. Trial registration HKCTR-1200.

  2. Depressive Symptoms After Critical Illness: A Systematic Review and Meta-Analysis.

    PubMed

    Rabiee, Anahita; Nikayin, Sina; Hashem, Mohamed D; Huang, Minxuan; Dinglas, Victor D; Bienvenu, O Joseph; Turnbull, Alison E; Needham, Dale M

    2016-09-01

    To synthesize data on prevalence, natural history, risk factors, and post-ICU interventions for depressive symptoms in ICU survivors. PubMed, EMBASE, Cumulative Index of Nursing and Allied Health Literature, PsycINFO, and Cochrane Controlled Trials Registry (1970-2015). Studies measuring depression after hospital discharge using a validated instrument in more than 20 adults from non-specialty ICUs. Duplicate independent review and data abstraction. The search identified 27,334 titles, with 42 eligible articles on 38 unique studies (n = 4,113). The Hospital Anxiety and Depression Scale-Depression subscale was used most commonly (58%). The pooled Hospital Anxiety and Depression Scale-Depression subscale prevalence (95% CI) of depressive symptoms at a threshold score greater than or equal to 8 was 29% (22-36%) at 2-3 months (12 studies; n = 1,078), 34% (24-43%) at 6 months (seven studies; n = 760), and 29% (23-34%) at 12-14 months (six studies; n = 1,041). The prevalence of suprathreshold depressive symptoms (compatible with Hospital Anxiety and Depression Scale-Depression subscale, ≥ 8) across all studies, using all instruments, was between 29% and 30% at all three time points. The pooled change in prevalence (95% CI) from 2-3 to 6 months (four studies; n = 387) was 5% (-1% to +12%), and from 6 to 12 months (three studies; n = 412) was 1% (-6% to +7%). Risk factors included pre-ICU psychologic morbidity and presence of in-ICU psychologic distress symptoms. We did not identify any post-ICU intervention with strong evidence of improvement in depressive symptoms. Clinically important depressive symptoms occurred in approximately one-third of ICU survivors and were persistent through 12-month follow-up. Greater research into treatment is needed for this common and persistent post-ICU morbidity.

  3. Depression.

    PubMed

    Choe, Christine J; Emslie, Graham J; Mayes, Taryn L

    2012-10-01

    This article reviews the assessment and treatment for depression in children and adolescents, emphasizing the implementation of evidence-based treatments into clinical care. Past trials of antidepressant medications are reviewed, as well as the clinical use of antidepressants and pharmacologic strategies for refractory illness or in the context of comorbid conditions. Clinicians who treat youth now have a body of empiric research to help guide treatment decisions; however, personalized treatment based on associated symptoms, comorbid conditions, contextual factors, and psychiatric history is essential. Further research is needed in the pharmacologic treatment of depressed youth, including expanding the study of non-SSRI antidepressants, augmentation and adjunctive strategies, and treatment in patients with comorbid conditions. Copyright © 2012 Elsevier Inc. All rights reserved.

  4. A New Empirical Definition of Major Depressive Episode Recovery and Its Positive Impact on Future Course of Illness.

    PubMed

    Judd, Lewis L; Schettler, Pamela J; Rush, A John; Coryell, William H; Fiedorowicz, Jess G; Solomon, David A

    2016-08-01

    To provide the first head-to-head test of the predictive validity of 2 resolution levels included in the current consensus definition of major depressive episode (MDE) recovery and provide an empirically based, clinically useful definition of the end of an MDE. 322 participants entering the National Institute of Mental Health Collaborative Depression Study with MDE (diagnosed by Research Diagnostic Criteria) in 1978-1981, and followed thereafter for up to 31 years, were divided into those with 8 consecutive weeks of asymptomatic MDE recovery or residual subsyndromal depressive symptom (SSD) resolution of their index MDE. These 2 levels of recovery were defined based on weekly symptom status on all depressive conditions, assessed by Longitudinal Interval Follow-Up Evaluation (LIFE) interviews conducted every 6 months. Primary measures of validity of these 2 alternative definitions were first well interval duration and long-term depressive illness burden. Groups were also compared on clinical variables, antidepressant treatment, and psychosocial function. 61.2% of subjects recovered asymptomatically from their index MDE. By survival analysis, they remained free of a depressive episode relapse or recurrence 4.2 times longer than those with SSD resolution (median = 135 vs 32 weeks; χ² = 70.65; P < .0001). This was not attributable to a difference in intensity of antidepressant medication. Compared to asymptomatic recovery, SSD resolution was associated with significantly longer and more severe index MDEs, with more miscellaneous psychopathology as well as increased long-term psychosocial dysfunction and a greater depressive illness burden during the ensuing 10 or 20 years. Asymptomatic MDE resolution was a stronger predictor of time well than any of 18 other predictors, singly or combined. Eight consecutive weeks of asymptomatic recovery had 93% overlap with a 4-week definition and conferred little benefit over 4 weeks. Four consecutive weeks of asymptomatic recovery

  5. Autonomic actions and interactions of mianserin hydrochloride (Org. GB 94) and amitriptyline in patients with depressive illness.

    PubMed

    Ghose, K; Coppen, A; Turner, P

    1976-09-17

    The clinical pharmacology of mianserin hydrochloride was studied in patients suffering from a primary depressive illness after steady-state plasma concentration of the drug had been achieved. The results were compared with those found with amitriptyline in both open and double-blind studies. The two drugs are equally effective in their antidepressive effect. Mianserin hydrochloride appears to be free of anticholinergic effects as assessed by the measurement of salivary volume, pupil diameter and the interactions with guanethidine and thymoxamine on the pupil. No peripheral adrenergic interaction as studied by the tyramine dose-pressor-response test were observed in patients treated with mianserin hydrochloride (20 mg three times daily).

  6. Depression and resilience mediate the relationship between traumatic life events and ill physical health: results from a population study.

    PubMed

    Karatzias, Thanos; Jowett, Sally; Yan, Elsie; Raeside, Robert; Howard, Ruth

    2016-11-10

    We set out to investigate the mediating roles of depression, resilience, smoking, and alcohol use, in the relationship between potentially traumatic life events and objective and subjective, physical and mental health in a single study. A face-to-face, population-based survey was conducted in Hong Kong (N = 1147). Information on health conditions and traumatic life events was obtained, and participants completed measures of subjective physical and mental health, depression, and resilience. Smoking and drinking were not significant mediators of the relationship between life events and both objective and subjective health. Depressive symptomatology was found to mediate the relationship between life threatening illness and subjective physical health, the relationship between abuse (physical and sexual) and subjective mental health, and the relationship between the death of a parent/partner and subjective mental health. Resilience was found to mediate the relationships between multiple traumatic life events and subjective physical and mental health. Our results indicate that psychological factors rather than biological are important mediators of the relationship between life events exposure and health. Our findings provide evidence that depressive symptomatology has a mediating role only in the case of specific potentially traumatic life events and that resilience is only a critical factor in the face of exposure to multiple traumatic events, rather than single events. Our results also indicate that behavioural factors, such as smoking and drinking, are not significant mediators of the relationship between life events and health.

  7. The Phenomenology of Depressive Illness in People with a Learning Disability and Autism.

    ERIC Educational Resources Information Center

    Perry, D. W.; Marston, G. M.; Hinder, S. A. J.; Munden, A. C.; Roy, A.

    2001-01-01

    This article examines issues associated with the diagnosis of depressive disorder in adolescents or young adults with autism. Specific methodological problems are identified. The use of treatment response methods to clarify symptoms that may be significant in diagnosing depression in this group is discussed. (Contains references.) (Author/DB)

  8. Neuroinflammation and cytokine abnormality in major depression: Cause or consequence in that illness?

    PubMed Central

    Jeon, Sang Won; Kim, Yong Ku

    2016-01-01

    Depression results from changes in the central nervous system (CNS) that may result from immunological abnormalities. The immune system affects the CNS through cytokines, which regulate brain activities and emotions. Cytokines affect two biological systems that are most associated with the pathophysiology of depression: The hypothalamic-pituitary-adrenal axis and the catecholamine/sympathetic nervous system. Neuroinflammation and cytokines affect the brain signal patterns involved in the psychopathology of depression and the mechanisms of antidepressants, and they are associated with neurogenesis and neural plasticity. These observations suggest that neuroinflammation and cytokines might cause and/or maintain depression, and that they might be useful in the diagnosis and prognosis of depression. This psychoneuroimmunologic perspective might compensate for some of the limitations of the monoamine theory by suggesting that depression is a result of a failure to adapt to stress and that inflammatory responses and cytokines are involved in this process. In this review, the interactions of cytokines with the CNS, neuroendocrine system, neurotransmitters, neurodegeneration/neurogenesis, and antidepressants are discussed. The roles of cytokines in the etiology and psychopathology of depression are examined. The use of cytokine inhibitors or anti-inflammatory drugs in depression treatment is explored. Finally, the significance and limitations of the cytokine hypothesis are discussed. PMID:27679767

  9. Neuroinflammation and cytokine abnormality in major depression: Cause or consequence in that illness?

    PubMed

    Jeon, Sang Won; Kim, Yong Ku

    2016-09-22

    Depression results from changes in the central nervous system (CNS) that may result from immunological abnormalities. The immune system affects the CNS through cytokines, which regulate brain activities and emotions. Cytokines affect two biological systems that are most associated with the pathophysiology of depression: The hypothalamic-pituitary-adrenal axis and the catecholamine/sympathetic nervous system. Neuroinflammation and cytokines affect the brain signal patterns involved in the psychopathology of depression and the mechanisms of antidepressants, and they are associated with neurogenesis and neural plasticity. These observations suggest that neuroinflammation and cytokines might cause and/or maintain depression, and that they might be useful in the diagnosis and prognosis of depression. This psychoneuroimmunologic perspective might compensate for some of the limitations of the monoamine theory by suggesting that depression is a result of a failure to adapt to stress and that inflammatory responses and cytokines are involved in this process. In this review, the interactions of cytokines with the CNS, neuroendocrine system, neurotransmitters, neurodegeneration/neurogenesis, and antidepressants are discussed. The roles of cytokines in the etiology and psychopathology of depression are examined. The use of cytokine inhibitors or anti-inflammatory drugs in depression treatment is explored. Finally, the significance and limitations of the cytokine hypothesis are discussed.

  10. Is it useful to ask "Está deprimido?" ("Are you depressed?") to terminally-ill Portuguese patients? Results from outpatient research.

    PubMed

    Julião, Miguel; Nunes, Baltazar; Sobral, Maria Ana; Dias, Daniela; Inocêncio, Inês; Barbosa, António

    2016-04-01

    Depression is a serious psychological problem in the palliative care setting. Brief screening tools for depression are lacking and need to be brief and acceptable. This study aimed to identify the properties of the single Portuguese question "Está deprimido?" ("Are you depressed?") to screen for depression. Retrospective study from 100 patient's medical records identifying the answers on the single Portuguese question for depression "Está deprimido?" ("Are you depressed?") and the HADS depression sub-scale, using a score ≥11 on the latter as the gold standard for clinically significant depressive symptoms. Sensitivity, specificity, positive predictive and negative values were calculated. Response rate for the single Portuguese question for depression was 100%. Prevalence of depression symptoms (HADS-d ≥ 11) was 43%. To the question "Está deprimido?" 60 patients responded "yes." Sixteen patients who replied "no" to the single question had clinically significant depressive symptoms based on the HADS depression sub-scale. The single tool had 65.2% sensitivity, 49.2% specificity and 50.0% and 64.4% of positive predictive and negative values, respectively. In this first preliminary retrospective Portuguese study, the single question for depression has shown poor screening properties. Future research in larger and mixed patientś samples of Portuguese terminally ill is necessary to find more accurate and robust properties of this brief tool.

  11. An Illness of Power: Gender and the Social Causes of Depression.

    PubMed

    Neitzke, Alex B

    2016-03-01

    There is considerable discourse surrounding the disproportionate diagnosis of women with depression as compared to men, often times cited at a rate around 2:1. While this disparity clearly draws attention to gender, a focus on gender tends to fall away in the study and treatment of depression in neuroscience and psychiatry, which largely understand its workings in mechanistic terms of brain chemistry and neurological processes. I first consider how this brain-centered biological model for depression came about. I then argue that the authoritative scientific models for disorder have serious consequences for those diagnosed. Finally, I argue that mechanistic biological models of depression have the effect of silencing women and marginalizing or preventing the examination of social-structural causes of depression, like gender oppression, and therein contribute to the ideological reproduction of oppressive social relations. I argue that depression is best understood in terms of systems of power, including gender, and where a given individual is situated within such social relations. The result is a model of depression that accounts for the influence of biological, psychological, and social factors.

  12. Association of antepartum and postpartum depression in Ghanaian and Ivorian women with febrile illness in their offspring: a prospective birth cohort study.

    PubMed

    Guo, Nan; Bindt, Carola; Te Bonle, Marguerite; Appiah-Poku, John; Hinz, Rebecca; Barthel, Dana; Koffi, Mathurin; Posdzich, Sarah; Deymann, Simon; Barkmann, Claus; Schlüter, Lisa; Jaeger, Anna; Blay Nguah, Samuel; Eberhardt, Kirsten A; N'Goran, Eliezer; Tagbor, Harry; Ehrhardt, Stephan

    2013-11-01

    In low-income countries, perinatal depression is common, but longitudinal data on its influence on child health are rare. We examined the association between maternal depression and febrile illness in children. There were 654 mother/child dyads in Ghana and Côte d'Ivoire that were enrolled in a prospective birth cohort in 2010-2011 and underwent 2-years of follow up. Mothers were examined for depression using the Patient Health Questionnaire depression module antepartum and 3 and 12 months postpartum. The hazard of febrile illness in children of depressed and nondepressed mothers was estimated using a recurrent event Cox proportional hazards model. The prevalences of antepartum depression in mothers from Côte d'Ivoire and Ghana were 28.3% and 26.3%, respectively. The prevalences of depression at 3 and 12 months postpartum were 11.8% and 16.1% (Côte d'Ivoire) and 8.9% and 7.2% (Ghana). The crude and adjusted (for country and socioeconomic status) hazard ratios of febrile illness in children of depressed mothers compared with those in children of nondepressed mothers were 1.57 (95% confidence interval: 1.20, 2.07) and 1.32 (95% confidence interval: 1.01, 1.74) respectively. Perinatal depression was frequent and associated with febrile illness in the offspring. Our results showed that a high prevalence of depression in sub-Saharan Africa may pose a serious public health threat to women and their offspring.

  13. Illness Perception and Depressive Symptoms among Persons with Type 2 Diabetes Mellitus: An Analytical Cross-Sectional Study in Clinical Settings in Nepal.

    PubMed

    Joshi, Suira; Dhungana, Raja Ram; Subba, Usha Kiran

    2015-01-01

    Background. This study aimed to assess the relationship between illness perception and depressive symptoms among persons with diabetes. Method. This was an analytical cross-sectional study conducted among 379 type 2 diabetic patients from three major clinical settings of Kathmandu, Nepal. Results. The prevalence of depressive symptoms was 44.1% (95% CI: 39.1, 49.1). Females (p < 0.01), homemakers (p < 0.01), 61-70 age group (p = 0.01), those without formal education (p < 0.01), and people with lower social status (p < 0.01) had significantly higher proportion of depressive symptoms than the others. Multivariable analysis identified age (β = 0.036, p = 0.016), mode of treatment (β = 0.9, p = 0.047), no formal educational level (β = 1.959, p = 0.01), emotional representation (β = 0.214, p < 0.001), identity (β = 0.196, p < 0.001), illness coherence (β = -0.109, p = 0.007), and consequences (β = 0.093, p = 0.049) as significant predictors of depressive symptoms. Conclusion. Our study demonstrated a strong relationship between illness perception and depressive symptoms among diabetic patients. Study finding indicated that persons living with diabetes in Nepal need comprehensive diabetes education program for changing poor illness perception, which ultimately helps to prevent development of depressive symptoms.

  14. Illness Perception and Depressive Symptoms among Persons with Type 2 Diabetes Mellitus: An Analytical Cross-Sectional Study in Clinical Settings in Nepal

    PubMed Central

    Joshi, Suira; Dhungana, Raja Ram; Subba, Usha Kiran

    2015-01-01

    Background. This study aimed to assess the relationship between illness perception and depressive symptoms among persons with diabetes. Method. This was an analytical cross-sectional study conducted among 379 type 2 diabetic patients from three major clinical settings of Kathmandu, Nepal. Results. The prevalence of depressive symptoms was 44.1% (95% CI: 39.1, 49.1). Females (p < 0.01), homemakers (p < 0.01), 61–70 age group (p = 0.01), those without formal education (p < 0.01), and people with lower social status (p < 0.01) had significantly higher proportion of depressive symptoms than the others. Multivariable analysis identified age (β = 0.036, p = 0.016), mode of treatment (β = 0.9, p = 0.047), no formal educational level (β = 1.959, p = 0.01), emotional representation (β = 0.214, p < 0.001), identity (β = 0.196, p < 0.001), illness coherence (β = −0.109, p = 0.007), and consequences (β = 0.093, p = 0.049) as significant predictors of depressive symptoms. Conclusion. Our study demonstrated a strong relationship between illness perception and depressive symptoms among diabetic patients. Study finding indicated that persons living with diabetes in Nepal need comprehensive diabetes education program for changing poor illness perception, which ultimately helps to prevent development of depressive symptoms. PMID:26236749

  15. Anxiety and depressive symptoms and medical illness among adults with anxiety disorders.

    PubMed

    Niles, Andrea N; Dour, Halina J; Stanton, Annette L; Roy-Byrne, Peter P; Stein, Murray B; Sullivan, Greer; Sherbourne, Cathy D; Rose, Raphael D; Craske, Michelle G

    2015-02-01

    Anxiety is linked to a number of medical conditions, yet few studies have examined how symptom severity relates to medical comorbidity. The current study assessed associations between severity of anxiety and depression and the presence of medical conditions in adults diagnosed with anxiety disorders. Nine-hundred eighty-nine patients diagnosed with panic, generalized anxiety, social anxiety, and posttraumatic stress disorders reported on the severity of anxiety and depressive symptoms and on diagnoses of 11 medical conditions. Severity of anxiety and depressive symptoms was strongly associated with having more medical conditions over and above control variables, and the association was as strong as that between BMI and disease. Odds of having asthma, heart disease, back problems, ulcer, migraine headache and eyesight difficulties also increased as anxiety and depressive symptom severity increased. Anxiety symptoms were independently associated with ulcer, whereas depressive symptoms were independently associated with heart disease, migraine, and eyesight difficulties. These findings add to a growing body of research linking anxiety disorders with physical health problems and indicate that anxiety and depressive symptoms deserve greater attention in their association with disease. Copyright © 2014 Elsevier Inc. All rights reserved.

  16. Anxiety and Depressive Symptoms and Medical Illness Among Adults with Anxiety Disorders

    PubMed Central

    Niles, Andrea N.; Dour, Halina J.; Stanton, Annette L.; Roy-Byrne, Peter P.; Stein, Murray B.; Sullivan, Greer; Sherbourne, Cathy D.; Rose, Raphael D.; Craske, Michelle G.

    2014-01-01

    Objective Anxiety is linked to a number of medical conditions, yet few studies have examined how symptom severity relates to medical comorbidity. Purpose The current study assessed associations between severity of anxiety and depression and presence of medical conditions in adults diagnosed with anxiety disorders. Method Nine-hundred eighty-nine patients diagnosed with panic, generalized anxiety, social anxiety, and posttraumatic stress disorders reported on the severity of anxiety and depressive symptoms and on diagnoses of 11 medical conditions. Results Severity of anxiety and depressive symptoms was strongly associated with having more medical conditions over and above control variables, and the association was as strong as that between BMI and disease. Odds of having asthma, heart disease, back problems, ulcer, migraine headache and eyesight difficulties also increased as anxiety and depressive symptom severity increased. Anxiety symptoms were independently associated with ulcer, whereas depressive symptoms were independently associated with heart disease, migraine, and eyesight difficulties. Conclusions These findings add to a growing body of research linking anxiety disorders with physical health problems and indicate that anxiety and depressive symptoms deserve greater attention in their association with disease. PMID:25510186

  17. How people evaluate others with social anxiety disorder: A comparison to depression and general mental illness stigma.

    PubMed

    Anderson, Kristin N; Jeon, Andrew B; Blenner, Jordan A; Wiener, Richard L; Hope, Debra A

    2015-03-01

    Despite the availability of effective interventions, most individuals with social anxiety disorder do not seek treatment. Given their fear of negative evaluation, socially anxious individuals might be especially susceptible to stigma concerns, a recognized barrier for mental health treatment. However, very little is known about the stigma specific to social anxiety disorder. In a design similar to Feldman and Crandall (2007), university undergraduate students read vignettes about target individuals with a generic mental illness label, major depressive disorder, and social anxiety disorder. Subjects rated each of 3 people in the vignettes on social distance and 17 dimensions including dangerousness, heritability and prevalence of the disorder, and gender ratio. Results indicated that being male and not having experience with mental health treatment was associated with somewhat greater preferred social distance. Multiple regression analyses revealed that being embarrassed by the disorder and dangerousness predicted social distance across all 3 vignettes. The vignette for social anxiety disorder had the most complex model and included work impairment, more common among women, and more avoidable. These results have implications for understanding the specific aspects of the stigma associated with social anxiety disorder. Public service messages to reduce stigma should focus on more accurate information about dangerousness and mental illness, given this is an established aspect of mental illness stigma. More nuanced messages about social anxiety might be best incorporated into the treatment referral process and as part of treatment.

  18. Illness burden and physical outcomes associated with collaborative care in patients with comorbid depressive disorder in chronic medical conditions: A systematic review and meta-analysis.

    PubMed

    van Eck van der Sluijs, Jonna F; Castelijns, Hilde; Eijsbroek, Vera; Rijnders, Cees A Th; van Marwijk, Harm W J; van der Feltz-Cornelis, Christina M

    2017-09-13

    Collaborative care (CC) improves depressive symptoms in people with comorbid depressive disorder in chronic medical conditions, but its effect on physical symptoms has not yet systematically been reviewed. This study aims to do so. Systematic review and meta-analysis was conducted using PubMed, the Cochrane Library, and the European and US Clinical Trial Registers. Eligible studies included randomized controlled trials (RCTs) of CC compared to care as usual (CAU), in primary care and general hospital setting, reporting on physical and depressive symptoms as outcomes. Overall treatment effects were estimated for illness burden, physical outcomes and depression, respectively. Twenty RCTs were included, with N=4774 patients. The overall effect size of CC versus CAU for illness burden was OR 1.64 (95%CI 1.47;1.83), d=0.27 (95%CI 0.21;0.33). Best physical outcomes in CC were found for hypertension with comorbiddepression. Overall, depression outcomes were better for CC than for CAU. Moderator analyses did not yield statistically significant differences. CC is more effective than CAU in terms of illness burden, physical outcomes and depression, in patients with comorbid depression in chronic medical conditions. More research covering multiple medical conditions is needed. The protocol for this systematic review and meta-analysis has been registered at the International Prospective Register of Systematic Reviews (PROSPERO) on February 19th 2016: http://www.crd.york.ac.uk/PROSPERO/DisplayPDF.php?ID=CRD42016035553. Copyright © 2017 Elsevier Inc. All rights reserved.

  19. Predicting relapse in major depressive disorder using patient-reported outcomes of depressive symptom severity, functioning, and quality of life in the Individual Burden of Illness Index for Depression (IBI-D).

    PubMed

    Ishak, Waguih William; Greenberg, Jared M; Cohen, Robert M

    2013-10-01

    Patients with Major Depressive Disorder (MDD) often experience unexpected relapses, despite achieving remission. This study examines the utility of a single multidimensional measure that captures variance in patient-reported Depressive Symptom Severity, Functioning, and Quality of Life (QOL), in predicting MDD relapse. Complete data from remitted patients at the completion of 12 weeks of citalopram in the STAR*D study were used to calculate the Individual Burden of Illness index for Depression (IBI-D), and predict subsequent relapse at six (n=956), nine (n=778), and twelve months (n=479) using generalized linear models. Depressive Symptom Severity, Functioning, and QOL were all predictors of subsequent relapse. Using Akaike information criteria (AIC), the IBI-D provided a good model for relapse even when Depressive Symptom Severity, Functioning, and QOL were combined in a single model. Specifically, an increase of one in the IBI-D increased the odds ratio of relapse by 2.5 at 6 months (β=0.921 ± 0.194, z=4.76, p<2 × 10(-6)), by 2.84 at 9 months (β=1.045 ± 0.22, z=4.74, p<2.2 × 10(-6)), and by 4.1 at 12 months (β=1.41 ± 0.29, z=4.79, p<1.7 × 10(-6)). Self-report poses a risk to measurement precision. Using highly valid and reliable measures could mitigate this risk. The IBI-D requires time and effort for filling out the scales and index calculation. Technological solutions could help ease these burdens. The sample suffered from attrition. Separate analysis of dropouts would be helpful. Incorporating patient-reported outcomes of Functioning and QOL in addition to Depressive Symptom Severity in the IBI-D is useful in assessing the full burden of illness and in adequately predicting relapse, in MDD. © 2013 Elsevier B.V. All rights reserved.

  20. Predicting relapse in major depressive disorder using patient-reported outcomes of depressive symptom severity, functioning, and quality of life in the individual burden of illness index for depression (IBI-D)

    PubMed Central

    IsHak, Waguih William; Greenberg, Jared M.; Cohen, Robert M.

    2014-01-01

    Background Patients with Major Depressive Disorder (MDD) often experience unexpected relapses, despite achieving remission. This study examines the utility of a single multidimensional measure that captures variance in patient-reported Depressive Symptom Severity, Functioning, and Quality of Life (QOL), in predicting MDD relapse. Methods Complete data from remitted patients at the completion of 12 weeks of citalopram in the STAR*D study were used to calculate the Individual Burden of Illness index for Depression (IBI-D), and predict subsequent relapse at six (n = 956), nine (n = 778), and twelve months (n = 479) using generalized linear models. Results Depressive Symptom Severity, Functioning, and QOL were all predictors of subsequent relapse. Using Akaike information criteria (AIC), the IBI-D provided a good model for relapse even when Depressive Symptom Severity, Functioning, and QOL were combined in a single model. Specifically, an increase of one in the IBI-D increased the odds ratio of relapse by 2.5 at 6 months (β = 0.921 ± 0.194, z = 4.76, p < 2 × 10−6), by 2.84 at 9 months (β = 1.045 ± 0.22, z = 4.74, p < 2.2 × 10−6), and by 4.1 at 12 months (β = 1.41 ± 0.29, z = 4.79, p < 1.7 × 10−6). Limitations Self-report poses a risk to measurement precision. Using highly valid and reliable measures could mitigate this risk. The IBI-D requires time and effort for filling out the scales and index calculation. Technological solutions could help ease these burdens. The sample suffered from attrition. Separate analysis of dropouts would be helpful. Conclusions Incorporating patient-reported outcomes of Functioning and QOL in addition to Depressive Symptom Severity in the IBI-D is useful in assessing the full burden of illness and in adequately predicting relapse, in MDD. PMID:23790554

  1. Revisiting the concept of severe mental illness: severity indicators and healthcare spending in psychotic, depressive and dissociative disorders.

    PubMed

    Gonzalez Vazquez, Ana Isabel; Seijo Ameneiros, Natalia; Díaz Del Valle, Juan Carlos; Lopez Fernandez, Ester; Santed Germán, Miguel Angel

    2017-08-10

    The concept of severe mental illness (SMI) has been related to bipolar or psychotic diagnosis, or to some cases of depressive disorders. Other mental health problems such as personality disorders or posttraumatic dissociative conditions, which can sometimes lead to relevant functional impairments, remain separate from the SMI construct. This study aimed to evaluate the clinical severity as well as healthcare spending on dissociative disorders (DDs). This diagnostic group was compared with two other groups usually considered as causing severe impairment and high healthcare spending: bipolar and psychotic disorders, and unipolar depression. From a random sample of 200 psychiatric outpatients, 108 with unipolar depression (N = 45), psychotic/bipolar (N = 31) or DDs (N = 32) were selected for this study. The three groups were compared by the severity of their disorder and healthcare indicators. Of the three groups, those with a DD were more prone to and showed higher indices of suicide, self-injury, emergency consultations, as well as psychotropic drug use. This group ranked just below psychotic/bipolar patients in the amount of psychiatric hospitalisations. Despite a certain intra-professional stigma regarding DDs, these data supported the severity of these posttraumatic conditions, and their inclusion in the construct of SMI.

  2. Lurasidone for the Treatment of Major Depressive Disorder With Mixed Features: A Randomized, Double-Blind, Placebo-Controlled Study.

    PubMed

    Suppes, Trisha; Silva, Robert; Cucchiaro, Josephine; Mao, Yongcai; Targum, Steven; Streicher, Caroline; Pikalov, Andrei; Loebel, Antony

    2016-04-01

    Accumulating evidence indicates that manic symptoms below the threshold for hypomania (mixed features) are common in individuals with major depressive disorder. This form of depression is often severe and is associated with an increased risk for recurrence, suicide attempts, substance abuse, and functional disability. This study evaluated the efficacy and safety of lurasidone in major depressive disorder with mixed features. Patients meeting DSM-IV-TR criteria for major depressive disorder who presented with two or three protocol-defined manic symptoms were randomly assigned to 6 weeks of double-blind treatment with either lurasidone at 20-60 mg/day (N=109) or placebo (N=100). Changes from baseline in Montgomery-Åsberg Depression Rating Scale score (MADRS; primary outcome measure) and Clinical Global Impressions severity subscale score (CGI-S; key secondary outcome measure) were evaluated using a mixed model for repeated-measures analysis. Lurasidone significantly improved depressive symptoms and overall illness severity, assessed by least squares mean change at week 6 in the MADRS and CGI-S scores: -20.5 compared with -13.0 (effect size, 0.80) and -1.8 compared with -1.2 (effect size, 0.60), respectively. Significant improvement in manic symptoms, assessed by the Young Mania Rating Scale, was also observed, in addition to other secondary efficacy endpoints. Rates of discontinuation due to adverse events were low. The most common adverse events were nausea (6.4% and 2.0% in the lurasidone and placebo groups, respectively) and somnolence (5.5% and 1.0%). Lurasidone was effective and well tolerated in this study involving patients with major depressive disorder associated with subthreshold hypomanic symptoms (mixed features).

  3. No Impact of Preadmission Anti-Inflammatory Drug Use on Risk of Depression and Anxiety After Critical Illness.

    PubMed

    Medici, Clara R; Gradus, Jaimie L; Pedersen, Lars; Sørensen, Henrik T; Østergaard, Søren D; Christiansen, Christian F

    2017-10-01

    , glucocorticoids, or combinations did not alter the risk of depression and anxiety after critical illness.

  4. Smartphone data as an electronic biomarker of illness activity in bipolar disorder.

    PubMed

    Faurholt-Jepsen, Maria; Vinberg, Maj; Frost, Mads; Christensen, Ellen Margrethe; Bardram, Jakob E; Kessing, Lars Vedel

    2015-11-01

    Objective methods are lacking for continuous monitoring of illness activity in bipolar disorder. Smartphones offer unique opportunities for continuous monitoring and automatic collection of real-time data. The objectives of the paper were to test the hypotheses that (i) daily electronic self-monitored data and (ii) automatically generated objective data collected using smartphones correlate with clinical ratings of depressive and manic symptoms in patients with bipolar disorder. Software for smartphones (the MONARCA I system) that collects automatically generated objective data and self-monitored data on illness activity in patients with bipolar disorder was developed by the authors. A total of 61 patients aged 18-60 years and with a diagnosis of bipolar disorder according to ICD-10 used the MONARCA I system for six months. Depressive and manic symptoms were assessed monthly using the Hamilton Depression Rating Scale 17-item (HDRS-17) and the Young Mania Rating Scale (YMRS), respectively. Data are representative of over 400 clinical ratings. Analyses were computed using linear mixed-effect regression models allowing for both between individual variation and within individual variation over time. Analyses showed significant positive correlations between the duration of incoming and outgoing calls/day and scores on the HDRS-17, and significant positive correlations between the number and duration of incoming calls/day and scores on the YMRS; the number of and duration of outgoing calls/day and scores on the YMRS; and the number of outgoing text messages/day and scores on the YMRS. Analyses showed significant negative correlations between self-monitored data (i.e., mood and activity) and scores on the HDRS-17, and significant positive correlations between self-monitored data (i.e., mood and activity) and scores on the YMRS. Finally, the automatically generated objective data were able to discriminate between affective states. Automatically generated objective data and

  5. Public Stigma Toward Mental Illness in Jordan: A Cross-Sectional Survey of Family Members of Individuals With Schizophrenia, Depression, and Anxiety.

    PubMed

    Hasan, Abd Al-Hadi; Musleh, Mahmoud

    2017-06-01

    Stigma affects family members of individuals with mental illness. A survey of 640 family members of individuals with mental illness was conducted. Three factors were found to influence stigma regarding schizophrenia, depression, and anxiety: (a) preconceived stereotypes, (b) a sense of personal responsibility or blame for the condition, and (c) perceptions of the patient's inability to recover from the condition. A stronger association between negative stereotypes and inability to recover was found with schizophrenia than depression or anxiety. Conversely, depression and anxiety were found to be correlated with personal responsibility or blame for the condition. The public perception of mental health conditions (e.g., depression, anxiety, schizophrenia) has a crucial role in deriving programs for reducing stigma and raising awareness. Personalized and efficacious treatment regimens may be facilitated by understanding these perceptions and the underlying explanations for why they exist. [Journal of Psychosocial Nursing and Mental Health Services, 55(6), 36-43.]. Copyright 2017, SLACK Incorporated.

  6. Depressive illness in teens and preteens and effectiveness of the RADS-2 as a first-stage assessment. Part 1: Descriptive paper.

    PubMed

    Weber, Scott

    2009-08-01

    Measurement of the characteristics and severity of depression in adolescence is an emerging science. During patient assessment, or if using first-stage screening measures in practice, nurses must be confident that these instruments demonstrate high levels of accuracy in capturing the specific features of depressive symptoms expressed in diverse individuals. A review of the scientific literature of depressive illness and its assessment in teens and preteens is presented. The Reynolds Adolescent Depression Scale-Revised (RADS-2) measure is introduced and evaluated from a nursing practice standpoint. The RADS-2 is easy to use and demonstrates good reliability, validity, and construct features, providing evidence for nurses that the measure can be used with confidence in assessment of depressive symptoms in adolescents. The RADS-2 is an effective first-stage assessment of depressive mood in teens and preteens.

  7. Parent Perceptions of Illness Uncertainty and Child Depressive Symptoms in Juvenile Rheumatic Diseases: Examining Caregiver Demand and Parent Distress as Mediators.

    PubMed

    Chaney, John M; Gamwell, Kaitlyn L; Baraldi, Amanda N; Ramsey, Rachelle R; Cushing, Christopher C; Mullins, Alexandria J; Gillaspy, Stephen R; Jarvis, James N; Mullins, Larry L

    2016-10-01

    Examine caregiver demand and general parent distress as mediators in the parent illness uncertainty-child depressive symptom association in youth with juvenile rheumatic diseases.   Children and adolescents completed the Child Depression Inventory; caregivers completed the Parent Perceptions of Uncertainty Scale, the Care for My Child with Rheumatic Disease Scale, and the Brief Symptom Inventory. The pediatric rheumatologist provided ratings of clinical disease status.   Analyses revealed significant direct associations between illness uncertainty and caregiver demand, and between caregiver demand and both parent distress and child depressive symptoms. Results also revealed significant parent uncertainty → caregiver demand → parent distress and parent uncertainty → caregiver demand → child depressive symptom indirect paths.   Results highlight the role of illness appraisals in adjustment to juvenile rheumatic diseases, and provide preliminary evidence that parent appraisals of illness uncertainty impact parent distress and child depressive symptoms indirectly through increased perceptions of caregiver demand. © The Author 2016. Published by Oxford University Press on behalf of the Society of Pediatric Psychology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  8. Shared Psychotic Manic Syndrome in Monozygotic Twins: A Case Report

    PubMed Central

    Ghasemzadeh, Mohammad Reza; Ghadiri Vasfi, Mohammad; Nohesara, Shabnam; Shabani, Amir

    2012-01-01

    Objective: A rare phenomenon of Shared Psychosis Disorder occurring in the context of Bipolar I Disorder, in identical twins is reported. Case Presentation: Two identical twins with shared Psychotic Manic Syndrome were admitted and received antipsychotic and lithium as their treatment. Psychotic symptoms of primary case did not improve and her diagnosis changed into Schizophrenia. They had hypothyroidism at the same time. Conclusion: Completely shared manic syndrome along with the psychotic features shows a need for the criteria of shared syndromes to develop, including both psychotic and mood symptoms. PMID:24644474

  9. [Hormones in depressive illness. The role of cortisol and sexual steroids (author's transl)].

    PubMed

    de Lignières, B; Mauvais-Jarvis, P

    1979-01-01

    It is actually highly probable than depression is linked to a decrease in noradrenergic activity in brain, at least in some areas including hypothalamus. The complexity of relations between dopaminergic and serotoninergic systems lead to multiple possibilities in hypothetical etiologic factors and in therapeutic interventions. A plasmatic drop in testosterone in men and estradiol in women is one of the situation able to induce a decrease in noradrenergic activity. It seems to be of primordial influence on depression at least in patients with predominant clinical hypogonadic symptoms. We still don't know the frequency on hypogonadism in peoples with predominant depressive symptoms. However this incidence may be fairly high because it is now demonstrated than environmental stress could impaired testicular and ovarian function by the means of anxiety hormones, catecholamines and cortisol, and also by a direct effect on hypothalamus. In no case this hormonal reactions are adaptative by means of anti-anxiety or anti-depressive effects. In contrary, they contribute to maintain the psycho-endocrine syndrome.

  10. Molecular genetics in affective illness

    SciTech Connect

    Mendlewicz, J.; Sevy, S.; Mendelbaum, K. )

    1993-01-01

    Genetic transmission in manic depressive illness (MDI) has been explored in twins, adoption, association, and linkage studies. The X-linked transmission hypothesis has been tested by using several markers on chromosome X: Xg blood group, color blindness, glucose-6-phosphate dehydrogenase (G6PD), factor IX (hemophilia B), and DNA probes such as DXS15, DXS52, F8C, ST14. The hypothesis of autosomal transmission has been tested by association studies with the O blood group located on chromosome 9, as well as linkage studies on chromosome 6 with the Human Leucocyte Antigens (HLA) haplotypes and on Chromosome 11 with DNA markers for the following genes: D2 dopamine receptor, tyrosinase, C-Harvey-Ras-A (HRAS) oncogene, insuline (ins), and tyrosine hydroxylase (TH). Although linkage studies support the hypothesis of a major locus for the transmission of MDI in the Xq27-28 region, several factors are limiting the results, and are discussed in the present review. 105 refs., 1 fig., 2 tabs.

  11. The effect of mental illness, substance use, and treatment for depression on the initiation of highly active antiretroviral therapy among HIV-infected individuals.

    PubMed

    Tegger, Mary K; Crane, Heidi M; Tapia, Kenneth A; Uldall, Karina K; Holte, Sarah E; Kitahata, Mari M

    2008-03-01

    Information regarding the prevalence of mental illness and substance use among HIV-infected patients and the effect of these problems on HIV treatment is needed. We conducted an observational study of patients in the University of Washington (UW) HIV Cohort to determine prevalence rates for mental illness and substance use. Cox regression analyses were used to examine the relationship between mental illness and substance use, pharmacologic treatment for depression/anxiety, and initiation of highly active antiretroviral therapy (HAART) within 9 months of becoming eligible for HAART. Among 1774 patients in the UW HIV cohort during 2004, 63% had a mental illness (including mood, anxiety, psychotic, or personality disorders), 45% had a substance use disorder, and 38% had both. There were 278 patients who met criteria for HAART eligibility. After controlling for other factors, patients with depression and/or anxiety were significantly less likely to initiate HAART compared with patients without a mental illness (hazard ratio [HR] 0.4, p = 0.02). However, patients with depression/anxiety who received antidepressant/antianxiety medications were equally likely to initiate HAART as patients without a mental illness (HR 0.9, p = 0.5). We found that patients with mental illness or substance use disorders receive HAART at lower CD4+ cell counts and higher HIV-1 RNA levels than patients without these disorders. However, HAART initiation among patients who receive treatment for depression/anxiety is associated with no delay. Screening for these disorders in primary care settings and access to appropriate treatment are increasingly important components of providing care to HIV-infected patients.

  12. EFFECTS OF RELIGIOUS VERSUS STANDARD COGNITIVE-BEHAVIORAL THERAPY ON OPTIMISM IN PERSONS WITH MAJOR DEPRESSION AND CHRONIC MEDICAL ILLNESS.

    PubMed

    Koenig, Harold G; Pearce, Michelle J; Nelson, Bruce; Daher, Noha

    2015-11-01

    We compared the effectiveness of religiously integrated cognitive behavioral therapy (RCBT) versus standard CBT (SCBT) on increasing optimism in persons with major depressive disorder (MDD) and chronic medical illness. Participants aged 18-85 were randomized to either RCBT (n = 65) or SCBT (n = 67) to receive ten 50-min sessions remotely (94% by telephone) over 12 weeks. Optimism was assessed at baseline, 12 and 24 weeks by the Life Orientation Test-Revised. Religiosity was assessed at baseline using a 29-item scale composed of religious importance, individual religious practices, intrinsic religiosity, and daily spiritual experiences. Mixed effects growth curve models were used to compare the effects of treatment group on trajectory of change in optimism. In the intention-to-treat analysis, both RCBT and SCBT increased optimism over time, although there was no significant difference between treatment groups (B = -0.75, SE = 0.57, t = -1.33, P = .185). Analyses in the highly religious and in the per protocol analysis indicated similar results. Higher baseline religiosity predicted an increase in optimism over time (B = 0.07, SE = 0.02, t = 4.12, P < .0001), and higher baseline optimism predicted a faster decline in depressive symptoms over time (B = -0.61, SE = 0.10, t = -6.30, P < .0001), both independent of treatment group. RCBT and SCBT are equally effective in increasing optimism in persons with MDD and chronic medical illness. While baseline religiosity does not moderate this effect, religiosity predicts increases in optimism over time independent of treatment group. © 2015 Wiley Periodicals, Inc.

  13. Endocannabinoid Signaling in the Etiology and Treatment of Major Depressive Illness

    PubMed Central

    Hillard, Cecilia J.; Liu, Qing-song

    2014-01-01

    The purpose of this review is to examine human and preclinical data that are relevant to the following hypotheses. The first hypothesis is that deficient CB1R-mediated signaling results in symptoms that mimic those seen in depression. The second hypothesis is that activation of CB1R-mediated signaling results in behavioral, endocrine and other effects that are similar to those produced by currently used antidepressants. The third hypothesis is that conventional antidepressant therapies act through enhanced CB1R mediated signaling. Together the available data indicate that activators of CB1R signaling, particularly inhibitors of fatty acid amide hydrolase, should be considered for clinical trials for the treatment of depression. PMID:24180398

  14. The quick inventory of depressive symptomatology (clinician and self-report versions) in patients with bipolar disorder.

    PubMed

    Bernstein, Ira H; Rush, A John; Suppes, Trisha; Kyotoku, Yakasushi; Warden, Diane

    2010-06-01

    The clinical and self-report versions of the Quick Inventory of Depressive Symptomatology (QIDS-C16 and QIDS-SR16) have been well studied in patients with major depressive disorder and in one recent study using patients with bipolar disorder. This article examines these measures in a second sample of 141 outpatients with bipolar disorder in different phases of the illness. At baseline, 61 patients were depressed and 30 were euthymic; at exit, 50 were depressed and 52 were euthymic. The remaining patients (at baseline or exit) were in either a manic or mixed phase and were pooled for statistical reasons. Similar results were found for the QIDS-C16 and QIDS-SR16. Scores were reasonably reliable to the extent that variability within groups permitted. As expected, euthymic patients showed less depressive symptomatology than depressed patients. Sad mood and general interest were the most discriminating symptoms between depressed and euthymic phases. Changes in illness phase (baseline to exit) were associated with substantial changes in scores. The relation of individual depressive symptoms to the overall level of depression was consistent across phases. Both the QIDS-SR16 and QIDS-C16 are suitable measures of depressive symptoms in patients with bipolar disorder.

  15. Spirituality and religious coping in African American youth with depressive illness

    PubMed Central

    Breland-Noble, Alfiee M.; Wong, Michele J; Childers, Trenita; Hankerson, Sidney; Sotomayor, Jason

    2015-01-01

    The research team completed a secondary data analysis of primary data from a 2 phase depression treatment engagement behavioral trial to assess African American adolescents reported experiences of spiritual and religious coping when dealing with depression. The team utilized data collected from twenty-eight youth who participated in focus groups or individual interviews. Qualitative data were analyzed using thematic techniques for transcript-based analysis to identify the key patterns and elements of the study participants’ accounts and to extract 6 primary themes. The main themes are reported in this manuscript and include; “Religion as Treatment Incentive”, “Prayer & Agency”, “Mixed Emotions”, “Doesn't Hurt, Might Help”, “Finding Support in the Church”, and “Prayer and Church: Barriers to Treatment?” Overall, the data suggested that religion and spirituality play a key role in African American adolescents’ experiences of depression. As well, it is surmised that these factors may be important for improving treatment seeking behaviors and reducing racial mental health disparities in this population of youth. PMID:26500425

  16. Object location and object recognition memory impairments, motivation deficits and depression in a model of Gulf War illness

    PubMed Central

    Hattiangady, Bharathi; Mishra, Vikas; Kodali, Maheedhar; Shuai, Bing; Rao, Xiolan; Shetty, Ashok K.

    2014-01-01

    Memory and mood deficits are the enduring brain-related symptoms in Gulf War illness (GWI). Both animal model and epidemiological investigations have indicated that these impairments in a majority of GW veterans are linked to exposures to chemicals such as pyridostigmine bromide (PB, an antinerve gas drug), permethrin (PM, an insecticide) and DEET (a mosquito repellant) encountered during the Persian Gulf War-1. Our previous study in a rat model has shown that combined exposures to low doses of GWI-related (GWIR) chemicals PB, PM, and DEET with or without 5-min of restraint stress (a mild stress paradigm) causes hippocampus-dependent spatial memory dysfunction in a water maze test (WMT) and increased depressive-like behavior in a forced swim test (FST). In this study, using a larger cohort of rats exposed to GWIR-chemicals and stress, we investigated whether the memory deficiency identified earlier in a WMT is reproducible with an alternative and stress free hippocampus-dependent memory test such as the object location test (OLT). We also ascertained the possible co-existence of hippocampus-independent memory dysfunction using a novel object recognition test (NORT), and alterations in mood function with additional tests for motivation and depression. Our results provide new evidence that exposure to low doses of GWIR-chemicals and mild stress for 4 weeks causes deficits in hippocampus-dependent object location memory and perirhinal cortex-dependent novel object recognition memory. An open field test performed prior to other behavioral analyses revealed that memory impairments were not associated with increased anxiety or deficits in general motor ability. However, behavioral tests for mood function such as a voluntary physical exercise paradigm and a novelty suppressed feeding test (NSFT) demonstrated decreased motivation levels and depression. Thus, exposure to GWIR-chemicals and stress causes both hippocampus-dependent and hippocampus-independent memory

  17. Object location and object recognition memory impairments, motivation deficits and depression in a model of Gulf War illness.

    PubMed

    Hattiangady, Bharathi; Mishra, Vikas; Kodali, Maheedhar; Shuai, Bing; Rao, Xiolan; Shetty, Ashok K

    2014-01-01

    Memory and mood deficits are the enduring brain-related symptoms in Gulf War illness (GWI). Both animal model and epidemiological investigations have indicated that these impairments in a majority of GW veterans are linked to exposures to chemicals such as pyridostigmine bromide (PB, an antinerve gas drug), permethrin (PM, an insecticide) and DEET (a mosquito repellant) encountered during the Persian Gulf War-1. Our previous study in a rat model has shown that combined exposures to low doses of GWI-related (GWIR) chemicals PB, PM, and DEET with or without 5-min of restraint stress (a mild stress paradigm) causes hippocampus-dependent spatial memory dysfunction in a water maze test (WMT) and increased depressive-like behavior in a forced swim test (FST). In this study, using a larger cohort of rats exposed to GWIR-chemicals and stress, we investigated whether the memory deficiency identified earlier in a WMT is reproducible with an alternative and stress free hippocampus-dependent memory test such as the object location test (OLT). We also ascertained the possible co-existence of hippocampus-independent memory dysfunction using a novel object recognition test (NORT), and alterations in mood function with additional tests for motivation and depression. Our results provide new evidence that exposure to low doses of GWIR-chemicals and mild stress for 4 weeks causes deficits in hippocampus-dependent object location memory and perirhinal cortex-dependent novel object recognition memory. An open field test performed prior to other behavioral analyses revealed that memory impairments were not associated with increased anxiety or deficits in general motor ability. However, behavioral tests for mood function such as a voluntary physical exercise paradigm and a novelty suppressed feeding test (NSFT) demonstrated decreased motivation levels and depression. Thus, exposure to GWIR-chemicals and stress causes both hippocampus-dependent and hippocampus-independent memory

  18. Effects of mood state on divided attention in patients with bipolar disorder: evidence for beneficial effects of subclinical manic symptoms.

    PubMed

    Koenders, Manja A; Spijker, Annet T; Hoencamp, Erik; Haffmans, Judith P M; Zitman, Frans G; Giltay, Erik J

    2014-12-15

    A relatively small number of studies have been dedicated to the differential effects of the current mood state on cognition in patients with a bipolar disorder (BD). The aim of the current study was to investigate the effect of current mood state on divided attention (DA) performance, and specifically examine possible beneficial effects of the (hypo-) manic state. Over a maximum period of 24 months, medication use, divided attention test (a subtest of the Test for Attentional Performance (TAP)) was assessed every 6 months in 189 outpatients with BD. Data were analyzed with multilevel regression analysis (i.e. linear mixed models). DA performance varied considerable over time within patients. Corrected for psychotropic medication a significant quadratic relationship between manic symptoms and DA performance was found, with mild hypomanic symptoms having a positive influence on divided attention scores and moderate to severe manic symptoms having a negative influence. No association between depressive symptoms and DA performance was found. In future research on mania and cognition as well as in the clinical practice both the beneficial and negative effects of mania should be taken into account.

  19. Mianserin in the treatment of depressive illness and anxiety states in general practice

    PubMed Central

    Murphy, J. E.

    1978-01-01

    1 In an initial study in general practice, mianserin was shown to be of similar antidepressant efficacy to imipramine. 2 A subsequent placebo-controlled study confirmed that mianserin is as effective as imipramine, and also demonstrated that both mianserin and imipramine are superior to placebo in the treatment of depression in general practice. 3 In a third trial, mianserin was found to be as effective as diazepam in the treatment of anxiety states in general practice. 4 The overall incidence of side-effects in this series of studies, either with mianserin or with the comparison drugs, was very low. PMID:341949

  20. Caring for Individuals with Chronic Illness and Minor Depression: Latino Perceptions of Caregiver Burden.

    PubMed

    Corvin, Jaime; Chan, Isabella; Tezak, Ann; Carpenter, Kelly; Aguado Loi, Claudia; Gonzales, Junius; Hoare, Ismael

    2017-01-01

    Informal caregiving can be fundamental to disease management. Yet, the psychosocial, physical, and financial burden experienced by caregivers can be significant. In the US, Latinos experience increasing rates of chronic conditions, the highest uninsured rates in the country, and a growing dependence on informal caregivers. This article explores the impact of caregiving on caregivers of individuals with comorbid chronic disease and depression. Findings highlight the impact of caregiving on financial insecurity, balancing competing demands, increased emotional distress, and community supports. Findings support the inclusion of caregivers in disease management programs to enhance psychosocial outcomes for both caregivers and their patients.

  1. Causal beliefs of the public and social acceptance of persons with mental illness: a comparative analysis of schizophrenia, depression and alcohol dependence.

    PubMed

    Schomerus, G; Matschinger, H; Angermeyer, M C

    2014-01-01

    There is an ongoing debate whether biological illness explanations improve tolerance towards persons with mental illness or not. Several theoretical models have been proposed to predict the relationship between causal beliefs and social acceptance. This study uses path models to compare different theoretical predictions regarding attitudes towards persons with schizophrenia, depression and alcohol dependence. In a representative population survey in Germany (n = 3642), we elicited agreement with belief in biogenetic causes, current stress and childhood adversities as causes of either disorder as described in an unlabelled case vignette. We further elicited potentially mediating attitudes related to different theories about the consequences of biogenetic causal beliefs (attribution theory: onset responsibility, offset responsibility; genetic essentialism: differentness, dangerousness; genetic optimism: treatability) and social acceptance. For each vignette condition, we calculated a multiple mediator path model containing all variables. Biogenetic beliefs were associated with lower social acceptance in schizophrenia and depression, and with higher acceptance in alcohol dependence. In schizophrenia and depression, perceived differentness and dangerousness mediated the largest indirect effects, the consequences of biogenetic causal explanations thus being in accordance with the predictions of genetic essentialism. Psychosocial causal beliefs had differential effects: belief in current stress as a cause was associated with higher acceptance in schizophrenia, while belief in childhood adversities resulted in lower acceptance of a person with depression. Biological causal explanations seem beneficial in alcohol dependence, but harmful in schizophrenia and depression. The negative correlates of believing in childhood adversities as a cause of depression merit further exploration.

  2. Circadian Rhythm Hypotheses of Mixed Features, Antidepressant Treatment Resistance, and Manic Switching in Bipolar Disorder

    PubMed Central

    Son, Gi-Hoon; Geum, Dongho

    2013-01-01

    Numerous hypotheses have been put forth over the years to explain the development of bipolar disorder. Of these, circadian rhythm hypotheses have gained much importance of late. While the hypothalamus-pituitary-adrenal (HPA) axis hyperactivation hypothesis and the monoamine hypothesis somewhat explain the pathogenic mechanism of depression, they do not provide an explanation for the development of mania/hypomania. Interestingly, all patients with bipolar disorder display significant disruption of circadian rhythms and sleep/wake cycles throughout their mood cycles. Indeed, mice carrying the Clock gene mutation exhibit an overall behavioral profile that is similar to human mania, including hyperactivity, decreased sleep, lowered depression-like behavior, and lower anxiety. It was recently reported that monoamine signaling is in fact regulated by the circadian system. Thus, circadian rhythm instability, imposed on the dysregulation of HPA axis and monoamine system, may in turn increase individual susceptibility for switching from depression to mania/hypomania. In addition to addressing the pathophysiologic mechanism underlying the manic switch, circadian rhythm hypotheses can explain other bipolar disorder-related phenomena such as treatment resistant depression and mixed features. PMID:24302944

  3. Complicated grief and manic comorbidity in the aftermath of the loss of a son.

    PubMed

    Carmassi, Claudia; Shear, M Katherine; Socci, Chiara; Corsi, Martina; Dell'osso, Liliana; First, Michael B

    2013-09-01

    Based on the recommendations of the sub-workgroup on trauma and dissociative disorders, the American Psychiatric Association (APA) removed the "bereavement exclusion" from the criteria for major depression in DSM-5. In addition, proposed DSM-5 research criteria for persistent complex bereavement disorder (PCBD) were included in the new manual in a section for conditions and criteria needing further research. We describe a case that warranted such a diagnosis. The patient was a 52- year-old woman who was admitted to the inpatient unit of our clinic on the birthday of her son who had died 18 months earlier. She was diagnosed with a manic episode with psychotic symptoms according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) criteria and was treated accordingly. Three months after discharge, she made a suicide attempt and was admitted and re-assessed. During this admission, she completed the Inventory of Complicated Grief (ICG), the Mood-Spectrum Rating Scale (MOODS-SR), and the Trauma and Loss Spectrum questionnaire (TALS-SR). She endorsed symptoms of intense yearning for her son, feelings of shock and disbelief, anger and bitterness related to his death, estrangement from others, auditory, tactile and visual hallucinations of the deceased, and intense emotional reactivity to memories of her son. These symptoms were sufficiently prolonged and severe to meet criteria for complicated grief. While complicated grief appeared to be the primary diagnosis for this patient, when she was diagnosed using only DSMIV-TR criteria, her treatment failed to address herprimary problem. This case draws attention to the occurrence of manic-like symptoms as well as depression-like manifestations following bereavement and highlights the importance of including the syndrome of complicated grief in the diagnostic nomenclature.

  4. Type and duration of subsyndromal symptoms in youth with bipolar I disorder prior to their first manic episode

    PubMed Central

    Correll, Christoph U; Hauser, Marta; Penzner, Julie B; Auther, Andrea M; Kafantaris, Vivian; Saito, Ema; Olvet, Doreen; Carrión, Ricardo E; Birmaher, Boris; Chang, Kiki D; DelBello, Melissa P; Singh, Manpreet K; Pavuluri, Mani; Cornblatt, Barbara A

    2014-01-01

    Objectives To systematically evaluate the prodrome to mania in youth. Methods New-onset/worsening symptoms/signs of ≥ moderate severity preceding first mania were systematically assessed in 52 youth (16.2 ± 2.8 years) with a research diagnosis of bipolar I disorder (BD-I). Youth and/or caregivers underwent semi-structured interviews, using the Bipolar Prodrome Symptom Scale–Retrospective. Results The mania prodrome was reported to start gradually in most youth (88.5%), with either slow (59.6%) or rapid (28.8%) deterioration, while a rapid-onset-and-deterioration prodrome was rare (11.5%). The manic prodrome, conservatively defined as requiring ≥ 3 symptoms, lasted 10.3 ± 14.4 months [95% confidence interval (CI): 6.3–14.4], being present for ≥ 4 months in 65.4% of subjects. Among prodromal symptoms reported in ≥ 50% of youth, three were subthreshold manic in nature (irritability: 61.5%, racing thoughts: 59.6%, increased energy/activity: 50.0%), two were non-specific (decreased school/work functioning: 65.4%, mood swings/lability: 57.7%), and one each was depressive (depressed mood: 53.8%) or subthreshold manic/depressive (inattention: 51.9%). A decreasing number of youth had ≥ 1 (84.6%), ≥ 2 (48.1%), or ≥ 3 (26.9%) specific subthreshold mania symptoms (i.e., elation, grandiosity, decreased need for sleep, racing thoughts, or hypersexuality), lasting 9.5 ± 14.9 months (95% CI: 5.0–14.0), 3.5 ± 3.5 months (95% CI: 2.0–4.9), and 3.0 ± 3.2 months (95% CI: 1.0–5.0) for ≥ 1, ≥ 2, or ≥ 3 specific symptoms, respectively. Conclusions In youth with BD-I, a relatively lengthy, predominantly slow-onset mania prodrome appears to be common, including subthreshold manic and depressive psychopathology symptoms. This suggests that early clinical identification and intervention may be feasible in bipolar disorder. Identifying biological markers associated with clinical symptoms of impending mania may help increase chances for early detection and

  5. Qigong exercise alleviates fatigue, anxiety, and depressive symptoms, improves sleep quality, and shortens sleep latency in persons with chronic fatigue syndrome-like illness.

    PubMed

    Chan, Jessie S M; Ho, Rainbow T H; Chung, Ka-Fai; Wang, Chong-Wen; Yao, Tzy-Jyun; Ng, Siu-Man; Chan, Cecilia L W

    2014-01-01

    Objectives. To evaluate the effectiveness of Baduanjin Qigong exercise on sleep, fatigue, anxiety, and depressive symptoms in chronic fatigue syndrome- (CFS-) like illness and to determine the dose-response relationship. Methods. One hundred fifty participants with CFS-like illness (mean age = 39.0, SD = 7.9) were randomly assigned to Qigong and waitlist. Sixteen 1.5-hour Qigong lessons were arranged over 9 consecutive weeks. Pittsburgh Sleep Quality Index (PSQI), Chalder Fatigue Scale (ChFS), and Hospital Anxiety and Depression Scale (HADS) were assessed at baseline, immediate posttreatment, and 3-month posttreatment. The amount of Qigong self-practice was assessed by self-report. Results. Repeated measures analyses of covariance showed a marginally nonsignificant (P = 0.064) group by time interaction in the PSQI total score, but it was significant for the "subjective sleep quality" and "sleep latency" items, favoring Qigong exercise. Improvement in "subjective sleep quality" was maintained at 3-month posttreatment. Significant group by time interaction was also detected for the ChFS and HADS anxiety and depression scores. The number of Qigong lessons attended and the amount of Qigong self-practice were significantly associated with sleep, fatigue, anxiety, and depressive symptom improvement. Conclusion. Baduanjin Qigong was an efficacious and acceptable treatment for sleep disturbance in CFS-like illness. This trial is registered with Hong Kong Clinical Trial Register: HKCTR-1380.

  6. The influence of depression, level of functioning in everyday life, and illness acceptance on quality of life in patients with Parkinson's disease: a preliminary study.

    PubMed

    Rosińczuk, Joanna; Kołtuniuk, Aleksandra

    2017-01-01

    Parkinson's disease (PD) is the second most common neurodegenerative disorder after Alzheimer's disease, and its incidence will increase as the global population ages. Due to the multitude of symptoms, this disease clearly has a significant impact on decreasing quality of life for those with PD. We aimed to evaluate the effect of selected variables on quality of life in people with idiopathic PD treated pharmacologically. This study was conducted among 50 patients with PD aged 47-85 years. The diagnostic survey method was applied to collect data with the use of the authors' questionnaire and standardized questionnaires, including, Parkinson's Disease Questionnaire (PDQ), Beck Depression Inventory, Instrumental Activities of Daily Living Scale, and Acceptance of Illness Scale. The results were statistically analyzed. Analysis of the study material showed that people who were more self-reliant were characterized by lower intensity of depressive symptoms (ρ=-0.567, P=0), were more likely to accept their illness (ρ=0.611, P=0), and assessed quality of life better in each of the studied domains of the PDQ. Illness acceptance correlated with the occurrence of depressive symptoms (ρ=-0.567, P=0) and significantly affected quality of life. Factors such as depression, disease acceptance, and functional capacity have a significant impact on the subjective assessment of quality of life in patients with PD. Evaluation of these factors should be taken into account in the therapeutic process, to minimize their negative impact on quality of life in patients with PD.

  7. Qigong Exercise Alleviates Fatigue, Anxiety, and Depressive Symptoms, Improves Sleep Quality, and Shortens Sleep Latency in Persons with Chronic Fatigue Syndrome-Like Illness

    PubMed Central

    Chan, Jessie S. M.; Ho, Rainbow T. H.; Chung, Ka-fai; Wang, Chong-wen; Yao, Tzy-jyun; Ng, Siu-man; Chan, Cecilia L. W.

    2014-01-01

    Objectives. To evaluate the effectiveness of Baduanjin Qigong exercise on sleep, fatigue, anxiety, and depressive symptoms in chronic fatigue syndrome- (CFS-) like illness and to determine the dose-response relationship. Methods. One hundred fifty participants with CFS-like illness (mean age = 39.0, SD = 7.9) were randomly assigned to Qigong and waitlist. Sixteen 1.5-hour Qigong lessons were arranged over 9 consecutive weeks. Pittsburgh Sleep Quality Index (PSQI), Chalder Fatigue Scale (ChFS), and Hospital Anxiety and Depression Scale (HADS) were assessed at baseline, immediate posttreatment, and 3-month posttreatment. The amount of Qigong self-practice was assessed by self-report. Results. Repeated measures analyses of covariance showed a marginally nonsignificant (P = 0.064) group by time interaction in the PSQI total score, but it was significant for the “subjective sleep quality” and “sleep latency” items, favoring Qigong exercise. Improvement in “subjective sleep quality” was maintained at 3-month posttreatment. Significant group by time interaction was also detected for the ChFS and HADS anxiety and depression scores. The number of Qigong lessons attended and the amount of Qigong self-practice were significantly associated with sleep, fatigue, anxiety, and depressive symptom improvement. Conclusion. Baduanjin Qigong was an efficacious and acceptable treatment for sleep disturbance in CFS-like illness. This trial is registered with Hong Kong Clinical Trial Register: HKCTR-1380. PMID:25610473

  8. A Pill for the Ill? Patients’ Reports of Their Experience of the Medical Encounter in the Treatment of Depression

    PubMed Central

    Vilhelmsson, Andreas; Svensson, Tommy; Meeuwisse, Anna

    2013-01-01

    Background Starting in the 1960s, a broad-based patients’ rights movement began to question doctors’ paternalism and to demand disclosure of medical information, informed consent, and active participation by the individual in personal health care. According to scholars, these changes contributed to downplay the biomedical approach in favor of a more patient-oriented perspective. The Swedish non-profit organization Consumer Association for Medicines and Health (KILEN) has offered the possibility for consumers to report their perceptions and experiences from their use of medicines in order to strengthen consumer rights within the health care sector. Methodology In this paper, qualitative content analysis was used to analyze 181 KILEN consumer reports of adverse events from antidepressant medications in order to explore patients’ views of mental ill health symptoms and the doctor-patient interaction. Principal Findings Overall, the KILEN stories contained negative experiences of the patients’ medical encounters. Some reports indicated intense emotional outrage and strong feelings of abuse by the health care system. Many reports suggested that doctors and patients had very different accounts of the nature of the problems for which the patient was seeking help. Although patients sought help for problems like tiredness and sleeplessness (often with a personal crisis of some sort as a described cause), the treating doctor in most cases was exceptionally quick in both diagnosing depression and prescribing antidepressant treatment. When patients felt they were not being listened to, trust in the doctor was compromised. This was evident in the cases when the doctor tried to convince them to take part in medical treatment, sometimes by threatening to withdraw their sick-listing. Conclusions Overall, this study suggests that the dynamics happening in the medical encounter may still be highly affected by a medical dominance, instead of a patient-oriented perspective

  9. Depression

    MedlinePlus

    ... The depression generally lifts during spring and summer. Bipolar disorder is different from depression but is included in this list is because someone with bipolar disorder experiences episodes of extreme low moods (depression). But ...

  10. Surviving depressive ill-health: a qualitative systematic review of older persons' narratives.

    PubMed

    Holm, Anne Lise; Severinsson, Elisabeth

    2014-03-01

    The aim of this qualitative systematic review was to report a comprehensive literature synthesis of older persons' narratives about what they need in order to survive when suffering from depression. Their survival strategies seem to be a state rarely outlined in the literature. A systematic search of EBSCOhost/Academic Search Premier, ProQuest and PubMed was conducted for the period January 2000 to April 2012. Data were analyzed by means of thematic analysis. Thirteen studies were selected and three themes emerged from synthesis: the need for courage, strength, and self-reliance; the meaning of responsibility; and wearing a mask of normalcy to hide the shame. The first comprised two subthemes: the value of faith and distraction and activity; the second had no subtheme; and the third had one subtheme: reaching out of loneliness towards aloneness and connectivity. Further research should be focused on how community projects can improve health services such as enhancing the safety of health care and disseminating health information.

  11. Geomagnetic storms: association with incidence of depression as measured by hospital admission.

    PubMed

    Kay, R W

    1994-03-01

    The hypothesis that geomagnetic storms may partly account for the seasonal variation in the incidence of depression, by acting as a precipitant of depressive illness in susceptible individuals, is supported by a statistically significant 36.2% increase in male hospital admissions with a diagnosis of depressed phase, manic-depressive illness in the second week following such storms compared with geomagnetically quiet control periods. There is a smaller but not statistically significant increase in female psychotic depression and non-psychotic depression admissions following storms. There was no correlation between geomagnetic storm levels and number of male admissions with psychotic depression, which is consistent with a threshold event affecting predisposed individuals. Phase advance in pineal circadian rhythms of melatonin synthesis may be a possible mechanism of causation or be present as a consequence of 5-hydroxytryptamine and adrenergic system dysfunction associated with geomagnetic disturbance. Effects on cell membrane permeability, calcium channel activity and retinal magneto-receptors are suggested as possible underlying biochemical mechanisms.

  12. Lifetime history of depression and anxiety disorders as a predictor of quality of life in midlife women in the absence of current illness episodes.

    PubMed

    Joffe, Hadine; Chang, Yuefang; Dhaliwal, Sammy; Hess, Rachel; Thurston, Rebecca; Gold, Ellen; Matthews, Karen A; Bromberger, Joyce T

    2012-05-01

    It is unknown whether a history of depression, anxiety disorders, or comorbid depression and anxiety affects subsequent health-related quality of life (HRQOL) during midlife in women when vasomotor symptoms (VMS) and sleep disturbance commonly disrupt QOL. To evaluate whether previous affective illness is associated with low HRQOL during midlife in the absence of current illness episodes and whether low HRQOL is explained by VMS or sleep disruption. Longitudinal, community-based study. Western Pennsylvania. A total of 425 midlife women in the Study of Women's Health Across the Nation who completed the Structured Clinical Interview for DSM-IV (SCID) and the 36-Item Short Form Health Survey (SF-36) annually during 6 years of follow-up. Scores on the SF-36 scales of social functioning (SF), role-emotional (RE), role-physical (RP), body pain (BP), and vitality. Ninety-seven women (22.8%) had comorbid affective illness histories, 162 (38.1%) had previous depression only, and 21 (4.9%) had previous anxiety only. Those with comorbid illness histories and depression alone were more likely to report low HRQOL on the SF, RE, RP, and BP domains (odds ratio [OR] = 2.31-3.54 and 1.59-2.28, respectively) than were women with neither disorder. After adjustment for VMS and sleep disturbance, the comorbid group continued to have low HRQOL on these domains (OR = 2.13-3.07), whereas the association was significant on SF and BP only for the depression-alone group (OR = 2.08 and 1.95, respectively). Compared with women with neither disorder, the anxiety-only group had low HRQOL on the RP domain (OR = 2.60). Sleep disturbance, but not VMS, was independently associated with low HRQOL on all the domains except RE. A history of both depression and anxiety has the most robust negative effect on HRQOL in women during midlife, an association not explained by VMS or sleep disturbance. For the depression-alone group, sleep disturbance may partially explain the negative impact of previous

  13. Distinct relationships between social aptitude and dimensions of manic-like symptoms in youth.

    PubMed

    Benarous, Xavier; Mikita, Nina; Goodman, Robert; Stringaris, Argyris

    2016-08-01

    Difficulties with interpersonal relationships have been reported in children and adolescents with manic symptoms, even if they do not fulfil criteria for a manic episode. The role of social aptitude (SA) in youths with manic symptoms has never been examined in the general population. Moreover, no study has examined whether SA is differentially associated with dimensions of manic symptoms. We hypothesised that youth with predominantly undercontrol manic symptoms (characterised by irritability) would show lower levels of SA; conversely, youth with predominantly exuberant symptoms would show better than average social skills. Our sample comprised 5325 participants from the 2004 British Child and Adolescent Mental Health Survey (B-CAMHS04), mean age 10.3 years, SD = 3.3, 48 % girls. Manic symptoms were assessed with the Development and Wellbeing Assessment by interviewing parents and young people. Children and adolescents with manic symptoms had a lower SA score, compared to the general population by parent report, but not by self-report. SA score was higher in youths with predominantly exuberant manic symptoms compared to the general population; whereas the youths with predominantly undercontrol manic symptoms had lower SA scores by parent and self-report. Our results provide further evidence for the distinction between exuberant and undercontrol manic symptoms and highlight the need to focus on SA in future research.

  14. Hippocampal abnormalities of glutamate/glutamine, N-acetylaspartate and choline in patients with depression are related to past illness burden

    PubMed Central

    de Diego-Adeliño, Javier; Portella, Maria J.; Gómez-Ansón, Beatriz; López-Moruelo, Olga; Serra-Blasco, Maria; Vives, Yolanda; Puigdemont, Dolors; Pérez-Egea, Rosario; Álvarez, Enric; Pérez, Víctor

    2013-01-01

    Background Smaller hippocampal volumes in major depressive disorder (MDD) have been linked with earlier onset, previous recurrences and treatment refractoriness. The aim of our study was to investigate metabolite abnormalities in the hippocampus associated with past depressive illness burden. Methods Glutamate/glutamine (Glx), N-acetylaspartate (NAA) and choline (Cho), potential markers of glial/neuronal integrity and membrane turnover, respectively, were measured in adults with depression and healthy controls using a 3 T magnetic resonance spectroscopy scanner. Voxels were placed in the head of the right and left hippocampus. We controlled for systematic differences resulting from volume-of-interest (VOI) tissue composition and total hippocampal volume. Results Our final sample comprised a total of 16 healthy controls and 52 adult patients with depression in different stages of the illness (20 treatment-resistant/chronic, 18 remitted-recurrent and 14 first-episode), comparable for age and sex distribution. Patients with treatment-resistant/chronic and remitted-recurrent depression had significantly lower levels of Glx and NAA than controls, especially in the right hippocampal region (p ≤ 0.025). Diminished levels of Glx were correlated with longer illness duration (left VOI r = −0.34, p = 0.01). By contrast, Cho levels were significantly higher in patients with treatment-resistant/chronic depression than those with first-episode depression or controls in the right and left hippocampus (up to 19% higher; all p ≤ 0.025) and were consistently related to longer illness duration (right VOI r = 0.30, p = 0.028; left VOI r = 0.38, p = 0.004) and more previous episodes (right VOI r = 0.46, p = 0.001; left VOI r = 0.44, p = 0.001). Limitations The cross-sectional design and the inclusion of treated patients are the main limitations of the study. Conclusion Our results support that metabolite alterations within the hippocampus are more pronounced in patients with a

  15. Cost-effectiveness of collaborative care for chronically ill patients with comorbid depressive disorder in the general hospital setting, a randomised controlled trial.

    PubMed

    Horn, Eva K; van Benthem, Tjeerd B; Hakkaart-van Roijen, Leona; van Marwijk, Harm W J; Beekman, Aartjan T F; Rutten, Frans F; van der Feltz-Cornelis, Christina M

    2007-02-26

    Depressive disorder is one of the most common disorders, and is highly prevalent in chronically ill patients. The presence of comorbid depression has a negative influence on quality of life, health care costs, self-care, morbidity, and mortality. Early diagnosis and well-organized treatment of depression has a positive influence on these aspects. Earlier research in the USA has reported good results with regard to the treatment of depression with a collaborative care approach and an antidepressant algorithm. In the UK 'Problem Solving Treatment' has proved to be feasible. However, in the general hospital setting this approach has not yet been evaluated. CC: DIM (Collaborative Care: Depression Initiative in the Medical setting) is a two-armed randomised controlled trial with randomisation at patient level. The aim of the trial is to evaluate the treatment of depressive disorder in general hospitals in the Netherlands based on a collaborative care framework, including contracting, 'Problem Solving Treatment', antidepressant algorithm, and manual-guided self-help. 126 outpatients with diabetes mellitus, chronic obstructive pulmonary disease, or cardiovascular diseases will be randomised to either the intervention group or the control group. Patients will be included if they have been diagnosed with moderate to severe depression, based on the DSM-IV criteria in a two-step screening method. The intervention group will receive treatment based on the collaborative care approach; the control group will receive 'care as usual'. Baseline and follow-up measurements (after 3, 6, 9, and 12 months) will be performed by means of questionnaires. The primary outcome measure is severity of depressive symptoms, as measured with the PHQ-9. The secondary outcome measure is the cost-effectiveness of these treatments according to the TiC-P, the EuroQol and the SF-36. Earlier research has indicated that depressive disorder is a chronic, mostly recurrent illness, which tends to cluster

  16. Chronic Illness & Mental Health

    MedlinePlus

    ... your overall health and treatment issues. Recovery from depression takes time, but treatment can improve the quality of life even if you have a medical illness. Treatments for depression include: Cognitive behavioral therapy (CBT), or talk therapy, ...

  17. 'Depression is not an illness. It's up to you to make yourself happy': Perceptions of Chinese health professionals and community workers about older Chinese immigrants' experiences of depression and anxiety.

    PubMed

    Haralambous, Betty; Dow, Briony; Goh, Anita; Pachana, Nancy A; Bryant, Christina; LoGiudice, Dina; Lin, Xiaoping

    2016-12-01

    The aim of this study was to improve our understanding of depression and anxiety among older immigrant Chinese Australians. The study was based on the National Ageing Research Institute's Cultural Exchange Model, an iterative process of exchange between researchers and stakeholders. The project involved a range of components including consultations with health professionals and community workers about perceptions of depression and anxiety within the Chinese community. This paper reports on these consultation findings. Thematic analysis generated five main categories to explain participants' perceptions of depression and anxiety within the Chinese community. Themes included: lack of knowledge; personal weakness rather than illness; stigma; somatisation; and experience of migration in later life. Responses to questions about education and information dissemination were collated separately and reported. Views of depression and anxiety among older Chinese people suggest that educating the community may be an important way to improve mental health literacy and help-seeking behaviour. © 2016 AJA Inc.

  18. How does mental-physical multimorbidity express itself in lived time and space? A phenomenological analysis of encounters with depression and chronic physical illness.

    PubMed

    Coventry, Peter A; Dickens, Chris; Todd, Chris

    2014-10-01

    Mental-physical multimorbidity (the co-existence of mental and physical ill health) is highly prevalent and associated with significant impairments and high healthcare costs. While the sociology of chronic illness has developed a mature discourse on coping with long term physical illness the impact of mental and physical health have remained analytically separated, highlighting the need for a better understanding of the day-to-day complexities encountered by people living with mental-physical multimorbidity. We used the phenomenological paradigm of the lived body to elucidate how the experience of mental-physical multimorbidity shapes people's lifeworlds. Nineteen people with chronic obstructive pulmonary disease (COPD) and depression (defined as a score ≥8 on depression scale of Hospital Anxiety and Depression Scale) were recruited from secondary NHS care and interviewed at their homes. Data were analysed phenomenologically using van Manen's lifeworld existential framework of the lived body, lived time, lived space, lived relations. Additionally, we re-analysed data (using the same framework) collected from 13 people recruited from secondary NHS care with either COPD, rheumatoid arthritis, heart disease, or type 1 or type 2 diabetes and depression. The phenomenology of mental-physical multimorbidity was articulated through embodied and emotional encounters with day-to-day life in four ways: [a] participants' perception of lived time and lived space contracted; [b] time and [c] space were experienced as liminal categories, enforcing negative mood and temporal and spatial contraction; and [d] time and space could also be customised to reinstate agency and self-determination. Mental-physical multimorbidity negatively impacts on individuals' perceptions of lived time and lived space, leading to a loss of agency, heightened uncertainty, and poor well-being. Harnessing people's capacity to modify their experience of time and space may be a novel way to support people

  19. Self-Efficacy, Depression, and Self-Care Activities in Adult Jordanians with Type 2 Diabetes: The Role of Illness Perception.

    PubMed

    Al-Amer, Rasmieh; Ramjan, Lucie; Glew, Paul; Randall, Sue; Salamonson, Yenna

    2016-10-01

    Diabetes mellitus is reaching epidemic levels worldwide. In a developing country like Jordan, type 2 diabetes mellitus (T2DM) has reached a prevalence rate of 17.1%. This cross-sectional study examined the relationship between self-care activities and: illness perception, depression, social support, religiosity and spiritual coping, and self-efficacy among patients with T2DM. A random sample of 220 patients with T2DM, who attended Jordan University Hospital in Jordan were enrolled. The data were collected through a structured interview and the medical files. The instruments consisted of a sociodemographic and clinical standardised questionnaires: Brief Illness Perception Questionnaire, Patients' Health Questionnaire-9; ENRICH Social Support Instrument; Religious and Spiritual Coping Subscale; Diabetes Management Self-Efficacy Scale; and Summary of Diabetes Self-Care Activities. Bivariate analysis investigated the relationship between variables. Structure Equation Modelling (SEM) was performed to test the proposed conceptual model. The study found that approximately 70% of the respondents suffered some form of depressive symptoms. The SEM showed a direct relationship between self-efficacy and self-care activities (β = 0.40; p < 0.001). Depression was indirectly related to self-care activities through self-efficacy (β = -0.20; p = 0.003); nevertheless, it was directly related to perception of: treatment control, consequences, and emotional representations. Overall, the sequence between illness perception and self-efficacy was mediated by depression. Strategies to promote self-efficacy and illness perception are vital in customising a diabetes health plan to meet Arabic cultural expectations.

  20. Illness perception is a strong parameter on anxiety and depression scores in early-stage breast cancer survivors: a single-center cross-sectional study of Turkish patients.

    PubMed

    Kus, Tulay; Aktas, Gokmen; Ekici, Hatice; Elboga, Gulcin; Djamgoz, Sabire

    2017-05-26

    Illness perception has been suggested to have a significant effect on anxiety and depression in cancer patients. In this cross-sectional study, we aimed to evaluate this on Turkish breast cancer patients with follow-up periods up to 12 years. A total of 225 patients (with 6 months to 12 years follow-up) were recruited in this cross-sectional study. The patients were divided into three groups of follow-up: 6 months-2 years, 2-5 years, and >5 years. Beck Depression Inventory, Beck Anxiety Inventory, Duke-University of North Carolina Functional Social Support Questionnaire, and Brief Illness Perception Questionnaire were used to assess the depression, anxiety, functional social support (FSS), and illness perception, respectively. Statistical significance of the associations was analyzed using Spearman correlation, Student's t, Mann-Whitney U, and ANOVA tests. Rates of moderate-severe anxiety and depression scores were not correlated with follow-up period and disease stage, whereas all these parameters were associated significantly with FSS and age. Parameters of illness perception were also not correlated with follow-up period and stage of disease. However, illness perception scores were noticeably better with increments in FSS. Also, the parameters of illness perception were strongly associated with the depression/anxiety score. Illness perception is an important determinant of the depression/anxiety score in Turkish breast cancer patients.

  1. Continuation versus discontinuation of lithium in recurrent bipolar illness: a naturalistic study.

    PubMed

    Biel, Matthew G; Peselow, Eric; Mulcare, Loretta; Case, Brady G; Fieve, Ron

    2007-08-01

    Lithium's efficacy in prophylaxis of mood episodes in bipolar disorder (BD) is well established in the clinical trial setting, but may be less robust in routine clinical practice. We compared illness recurrence in bipolar patients naturalistically continued on or discontinued from lithium after an extended period of clinical stability on lithium monotherapy, and evaluated other potential risk factors for relapse. We followed 213 patients who were stable for 2 years on lithium monotherapy following resolution of acute symptoms marking their last manic episode. Based upon patient preference and clinical judgment, 159 patients were continued on lithium monotherapy and 54 patients were slowly discontinued. Survival differences between the continued and discontinued groups were assessed using the Kaplan-Meier product limit method, and risk factors for relapse were evaluated in Cox proportional hazards regression. Patients continued on lithium prophylaxis experienced risk of recurrence equivalent to a third of that suffered by discontinued patients during the first year of treatment (0.15 versus 0.45), and significant survival differences persisted throughout follow-up. Median survival time to illness recurrence for patients continued on lithium was 7.33 years [95% confidence interval (CI) 5.67-9.67]; that for patients discontinued from lithium was 1.33 years (95% CI 0.33-2.33). After controlling for all significant covariates, lithium discontinuation was associated with a hazard ratio of 4.85. Inter-episode manic and depressive symptoms conferred increased risk for subsequent recurrence of illness in both groups, while lower lithium levels recorded during the two years of clinical stability preceding study onset were protective. Despite considerable rates of illness recurrence in both groups, those who continued on lithium sustained markedly lower rates of recurrence over a lengthy follow-up period. Lithium discontinuation in BD after successful maintenance monotherapy

  2. Cannabis use disorder is associated with greater illness severity in tobacco smoking patients with bipolar disorder.

    PubMed

    Lagerberg, T V; Icick, R; Andreassen, O A; Ringen, P A; Etain, B; Aas, M; Henry, C; Bjella, T D; Melle, I; Bellivier, F

    2016-01-15

    Cannabis use disorders (CUD) may influence the course of bipolar disorder (BD), but key confounding factors such as tobacco smoking have not been adequately addressed. This study examined whether CUD was associated with a more severe illness course in tobacco smoking BD patients. A sample of French and Norwegian tobacco smoking patients with BD I and II (N=642) was investigated. DSM-IV diagnoses and other characteristics were obtained through personal interviews using structured questionnaires. The association between CUD and illness course was assessed in regression analyses. In bivariate analyses, CUD was associated with earlier BD onset, higher frequency of manic (in BD I) and depressive episodes and hospitalizations per illness year, and a higher occurrence of psychotic episodes. After controlling for potential confounders, the relationships with earlier BD onset (B=-5.60 95% CI=-7.65 to -3.64), and increased rates of manic episodes (OR=1.93, 95% CI: 1.15 to 3.23) and hospitalizations (OR=2.93, 95% CI: 1.85 to 4.64) remained statistically significant. Despite the multivariate approach, differences between the two samples may lead to spurious findings related to hidden confounders. Substance use and mood episode information was collected retrospectively, and potential birth cohort effects could not be controlled for. Studies have found associations between tobacco smoking and poorer outcomes in BD. In this study on tobacco smoking BD patients we report an association between CUD and illness severity, suggesting that CUD exacerbates the disease evolution independently of tobacco smoking. Specific treatment and prevention programs addressing CUD in BD patients are warranted. Copyright © 2015 Elsevier B.V. All rights reserved.

  3. Impaired glucose metabolism moderates the course of illness in bipolar disorder.

    PubMed

    Mansur, Rodrigo B; Rizzo, Lucas B; Santos, Camila M; Asevedo, Elson; Cunha, Graccielle R; Noto, Mariane N; Pedrini, Mariana; Zeni, Maiara; Cordeiro, Quirino; McIntyre, Roger S; Brietzke, Elisa

    2016-05-01

    The longitudinal course of bipolar disorder (BD) is highly heterogeneous, and is moderated by the presence of general medical comorbidities. This study aimed to investigate the moderating effects of impaired glucose metabolism (IGM) on variables of illness course and severity in a BD population. Fifty-five patients with BD were evaluated. All subjects were evaluated with respect to current and past psychiatric and medical disorders, as well as lifetime use of any medication. Body mass index (BMI) and metabolic parameters were obtained. IGM was operationalized as pre-diabetes or type 2 diabetes mellitus. Thirty (54.5%) individuals had IGM. After adjustment for age, gender, ethnicity, alcohol use, smoking, BMI and past and current exposure to psychotropic medications, individuals with IGM, when compared to euglycemic participants, had an earlier age of onset (RR: 0.835, p=0.024), longer illness duration (RR: 1.754, p=0.007), a higher number of previous manic/hypomanic episodes (RR: 1.483, p=0.002) and a higher ratio of manic/hypomanic to depressive episodes (RR: 1.753, p=0.028). Moreover, we observed a moderating effect of IGM on the association between number of mood episodes and other variables of illness course, with the correlation between lifetime mood episodes and frequency of episodes being significantly greater in the IGM subgroup (RR: 1.027, p=0.029). All associations observed herein remained significant after adjusting for relevant confounding factors (e.g. age, alcohol and tobacco use, exposure to psychotropic agents, BMI). Cross-sectional design, small sample size. Comorbid IGM may be a key moderator of illness progression in BD. Copyright © 2016 Elsevier B.V. All rights reserved.

  4. [Are the representations of the "madman", the "mentally ill person", the "depressive" and the opinions towards psychiatric hospitals homogeneous according to the populations of the investigated sites?].

    PubMed

    Quidu, F; Escaffre, J P

    2010-01-01

    The concept of policy management in psychiatry requires knowledge representations of the "mad", the "mentally ill" and "depressed" by the people. It is therefore to highlight the diversity of definitions that it attributes to individual psychiatric disorders, particularly by cultural norms typically associated with geographic locations. To do this, we successively study the forms of stigmatisations broadly, and then by site, and the causes of thereof. But this does not suffice for the design of any policy in this area must also take into account the attitudes and behaviours of the population vis-à-vis the existing psychiatric facilities globally and per site. The treatments were carried out using data from the socio-anthropological and epidemiological "Mental Health in the general population: images and realities" made by the French Collaborating Centre of WHO for research and training Mental Health (WHOCC, Lille, France) and the Directorate of Research, Studies, Evaluation and Statistics (DREES) with 40 000 people aged 18 and older in metropolitan France and in the departments of overseas between 1999 and 2003. The techniques used range from descriptive statistics to multivariate analysis (correspondence analysis and multiple ascending hierarchical classification). The images of the "madness", the "mentally ill" or the "depression" in the French population are disparate. Nevertheless, some characteristics are found with high frequency: the "depressive" is rather seen as an isolated person, the "mentally ill" as a mental defective with bizarre speech, while "crazy" would rather characterized by violence (delusions and violent towards others, beat his family, incest). The "mentally ill" is sometimes defined by these last criteria. These images are not influenced by knowledge of a relative suffering from mental illness or a psychiatric episode experienced by the interviewee. The causes of mental illness (the "madness" and "mentally ill"), two contradictory trends

  5. Disentangling depression and anxiety in relation to neuroticism, extraversion, suicide, and self-harm among adult psychiatric inpatients with serious mental illness.

    PubMed

    Subica, Andrew M; Allen, Jon G; Frueh, B Christopher; Elhai, Jon D; Fowler, J Christopher

    2016-11-01

    Little is known about depression-anxiety comorbidity and its association with personality traits and suicide/self-harm in adult psychiatric inpatients with serious mental illness (SMI), impacting clinical assessment and treatment. This study sought to determine the symptom structure of depression-anxiety comorbidity and its relation to neuroticism, extraversion, and suicide/self-harm behaviour in this high-risk population. Nine hundred and sixty-two adults receiving inpatient care at a private psychiatric hospital completed questionnaires at admission. Confirmatory factor analyses compared a bifactor solution specifying a general distress factor and two specific depression and anxiety factors against unidimensional and correlated factors solutions. The bifactor solutions' factors were subsequently correlated with neuroticism and extraversion subscales and pre-hospitalization suicide/self-harm behaviours. The bifactor model rendered superior fit to sample data and a robust general factor - accounting for 77.61% of common item variance - providing the first evidence for a tripartite structure of depression and anxiety among adult inpatients. The bifactor solution-outputted independent general distress, depression, and anxiety factors positively correlated with neuroticism, the personality dimension corresponding to trait negative affectivity. The general distress and depression factors associated with recent self-harm, but factors showed no associations with prior suicidal behaviour. In adult psychiatric inpatients, general distress substantially underlies comorbid depression and anxiety symptom variation and may contribute to recent incidence of self-harm. Transdiagnostic assessments and interventions targeting general distress may temper depression, anxiety, and self-harm in adult inpatients. Clinical implications Depression-anxiety comorbidity symptomology in adult psychiatric inpatients is primarily composed of general distress. General distress and specific

  6. Age at onset, course of illness and response to psychotherapy in bipolar disorder: results from the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD)

    PubMed Central

    Peters, A.; Sylvia, L. G.; da Silva Magalhães, P. V.; Miklowitz, D. J.; Frank, E.; Otto, M. W.; Hansen, N. S.; Dougherty, D. D.; Berk, M.; Nierenberg, A. A.; Deckersbach, T.

    2015-01-01

    Background The course of bipolar disorder progressively worsens in some patients. Although responses to pharmacotherapy appear to diminish with greater chronicity, less is known about whether patients’ prior courses of illness are related to responses to psychotherapy. Method Embedded in the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) was a randomized controlled trial of psychotherapy for bipolar depression comparing the efficacy of intensive psychotherapy with collaborative care (a three-session psycho-educational intervention). We assessed whether the number of previous mood episodes, age of illness onset, and illness duration predicted or moderated the likelihood of recovery and time until recovery from a depressive episode in patients in the two treatments. Results Independently of treatment condition, participants with one to nine prior depressive episodes were more likely to recover and had faster time to recovery than those with 20 or more prior depressive episodes. Participants with fewer than 20 prior manic episodes had faster time to recovery than those with 20 or more episodes. Longer illness duration predicted a longer time to recovery. Participants were more likely to recover in intensive psychotherapy than collaborative care if they had 10–20 prior episodes of depression [number needed to treat (NNT)=2.0], but equally likely to respond to psychotherapy and collaborative care if they had one to nine (NNT=32.0) or >20 (NNT=9.0) depressive episodes. Conclusions Number of previous mood episodes and illness duration are associated with the likelihood and speed of recovery among bipolar patients receiving psychosocial treatments for depression. PMID:25066366

  7. Age at onset, course of illness and response to psychotherapy in bipolar disorder: results from the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD).

    PubMed

    Peters, A; Sylvia, L G; Magalhães, P V da Silva; Miklowitz, D J; Frank, E; Otto, M W; Hansen, N S; Dougherty, D D; Berk, M; Nierenberg, A A; Deckersbach, T

    2014-12-01

    The course of bipolar disorder progressively worsens in some patients. Although responses to pharmacotherapy appear to diminish with greater chronicity, less is known about whether patients' prior courses of illness are related to responses to psychotherapy. Embedded in the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) was a randomized controlled trial of psychotherapy for bipolar depression comparing the efficacy of intensive psychotherapy with collaborative care (a three-session psycho-educational intervention). We assessed whether the number of previous mood episodes, age of illness onset, and illness duration predicted or moderated the likelihood of recovery and time until recovery from a depressive episode in patients in the two treatments. Independently of treatment condition, participants with one to nine prior depressive episodes were more likely to recover and had faster time to recovery than those with 20 or more prior depressive episodes. Participants with fewer than 20 prior manic episodes had faster time to recovery than those with 20 or more episodes. Longer illness duration predicted a longer time to recovery. Participants were more likely to recover in intensive psychotherapy than collaborative care if they had 10-20 prior episodes of depression [number needed to treat (NNT) = 2.0], but equally likely to respond to psychotherapy and collaborative care if they had one to nine (NNT = 32.0) or >20 (NNT = 9.0) depressive episodes. Number of previous mood episodes and illness duration are associated with the likelihood and speed of recovery among bipolar patients receiving psychosocial treatments for depression.

  8. A feasibility study of a telephone-supported self-care intervention for depression among adults with a comorbid chronic physical illness in primary care

    PubMed Central

    2012-01-01

    Objective We assessed the feasibility and acceptability to patients of a telephone-supported self-care intervention for depression among adults aged 40 years or over with one of six targeted chronic physical illnesses and comorbid depressive symptoms in family practice settings. Methods An open, uncontrolled trial (feasibility study) was conducted among patients treated in Montreal family practices. Eligible patients were aged 40 years or over, had one or more of the targeted chronic physical illnesses for at least 6 months (arthritis, hypertension, diabetes, heart disease, asthma and chronic obstructive pulmonary disease) and were evaluated as having at least mild depressive symptoms (a score of ≥ 5 on the 9-item Patient Health Questionnaire, PHQ-9). Participants received a package of six self-care tools (information booklet, video, Internet programme, action plan, workbook and mood-monitoring tool) with telephone support by a lay coach for up to 6 months. Results In total, 63 eligible patients provided written consent and completed the baseline interview; 57 (90%) and 55 (87%) patients completed 2-month and 6-month follow-up interviews, respectively. The mean number of telephone calls made by coaches to participants was 10.5 (SD 4.0), and the average length of these calls was 10.6 minutes. At the 6-month follow-up, 83.6% of the participants reported that one or more of the tools were helpful. Clinically significant improvements were seen in depressive symptoms (as assessed by the PHQ-9) at 6 months, with an effect size of 0.88 (95% CI, 0.55, 1.14). Conclusion A telephone-supported self-care intervention for depression was feasible, was acceptable to patients, and was associated with a significant 6-month improvement in depressive symptoms. A randomised trial of this intervention is justified. PMID:24294301

  9. Depression

    MedlinePlus

    ... the winter months, when there is less natural sunlight. Return to top What causes depression? There is ... alone. Others with moderate to severe depression might benefit from antidepressants. It may take a few weeks ...

  10. Depressants

    MedlinePlus

    ... judgment and mental functioning nausea and vomiting memory loss (depressants can cause users to have no memory of events that happened while they were under the influence) Long-Term Effects When people misuse depressants over a long ...

  11. Depression

    MedlinePlus

    ... the birth of a baby. Some people get seasonal affective disorder in the winter. Depression is one part of bipolar disorder. There are effective treatments for depression, including antidepressants, talk therapy, or ...

  12. Depressants

    MedlinePlus

    ... of depressants, including alcohol and the illegal drugs GHB and Rohypnol , come in liquid or powder form ... by prescription only. Some depressants, including Rohypnol and GHB, are illegal in the United States. Illegal possession ...

  13. [Occupational therapy: benefit of early intervention in the manic phase].

    PubMed

    Riou, Gaëlle

    When people experiencing a manic episode arrive in hospital, restrictive measures are often put in place. The priority is to avoid all sources of stimulation, especially anything likely to activate the patient. The prescribing of occupational therapy sessions in a well-defined framework may however be appropriate at an early stage in the care. Aside from its effect on the therapeutic alliance, occupational therapy can help on the cognitive and temporal level, increasing awareness of the condition and engagement in the care. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  14. Depression in Multiple Sclerosis as a Function of Length and Severity of Illness, Age, Remissions, and Perceived Social Support.

    ERIC Educational Resources Information Center

    McIvor, Geraldine P.; And Others

    1984-01-01

    Investigated correlates of depression in spinal multiple sclerosis outpatients (N=120). Results showed that the more depressed individuals tended to be more disabled, older, had never experienced a remission, and, in particular, perceived family and friends as providing less social support than those who were less depressed. (LLL)

  15. The influence of depression, level of functioning in everyday life, and illness acceptance on quality of life in patients with Parkinson’s disease: a preliminary study

    PubMed Central

    Rosińczuk, Joanna; Kołtuniuk, Aleksandra

    2017-01-01

    Background Parkinson’s disease (PD) is the second most common neurodegenerative disorder after Alzheimer’s disease, and its incidence will increase as the global population ages. Due to the multitude of symptoms, this disease clearly has a significant impact on decreasing quality of life for those with PD. We aimed to evaluate the effect of selected variables on quality of life in people with idiopathic PD treated pharmacologically. Materials and methods This study was conducted among 50 patients with PD aged 47–85 years. The diagnostic survey method was applied to collect data with the use of the authors’ questionnaire and standardized questionnaires, including, Parkinson’s Disease Questionnaire (PDQ), Beck Depression Inventory, Instrumental Activities of Daily Living Scale, and Acceptance of Illness Scale. The results were statistically analyzed. Results Analysis of the study material showed that people who were more self-reliant were characterized by lower intensity of depressive symptoms (ρ=−0.567, P=0), were more likely to accept their illness (ρ=0.611, P=0), and assessed quality of life better in each of the studied domains of the PDQ. Illness acceptance correlated with the occurrence of depressive symptoms (ρ=−0.567, P=0) and significantly affected quality of life. Conclusion Factors such as depression, disease acceptance, and functional capacity have a significant impact on the subjective assessment of quality of life in patients with PD. Evaluation of these factors should be taken into account in the therapeutic process, to minimize their negative impact on quality of life in patients with PD. PMID:28356744

  16. Cracking the Cycles of Depression and Mania.

    ERIC Educational Resources Information Center

    Greenberg, Joel

    1978-01-01

    Some newly reported research results indicate that slightly abnormal biological rhythms, both long- and short-term, may be key factors in the development of depression and manic-depression. The results may also hold clues about why certain drugs work or fail to work with different individuals. (Author/BB)

  17. Increased uric acid levels in bipolar disorder subjects during different phases of illness.

    PubMed

    Albert, Umberto; De Cori, David; Aguglia, Andrea; Barbaro, Francesca; Bogetto, Filippo; Maina, Giuseppe

    2015-03-01

    Recent evidence indicates the possible involvement of adenosine and the purinergic system in the pathophysiology of bipolar disorder (BD). The aim of this study is to compare serum uric acid (UA) levels in a large group of BD patients (in mania, depression and euthymia) vs. a control group of patients with different psychiatric disorders. 150 BD (SCID-I; DSM-IV) patients were compared to 150 age- and gender-matched subjects with MDD, OCD, or Schizophrenia. Mean serum UA values were compared with the ANOVA, with Bonferroni's post-hoc tests. Mean serum UA levels (5.06 ± 1.45 vs. 4.17 ± 1.05 mg/dL) and rates of hyperuricaemia (30.7% vs. 6.7%) were significantly higher in the bipolar than in the control group. No differences were detected between bipolars in different phases of illness, with all three groups (manic, depressive and euthymic bipolars) showing significantly higher UA levels as compared to controls. No correlations were found between UA levels and YMRS or HAM-D scores. Mean UA levels were also higher in bipolars never exposed to mood stabilizers vs. controls (5.08 ± 1.43 vs. 4.17 ± 1.05 mg/dL), with no differences compared to other bipolars. Our study suffers from the lack of a healthy comparison group; moreover, longitudinal data are missing. Our study provides further evidence of a purinergic dysfunction associated with BD, in all phases of the illness. It is possible that increased UA levels are a trait marker of higher vulnerability to bipolar disorder, and are even more increased during mania (mostly in the first manic episode of drug-naïve patients). Copyright © 2014 Elsevier B.V. All rights reserved.

  18. Manic Defences in Contemporary Society. The Psychocultural Approach.

    PubMed

    Rudan, Dusko; Jakovljevic, Miro; Marcinko, Darko

    2016-12-01

    The article discusses the impact of contemporary culture on the individual's personality. We used the "psychocultural" approach whose key feature is the amalgamation of theories and methods belonging to psychodynamic and psychosocial studies, as well as those used in the field of media and cultural studies. The idea of a potentially therapeutic effect of culture (therapy culture) can already been seen in Freud's and Lacan's texts, and it is often used in critical analyses of contemporary corporate culture, which is more or less developed in some parts of the world. In their criticisms, many contemporary authors emphasize that modern societies have a tendency towards the weakening of basic commitment, or lack thereof, to a social equivalent of Winnicott's concept of environmental provisions as an inalienable democratic right essential for human emotional and mental progress or emotional well-being. The article describes frequent resorting to the so-called manic defences that defensively distort, deny and obscure the awareness that a human being is not the omnipotent source of life, but instead depends on other human beings, and often tries to compensate for loss through various activities. The article describes excessive shopping as an activity that often serves as an attempt to find what was lost, i.e. to fill an emotional void. This solution (resorting to manic defences) is encouraged by contemporary culture, especially through promotional material (e.g. advertising). The main theses of this article are supported by quotations and data from world literature.

  19. Epidemiology and Heritability of Major Depressive Disorder, Stratified by Age of Onset, Sex, and Illness Course in Generation Scotland: Scottish Family Health Study (GS:SFHS)

    PubMed Central

    Thomson, Pippa; McKechanie, Andrew G.; Blackwood, Douglas H. R.; Smith, Blair H.; Dominiczak, Anna F.; Morris, Andrew D.; Matthews, Keith; Campbell, Archie; Linksted, Pamela; Haley, Chris S.; Deary, Ian J.; Porteous, David J.; McIntosh, Andrew M.

    2015-01-01

    The heritability of Major Depressive Disorder (MDD) has been estimated at 37% based largely on twin studies that rely on contested assumptions. More recently, the heritability of MDD has been estimated on large populations from registries such as the Swedish, Finnish, and Chinese cohorts. Family-based designs utilise a number of different relationships and provide an alternative means of estimating heritability. Generation Scotland: Scottish Family Health Study (GS:SFHS) is a large (n = 20,198), family-based population study designed to identify the genetic determinants of common diseases, including Major Depressive Disorder. Two thousand seven hundred and six individuals were SCID diagnosed with MDD, 13.5% of the cohort, from which we inferred a population prevalence of 12.2% (95% credible interval: 11.4% to 13.1%). Increased risk of MDD was associated with being female, unemployed due to a disability, current smokers, former drinkers, and living in areas of greater social deprivation. The heritability of MDD in GS:SFHS was between 28% and 44%, estimated from a pedigree model. The genetic correlation of MDD between sexes, age of onset, and illness course were examined and showed strong genetic correlations. The genetic correlation between males and females with MDD was 0.75 (0.43 to 0.99); between earlier (≤ age 40) and later (> age 40) onset was 0.85 (0.66 to 0.98); and between single and recurrent episodic illness course was 0.87 (0.72 to 0.98). We found that the heritability of recurrent MDD illness course was significantly greater than the heritability of single MDD illness course. The study confirms a moderate genetic contribution to depression, with a small contribution of the common family environment (variance proportion = 0.07, CI: 0.01 to 0.15), and supports the relationship of MDD with previously identified risk factors. This study did not find robust support for genetic differences in MDD due to sex, age of onset, or illness course. However, we found

  20. Epidemiology and Heritability of Major Depressive Disorder, Stratified by Age of Onset, Sex, and Illness Course in Generation Scotland: Scottish Family Health Study (GS:SFHS).

    PubMed

    Fernandez-Pujals, Ana Maria; Adams, Mark James; Thomson, Pippa; McKechanie, Andrew G; Blackwood, Douglas H R; Smith, Blair H; Dominiczak, Anna F; Morris, Andrew D; Matthews, Keith; Campbell, Archie; Linksted, Pamela; Haley, Chris S; Deary, Ian J; Porteous, David J; MacIntyre, Donald J; McIntosh, Andrew M

    2015-01-01

    The heritability of Major Depressive Disorder (MDD) has been estimated at 37% based largely on twin studies that rely on contested assumptions. More recently, the heritability of MDD has been estimated on large populations from registries such as the Swedish, Finnish, and Chinese cohorts. Family-based designs utilise a number of different relationships and provide an alternative means of estimating heritability. Generation Scotland: Scottish Family Health Study (GS:SFHS) is a large (n = 20,198), family-based population study designed to identify the genetic determinants of common diseases, including Major Depressive Disorder. Two thousand seven hundred and six individuals were SCID diagnosed with MDD, 13.5% of the cohort, from which we inferred a population prevalence of 12.2% (95% credible interval: 11.4% to 13.1%). Increased risk of MDD was associated with being female, unemployed due to a disability, current smokers, former drinkers, and living in areas of greater social deprivation. The heritability of MDD in GS:SFHS was between 28% and 44%, estimated from a pedigree model. The genetic correlation of MDD between sexes, age of onset, and illness course were examined and showed strong genetic correlations. The genetic correlation between males and females with MDD was 0.75 (0.43 to 0.99); between earlier (≤ age 40) and later (> age 40) onset was 0.85 (0.66 to 0.98); and between single and recurrent episodic illness course was 0.87 (0.72 to 0.98). We found that the heritability of recurrent MDD illness course was significantly greater than the heritability of single MDD illness course. The study confirms a moderate genetic contribution to depression, with a small contribution of the common family environment (variance proportion = 0.07, CI: 0.01 to 0.15), and supports the relationship of MDD with previously identified risk factors. This study did not find robust support for genetic differences in MDD due to sex, age of onset, or illness course. However, we found

  1. Mind-body interface: the role of n-3 fatty acids in psychoneuroimmunology, somatic presentation, and medical illness comorbidity of depression.

    PubMed

    Su, Kuan-Pin

    2008-01-01

    With the unsatisfaction of monoamine-based pharmacotherapy and the high comorbidity of other medical illness in depression, the serotonin hypothesis seems to fail in approaching the aetiology of depression. Based upon the evidence from epidemiological data, case-control studies of phospholipid polyunsaturated fatty acids (PUFAs) levels in human tissues, and antidepressant effect in clinical trials, PUFAs have shed a light to discover the unsolved of depression and connect the mind and body. Briefly, the deficit of n-3 PUFAs has been reported to be associated with neurological, cardiovascular, cerebrovascular, autoimmune, metabolic diseases and cancers. Recent studies revealed that the deficit of n-3 PUFAs is also associated with depression. For example, societies that consume a small amount of omega-3 PUFAs appear to have a higher prevalence of major depressive disorder. In addition, depressive patients had showed a lower level of omega-3 PUFAs; and the antidepressant effect of PUFAs had been reported in a number of clinical trials. The PUFAs are classified into n-3 (or omega-3) and n-6 (or omega-6) groups. Eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), the major bioactive components of n-3 PUFAs, are not synthesized in human body and can only be obtained directly from the diet, particularly by consuming fish. DHA deficit is associated with dysfunctions of neuronal membrane stability and transmission of serotonin, norepinephrine and dopamine, which might connect to the aetiology of mood and cognitive dysfunction of depression. On the other hand, EPA is important in balancing the immune function and physical healthy by reducing arachidonic acid (AA, an n-6 PUFA) level on cell membrane and prostaglandin E2 (PGE2) synthesis. Interestingly, animals fed with high AA diet or treated with PGE2 were observed to present sickness behaviours of anorexia, low activity, change in sleep pattern and attention, which are similar to somatic symptoms of depression in

  2. Effects of illness representation, perceived quality of information provided by the health-care professional, and perceived social support on depressive symptoms of the caregivers of children with leukemia.

    PubMed

    Bozo, Ozlem; Anahar, Selin; Ateş, Gizem; Etel, Evren

    2010-03-01

    The present study examined the effects of illness representation, perceived quality of information provided by the health-care professional, and perceived social support on the depressive symptoms of the caregivers of children with leukemia. The sample was composed of 71 caregivers of children with leukemia living in Turkey. The obtained data were analyzed by path analysis. The results show that caregivers of children with leukemia experience higher levels of depressive symptoms when they have negative illness representation and lower levels of depressive symptoms when they perceive higher levels of social support. Moreover, they perceive higher social support when they perceive high quality of information provided by health-care professionals. It can be suggested that intervention programs which aim to increase caregivers' social support and change their illness representation in a positive way would be helpful for the caregivers showing depressive symptoms.

  3. Dysfunctional attitudes, self-esteem, and hassles: cognitive vulnerability to depression in children of affectively ill parents.

    PubMed

    Abela, John R Z; Skitch, Steven A

    2007-06-01

    The current study tested the diathesis-stress component of Beck's [(1967). Depression: Clinical, experimental, and theoretical aspects. New York: Harper & Row, (1983). Cognitive therapy of depression: New perspectives. In P.J. Clayton, J.E. Barnett (Eds.), Treatment of depression: Old controversies and new approaches (pp. 265-290). New York: Raven Press] cognitive theory of depression in a sample of children between the ages of 6 and 14. We also examined whether high self-esteem buffers cognitively vulnerable youth against experiencing increases in depressive symptoms following increases in hassles. To provide a effective test of hypotheses, an at-risk sample (children of parents with a history of major depressive episodes) and a multi-wave longitudinal design were used. At Time 1, children (n=140) completed measures assessing dysfunctional attitudes, self-esteem, and depressive symptoms. Every 6 weeks for the next year, children completed measures assessing depressive symptoms and hassles. Hierarchical linear modeling analyses indicated that children possessing high levels of dysfunctional attitudes and low levels of self-esteem reported greater elevations in depressive symptoms following elevations in hassles than other children.

  4. Brief version of the Internalized Stigma of Mental Illness (ISMI) scale: psychometric properties and relationship to depression, self esteem, recovery orientation, empowerment, and perceived devaluation and discrimination.

    PubMed

    Boyd, Jennifer E; Otilingam, Poorni G; Deforge, Bruce R

    2014-03-01

    The internalized stigma of mental illness impedes recovery and is associated with increased depression, reduced self-esteem, reduced recovery orientation, reduced empowerment, and increased perceived devaluation and discrimination. The Internalized Stigma of Mental Illness (ISMI) scale is a 29-item self-report questionnaire developed with consumer input that includes the following subscales: Alienation, Discrimination Experience, Social Withdrawal, Stereotype Endorsement, and Stigma Resistance. Here we present a 10-item version of the ISMI containing the two strongest items from each subscale. Participants were all outpatient veterans with serious mental illness. Following the rigorous scale-reduction methods set forth by Stanton and colleagues (2002), we selected the 10 items, tested the psychometrics of the shortened scale in the original validation sample (N = 127), and cross-checked the results in a second dataset (N = 760). As expected, the ISMI-10 retained the essential properties of the ISMI-29, including adequate internal consistency reliability and external validity in relation to depression, self-esteem, recovery orientation, perceived devaluation and discrimination, and empowerment. The ISMI-10 scores are normally distributed and have similar descriptive statistics to the ISMI-29. The reliability and depression findings were replicated in a cross-validation sample. We conclude that the ISMI-10 has strong psychometric properties and is a practical, reliable, and valid alternative to the original ISMI-29. Future work should test the ISMI-10 in more diverse samples. This shorter version should reduce respondent burden in program evaluation projects that seek to determine whether participation in psychosocial rehabilitation programming reduces internalized stigma.

  5. Towards a scientific taxonomy of depression

    PubMed Central

    K. Ranga, Rama Krishnan

    Many concepts have been introduced into the classification of depression, including manic-depressive/bipolar disorder depression, etc. Kraepelin's original concept of manic-depressive disorder has evolved into the concept of polarity, and bipolar and unipolar disorders. Psychiatric classification is characterized by an inflation of the diagnostic categories, including subtypes of depression. This rapid multiplier effect is primarily descriptive, and there is a need to rethink, in a pragmatic fashion, the classification system, in order to develop one that is likely to be of utility and which has a scientific basis. Is the time now right to ask whether there are essential conditions relevant to depression? I think that it is, and here I will introduce the notion with two such conditions. The first is early life stress disorder, and the second vascular depression. These conditions have reached a point where the data supports them as distinct entities. In this paper, the rationale for this is discussed. PMID:18979943

  6. Maternal inheritance and chromosome 18 allele sharing in unilineal bipolar illness pedigrees

    SciTech Connect

    Gershon, E.S.; Badner, J.A.; Detera-Wadleigh, S.D.

    1996-04-09

    We have replicated the observation that there is excess maternal transmission of illness in a series of previously described unilineal Bipolar manic-depressive illness extended pedigrees. ({open_quotes}Transmission{close_quotes} is defined for any ill person in a pedigree when father or mother has a personal or immediate family history of major affective disorder.) We divided our pedigrees into exclusively maternal transmission (Mat) and mixed maternal-paternal transmission (in different pedigree branches) (Pat). Using affected sib-pair-analysis, linkage to a series of markers on chromosome 18p-cen was observed in the Pat but not the Mat pedigrees, with significantly greater identity by descent (IBD) at these markers in the Pat pedigrees. As compared with the pedigree series as a whole, the proportion of alleles IBD in the linkage region is much increased in the Pat pedigrees. As the sharing proportion of alleles in affected relative pairs increases, the number of such pairs needed to resolve the linkage region to a 1 cM interval becomes smaller. Genetic subdivision of an illness by clinical or pedigree configuration criteria may thus play an important role in discovery of disease susceptibility mutations. 10 refs., 2 figs., 3 tabs.

  7. Pharmacotherapy of Acute Bipolar Depression in Adults: An Evidence Based Approach

    PubMed Central

    2016-01-01

    In the majority of cases of bipolar disorder, manic episodes are usually brief and typically responsive to currently available psychopharmacological agents. In contrast, depressive manifestations are more prevalent and persistent, and can present as major depressive/mixed episodes or residual interepisode symptoms. The depressive phase is often associated with other neuropsychiatric conditions, such as anxiety spectrum disorders, substance use disorders, stressor-related disorders, and eating disorders. It is viewed as a systemic disease with associated ailments such as metabolic syndrome, diabetes mellitus, and cardiovascular disease. There is an increased rate of mortality not only from suicide, but also from concomitant physical illness. This scenario is made worse by the fact that depressive symptoms, which represent the main disease burden, are often refractory to existing psychotropic drugs. As such, there is a pressing need for novel agents that are efficacious in acute depressive exacerbations, and also have applicable value in preventing recurrent episodes. The rationale of the present review is to delineate the pharmacotherapy of the depressive phase of bipolar disorder with medications for which there is evidence in the form of observational, open-label, or double-blind randomized controlled studies. In the treatment of acute bipolar depression in adults, a comprehensive appraisal of the extant literature reveals that among mood stabilizers, the most robust proof of efficacy exists for divalproex sodium; while atypical antipsychotics, which include olanzapine, quetiapine, lurasidone, and cariprazine, are also effective, as demonstrated in controlled trials. PMID:27274384

  8. Aggression Protects Against the Onset of Major Depressive Episodes in Individuals With Bipolar Spectrum Disorder.

    PubMed

    Ng, Tommy H; Freed, Rachel D; Titone, Madison K; Stange, Jonathan P; Weiss, Rachel B; Abramson, Lyn Y; Alloy, Lauren B

    2017-05-01

    A growing body of research suggests that bipolar spectrum disorders (BSDs) are associated with high aggression. However, little research has prospectively examined how aggression may affect time to onset of hypomanic/manic versus major depressive episodes. In a longitudinal study, we tested the hypothesis that aggression would prospectively predict a shorter time to the onset of hypomanic/manic episodes and a longer time to the onset of major depressive episodes, based on the behavioral approach system theory of BSDs. Young adults (N = 120) diagnosed with cyclothymia, bipolar II disorder, or bipolar disorder not otherwise specified were followed every 4 months for an average of 3.55 years. Participants completed measures of depressive and manic symptoms, family history of mood disorder, impulsivity, and aggression at baseline and were followed prospectively with semistructured diagnostic interview assessments of hypomanic/manic and major depressive episodes and treatment seeking for mood problems. Cox proportional hazard regression analyses indicated that overall, physical, and verbal aggression predicted a longer time to major depressive episode onset, even after controlling for baseline depressive and manic symptoms, family history of mood disorder, treatment seeking for mood problems, and impulsivity. Aggression, however, did not significantly predict time to onset of hypomanic/manic episodes, controlling for the same covariates. The findings suggest that approach-related behaviors may be utilized to delay the onset of major depressive episodes among people with BSDs.

  9. A LONGITUDINAL STUDY OF POOR SLEEP AFTER INPATIENT POST-ACUTE REHABILITATION: THE ROLE OF DEPRESSION AND PRE-ILLNESS SLEEP QUALITY

    PubMed Central

    Martin, Jennifer L.; Jouldjian, Stella; Mitchell, Michael N.; Josephson, Karen R.; Alessi, Cathy A.

    2012-01-01

    Objectives To explore the unique impact of poor sleep and symptoms of depression on sleep quality for up to one year after inpatient post-acute rehabilitation among older adults. Design Prospective longitudinal cohort study. Setting Two in-patient post-acute rehabilitation facilities Participants 245 individuals over age 65 years (mean age=80 years, 38% female) Interventions None. Measurements Sleep quality was assessed with the Pittsburgh Sleep Quality Index (PSQI) during the post-acute care stay twice to evaluate pre-illness sleep quality and sleep quality during the post-acute care stay, and again at 3, 6, 9 and 12-months follow-up. Demographics, symptoms of depression, cognitive functioning, and comorbidities were also assessed. Results Across time points, sleep was significantly disturbed for many individuals. Nested regression models predicting PSQI total score at 3, 6, 9 and 12 months showed that variables entered in Block 1 (age, gender, cognitive functioning and comorbidities) were significant predictors of poor sleep at 6-months, but not at 3, 9 or 12 months follow-up. Depression (Block 2) and pre-illness PSQI total score (Block 3) were significant predictors of PSQI total score at all follow-up time points. PSQI total score during post-acute care (Block 4) explained a significant proportion of variance only at the 3-month follow-up. Conclusions This study confirms that chronic poor sleep is common among older adults during post-acute rehabilitation, and resolution of sleep disturbance after acute health events may be a lengthy process. Our findings expand understanding of the role of depressive symptoms and pre-existing sleep complaints in predicting poor sleep over time among these vulnerable older adults. PMID:22617164

  10. Excessive Reassurance Seeking, Hassles, and Depressive Symptoms in Children of Affectively Ill Parents: A Multiwave Longitudinal Study

    ERIC Educational Resources Information Center

    Abela, John R. Z.; Zuroff, David C.; Ho, Moon-Ho R.; Adams, Philippe; Hankin, Benjamin L.

    2006-01-01

    The current study examined whether excessive reassurance seeking serves as a vulnerability factor to depression in a sample of high-risk youth using a multiwave longitudinal design. At Time 1, 140 children (aged 6-14) of affectively disordered parents completed measures assessing reassurance seeking and depressive symptoms. In addition, every 6…

  11. Personality Predispositions to Depression in Children of Affectively-Ill Parents: The Buffering Role of Self-Esteem

    ERIC Educational Resources Information Center

    Abela, John R. Z.; Fishman, Michael B.; Cohen, Joseph R.; Young, Jami F.

    2012-01-01

    A major theory of personality predispositions to depression posits that individuals who possess high levels of self-criticism and/or dependency are vulnerable to developing depression following negative life events. The goal of the current study was to test this theory of personality predispositions and the self-esteem buffering hypothesis in a…

  12. Personality Predispositions to Depression in Children of Affectively-Ill Parents: The Buffering Role of Self-Esteem

    ERIC Educational Resources Information Center

    Abela, John R. Z.; Fishman, Michael B.; Cohen, Joseph R.; Young, Jami F.

    2012-01-01

    A major theory of personality predispositions to depression posits that individuals who possess high levels of self-criticism and/or dependency are vulnerable to developing depression following negative life events. The goal of the current study was to test this theory of personality predispositions and the self-esteem buffering hypothesis in a…

  13. Bipolar postpartum depression: An update and recommendations.

    PubMed

    Sharma, Verinder; Doobay, Minakshi; Baczynski, Christine

    2017-09-01

    Over the past few years there has been a surge of interest in the study of bipolar postpartum depression (PPD); however, questions remain about its prevalence, screening, clinical features, and treatment. Three electronic databases, MEDLINE/PubMed (1966-2016), PsycINFO (1806-2016), and the Cochrane Database of Systematic Reviews, were searched using a combination of the keywords bipolar, depression, postpartum, peripartum, prevalence, screening, diagnosis, treatment, drugs, and psychotherapy. The reference lists of articles identified were also searched. All relevant articles published in English were included. Depending on the population studied, 21.4-54% of women with PPD have a diagnosis of bipolar disorder (BD). Characteristic clinical features include younger age at illness onset, first onset of depression after childbirth, onset immediately after delivery, atypical depressive symptoms, psychotic features, mixed features, and history of BD in first-degree family members. Treatment should be guided by symptom acuity, safety concerns, the patient's response to past treatments, drug tolerability, and breastfeeding preference. In the absence of controlled treatment data, preference should be given to drugs normally indicated for bipolar depression including lithium, quetiapine and lamotrigine. Although antidepressants have been studied in combination with mood stabilizers in bipolar depression, these drugs should be avoided due to likelihood of elevated risk of induction of manic symptoms in the postpartum period. In the postpartum period, bipolar PPD is common, can be differentiated from unipolar PPD, and needs to be identified promptly in order to expedite appropriate treatment. Future studies on pharmacotherapy and psychotherapy should focus on the acute and preventative treatment of bipolar PPD. Copyright © 2017 Elsevier B.V. All rights reserved.

  14. The structure of lifetime manic-hypomanic spectrum.

    PubMed

    Cassano, G B; Mula, M; Rucci, P; Miniati, M; Frank, E; Kupfer, D J; Oppo, A; Calugi, S; Maggi, L; Gibbons, R; Fagiolini, A

    2009-01-01

    The observation that bipolar disorders frequently go unrecognized has prompted the development of screening instruments designed to improve the identification of bipolarity in clinical and non-clinical samples. Starting from a lifetime approach, researchers of the Spectrum Project developed the Mood Spectrum Self-Report (MOODS-SR) that assesses threshold-level manifestations of unipolar and bipolar mood psychopathology, but also atypical symptoms, behavioral traits and temperamental features. The aim of the present study is to examine the structure of mania/hypomania using 68 items of the MOODS-SR that explore cognitive, mood and energy/activity features associated with mania/hypomania. A data pool of 617 patients with bipolar disorders, recruited at Pittsburgh and Pisa, Italy was used for this purpose. Classical exploratory factor analysis, based on a tetrachoric matrix, was carried out on the 68 items, followed by an Item Response Theory (IRT)-based factor analytic approach. Nine factors were initially identified, that include Psychomotor Activation, Creativity, Mixed Instability, Sociability/Extraversion, Spirituality/Mysticism/Psychoticism, Mixed Irritability, Inflated Self-esteem, Euphoria, Wastefulness/Recklessness, and account overall for 56.4% of the variance of items. In a subsequent IRT-based bi-factor analysis, only five of them (Psychomotor Activation, Mixed Instability, Spirituality/Mysticism/Psychoticism, Mixed Irritability, Euphoria) were retained. Our data confirm the central role of Psychomotor Activation in mania/hypomania and support the definitions of pure manic (Psychomotor Activation and Euphoria) and mixed manic (Mixed Instability and Mixed Irritability) components, bearing the opportunity to identify patients with specific profiles for a better clinical and neurobiological definition.

  15. History of manic and hypomanic episodes and risk of incident cardiovascular disease: 11.5 year follow-up from the Baltimore Epidemiologic Catchment Area Study.

    PubMed

    Ramsey, Christine M; Leoutsakos, Jeannie-Marie; Mayer, Lawrence S; Eaton, William W; Lee, Hochang B

    2010-09-01

    While several studies have suggested that bipolar disorder may elevate risk of cardiovascular disease, few studies have examined the relationship between mania or hypomania and cardiovascular disease. The purpose of this study is to examine history of manic and hypomanic episodes as an independent risk factor for cardiovascular disease (CVD) during an 11.5 year follow-up of the Baltimore Epidemiologic Catchment Area Follow-up Study. All participants were psychiatrically assessed face-to-face based on Diagnostic Interview Schedule in 1981 and 1982 and were categorized as having either history of manic or hypomanic episode (MHE; n=58), major depressive episode only (MDE; n=71) or no mood episode (NME; n=1339). Incident cardiovascular disease (CVD; n=67) was determined by self-report of either myocardial infarction (MI) or congestive heart failure (CHF) in 1993-6. Compared with NME subjects, the odds ratio for incident CVD among MHE subjects was 2.97 (95% confidence interval: 1.40, 6.34) after adjusting for putative risk factors. These data suggest that a history of MHE increase the risk of incident CVD among community residents. Recognition of manic symptoms and addressing related CVD risk factors could have long term preventative implications in the development of cardiovascular disease in the community. 2010. Published by Elsevier B.V.

  16. Causes, Detection and Treatment of Childhood Depression.

    ERIC Educational Resources Information Center

    Yahraes, Herbert

    Three types of depressive illness of childhood (masked depression, acute depressive illness, and chronic depressive illness) are described; contributing factors (heredity and parental behavior) are discussed; and indications of depression are considered. Briefly reviewed are various methods of treating depressed children, including the use of…

  17. Stress, illness, and the social environment: depressive symptoms among first generation mandarin speaking Chinese in greater Los Angeles.

    PubMed

    Li, Yueling; Hofstetter, C Richard; Irving, Veronica; Chhay, Doug; Hovell, Melbourne F

    2014-12-01

    This study documents the indirect effects of social and environmental variables as mediated by immigrant stress and physical health. Using data from a large dual frame sample of first generation mandarin speaking Chinese immigrants in metropolitan Los Angeles counties with the largest groups of Chinese immigrants, this study uses a path analytic approach to trace how predictors are related to depressive symptoms and to measure direct and indirect influences of variables. Although bivariate analyses suggested that many predictors were associated with depressive symptoms, multivariate path analysis revealed a more complex structure of mediated associations. In the multivariate path analysis only reports of physical health and immigrant stress were directly related to depressive symptoms (P < 0.05), while acculturation, time in the US, income, US citizenship, and distance of persons on whom one could rely were related to stress (but not to physical health status) and only to depressive symptoms as mediated by stress. Age and educational attainment were related to health status (and to stress as mediated by physical health) and to depressive symptoms as mediated by both health and stress. These variables were also unrelated directly to health status and to depressive symptoms. Associations were evaluated using statistical significance, P < 0.05. This study demonstrates the significance of stress and health as mediators of variables in the larger context of the physical environment and suggests that the mechanisms linking ecological characteristics of immigrants to depressive symptoms may be stress and physical health among immigrants.

  18. Impact of depressive episodes on cognitive deficits in early bipolar disorder: data from the Systematic Treatment Optimization Programme for Early Mania (STOP-EM).

    PubMed

    Muralidharan, Kesavan; Torres, Ivan J; Silveira, Leonardo E; Kozicky, Jan-Marie; Bücker, Joana; Fernando, Nadeesha; Yatham, Lakshmi N

    2014-07-01

    Although manic episodes reportedly contribute to cognitive deficits in bipolar I disorder, the contribution of depressive episodes is poorly researched. We investigated the impact of depressive episodes on cognitive function early in the course of bipolar I disorder. A total of 68 patients and 38 controls from the Systematic Treatment Optimization Programme for Early Mania (STOP-EM) first-episode mania programme were examined. We conducted (a) a cross-sectional analysis of the impact of prior depressive episodes on baseline cognitive function and (b) a prospective analysis assessing the contribution of depression recurrence within 1 year following a first episode of mania on cognitive functioning. The cross-sectional analysis showed no significant differences between patients with past depressive episodes compared with those without, on overall or individual domains of cognitive function (all P>0.09). The prospective analysis failed to reveal a significant group×time interaction for cognitive decline from baseline to 1 year (P = 0.99) in patients with a recurrence of depressive episodes compared with those with no recurrence. However, impaired verbal memory at baseline was associated with a depression recurrence within 1 year. Although deficits in all domains of cognitive function are seen in patients early in the course of bipolar disorder, depressive episodes do not confer additional burden on cognitive function. However, poorer verbal memory may serve as a marker for increased susceptibility to depression recurrence early in the course of illness. Royal College of Psychiatrists.

  19. Serum BDNF levels in relation to illness severity, suicide attempts, and central serotonin activity in patients with major depressive disorder: a pilot study.

    PubMed

    Park, Young-Min; Lee, Bun-Hee; Um, Tae Hyun; Kim, Sollip

    2014-01-01

    The aim of this study was to test the hypothesis that serum levels of brain-derived neurotrophic factor (BDNF) are correlated with the loudness dependence of auditory evoked potentials (LDAEP). The question of whether there is a difference in BDNF levels between depressive patients according to their illness severity, history of suicide attempts, and central serotonin activity was also addressed. A sample of 51 patients who met the criteria for major depressive disorder following diagnosis using axis I of the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders - text revision comprised the study subjects. The patients were stratified into two subgroups based on their illness severity, history of suicide attempts, and their LDAEP values. The LDAEP was evaluated by measuring the auditory event-related potentials, and serum BDNF was measured using blood sampling before beginning medication with serotonergic agents. There was no difference in serum BDNF levels between the two patient subgroups. The subgroup with moderate-to-severe depression (n = 16) was reanalyzed after stratifying it into two subgroups according to LDAEP and BDNF values (dichotomized at the medians into low and high). The high-LDAEP subgroup had higher serum BDNF levels and total Barratt Impulsiveness Scale score than the low-LDAEP subgroup (p = 0.03 and 0.036, respectively). Serum BDNF levels were positively correlated with LDAEP and total Beck Hopelessness Scale (BHS) score (r = 0.56, p = 0.025, and r = 0.59, p = 0.016, respectively). The high-BDNF subgroup had a higher LDAEP and total BHS score than the low-BDNF subgroup (p = 0.046 and p = 0.011, respectively). This is the first study to demonstrate a relationship between the BDNF level and LDAEP in Asian depressive patients. Intriguingly, the high-BDNF subgroup (divided according to illness severity) exhibited a more severe psychopathology on some psychometric rating scales, a finding that

  20. Serum BDNF Levels in Relation to Illness Severity, Suicide Attempts, and Central Serotonin Activity in Patients with Major Depressive Disorder: A Pilot Study

    PubMed Central

    Park, Young-Min; Lee, Bun-Hee; Um, Tae Hyun; Kim, Sollip

    2014-01-01

    The aim of this study was to test the hypothesis that serum levels of brain-derived neurotrophic factor (BDNF) are correlated with the loudness dependence of auditory evoked potentials (LDAEP). The question of whether there is a difference in BDNF levels between depressive patients according to their illness severity, history of suicide attempts, and central serotonin activity was also addressed. A sample of 51 patients who met the criteria for major depressive disorder following diagnosis using axis I of the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders – text revision comprised the study subjects. The patients were stratified into two subgroups based on their illness severity, history of suicide attempts, and their LDAEP values. The LDAEP was evaluated by measuring the auditory event-related potentials, and serum BDNF was measured using blood sampling before beginning medication with serotonergic agents. There was no difference in serum BDNF levels between the two patient subgroups. The subgroup with moderate-to-severe depression (n = 16) was reanalyzed after stratifying it into two subgroups according to LDAEP and BDNF values (dichotomized at the medians into low and high). The high-LDAEP subgroup had higher serum BDNF levels and total Barratt Impulsiveness Scale score than the low-LDAEP subgroup (p = 0.03 and 0.036, respectively). Serum BDNF levels were positively correlated with LDAEP and total Beck Hopelessness Scale (BHS) score (r = 0.56, p = 0.025, and r = 0.59, p = 0.016, respectively). The high-BDNF subgroup had a higher LDAEP and total BHS score than the low-BDNF subgroup (p = 0.046 and p = 0.011, respectively). This is the first study to demonstrate a relationship between the BDNF level and LDAEP in Asian depressive patients. Intriguingly, the high-BDNF subgroup (divided according to illness severity) exhibited a more severe psychopathology on some psychometric rating scales, a finding that

  1. Antidepressant-resistant depression and antidepressant-associated suicidal behaviour: the role of underlying bipolarity.

    PubMed

    Rihmer, Zoltan; Gonda, Xenia

    2011-01-01

    The complex relationship between the use of antidepressants and suicidal behaviour is one of the hottest topics of our contemporary psychiatry. Based on the literature, this paper summarizes the author's view on antidepressant-resistant depression and antidepressant-associated suicidal behaviour. Antidepressant-resistance, antidepressant-induced worsening of depression, antidepressant-associated (hypo)manic switches, mixed depressive episode, and antidepressant-associated suicidality among depressed patients are relatively most frequent in bipolar/bipolar spectrum depression and in children and adolescents. As early age at onset of major depressive episode and mixed depression are powerful clinical markers of bipolarity and the manic component of bipolar disorder (and possible its biological background) shows a declining tendency with age antidepressant-resistance/worsening, antidepressant-induced (hypo)manic switches and "suicide-inducing" potential of antidepressants seem to be related to the underlying bipolarity.

  2. Personality predispositions to depression in children of affectively-ill parents: the buffering role of self-esteem.

    PubMed

    Abela, John R Z; Fishman, Michael B; Cohen, Joseph R; Young, Jami F

    2012-01-01

    A major theory of personality predispositions to depression posits that individuals who possess high levels of self-criticism and/or dependency are vulnerable to developing depression following negative life events. The goal of the current study was to test this theory of personality predispositions and the self-esteem buffering hypothesis in a sample of youth using an idiographic approach, a high-risk sample, and a multiwave longitudinal design. One hundred forty children aged 6 to 14 completed measures of dependency, self-criticism, self-esteem, and depressive symptoms. Over the course of the following year, 8 follow-up assessments were conducted 6 weeks apart during which all children were administered measures assessing depressive symptoms and the occurrence of negative events. Results of hierarchical linear modeling analyses indicated that higher levels of dependency were associated with greater increases in depressive symptoms following negative events among children possessing low, but not high, self-esteem. In contrast, self-criticism was not associated with changes in depressive symptoms over time regardless of children's levels of stress and/or self-esteem.

  3. The impact of parental borderline personality disorder on vulnerability to depression in children of affectively ill parents.

    PubMed

    Abela, John R Z; Skitch, Steven A; Auerbach, Randy P; Adams, Philippe

    2005-02-01

    Children of parents with major depressive disorder (MDD) are four to six times more likely than other children to develop MDD. Little research has examined whether comorbid parental diagnoses further increase children's risk. This study examines whether children of parents with comorbid MDD and Borderline Personality Disorder (BPD) (1) are at greater risk for experiencing depressive symptoms and/or episodes and (2) whether such increased risk may be due, in part, to their exhibiting higher levels of cognitive/interpersonal vulnerability factors. Children (n = 140; ages 6-14) of parents with MDD completed measures assessing cognitive/interpersonal vulnerability factors. Parents completed semi-structured clinical interviews assessing severity of current depressive symptoms and BPD. Both children and parents completed a semi-structured clinical interview assessing the child's current and past history of MDD. Children of parents with comorbid MDD and BPD exhibited higher levels of current depressive symptoms and higher levels of cognitive/interpersonal vulnerability factors than children of parents with MDD but no BPD, even after controlling for parents' current levels of depressive symptoms. The relationship between parental BPD and chil-dren's current levels of depressive symptoms was partially mediated by children's cognitive/interpersonal vulnerability factors. Last, children of parents with comorbid BPD and MDD were 6.84 times more likely to exhibit a current or past diagnosis of MDD.

  4. Risk of mental illness in offspring of parents with schizophrenia, bipolar disorder, and major depressive disorder: a meta-analysis of family high-risk studies.

    PubMed

    Rasic, Daniel; Hajek, Tomas; Alda, Martin; Uher, Rudolf

    2014-01-01

    Offspring of parents with severe mental illness (SMI; schizophrenia, bipolar disorder, major depressive disorder) are at an increased risk of developing mental illness. We aimed to quantify the risk of mental disorders in offspring and determine whether increased risk extends beyond the disorder present in the parent. Meta-analyses of absolute and relative rates of mental disorders in offspring of parents with schizophrenia, bipolar disorder, or depression in family high-risk studies published by December 2012. We included 33 studies with 3863 offspring of parents with SMI and 3158 control offspring. Offspring of parents with SMI had a 32% probability of developing SMI (95% CI: 24%-42%) by adulthood (age >20). This risk was more than twice that of control offspring (risk ratio [RR] 2.52; 95% CI 2.08-3.06, P < .001). High-risk offspring had a significantly increased rate of the disorder present in the parent (RR = 3.59; 95% CI: 2.57-5.02, P < .001) and of other types of SMI (RR = 1.92; 95% CI: 1.48-2.49, P < .001). The risk of mood disorders was significantly increased among offspring of parents with schizophrenia (RR = 1.62; 95% CI: 1.02-2.58; P = .042). The risk of schizophrenia was significantly increased in offspring of parents with bipolar disorder (RR = 6.42; 95% CI: 2.20-18.78, P < .001) but not among offspring of parents with depression (RR = 1.71; 95% CI: 0.19-15.16, P = .631). Offspring of parents with SMI are at increased risk for a range of psychiatric disorders and one third of them may develop a SMI by early adulthood.

  5. Predictors of switch from depression to mania in bipolar disorder.

    PubMed

    Niitsu, Tomihisa; Fabbri, Chiara; Serretti, Alessandro

    2015-01-01

    Manic switch is a relevant issue when treating bipolar depression. Some risk factors have been suggested, but unequivocal findings are lacking. We therefore investigated predictors of switch from depression to mania in the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) sample. Manic switch was defined as a depressive episode followed by a (hypo)manic or mixed episode within the following 12 weeks. We assessed possible predictors of switch using generalized linear mixed models (GLMM). 8403 episodes without switch and 512 episodes with switch (1720 subjects) were included in the analysis. Several baseline variables were associated with a higher risk of switch. They were younger age, previous history of: rapid cycling, severe manic symptoms, suicide attempts, amphetamine use and some pharmacological and psychotherapeutic treatments. During the current depressive episode, the identified risk factors were: any possible mood elevation, multiple mania-associated symptoms with at least moderate severity, and comorbid panic attacks. In conclusion, our study suggests that both characteristics of the disease history and clinical features of the current depressive episode may be risk factors for manic switch.

  6. Risk Prediction Models in Psychiatry: Toward a New Frontier for the Prevention of Mental Illnesses.

    PubMed

    Bernardini, Francesco; Attademo, Luigi; Cleary, Sean D; Luther, Charles; Shim, Ruth S; Quartesan, Roberto; Compton, Michael T

    2017-05-01

    We conducted a systematic, qualitative review of risk prediction models designed and tested for depression, bipolar disorder, generalized anxiety disorder, posttraumatic stress disorder, and psychotic disorders. Our aim was to understand the current state of research on risk prediction models for these 5 disorders and thus future directions as our field moves toward embracing prediction and prevention. Systematic searches of the entire MEDLINE electronic database were conducted independently by 2 of the authors (from 1960 through 2013) in July 2014 using defined search criteria. Search terms included risk prediction, predictive model, or prediction model combined with depression, bipolar, manic depressive, generalized anxiety, posttraumatic, PTSD, schizophrenia, or psychosis. We identified 268 articles based on the search terms and 3 criteria: published in English, provided empirical data (as opposed to review articles), and presented results pertaining to developing or validating a risk prediction model in which the outcome was the diagnosis of 1 of the 5 aforementioned mental illnesses. We selected 43 original research reports as a final set of articles to be qualitatively reviewed. The 2 independent reviewers abstracted 3 types of data (sample characteristics, variables included in the model, and reported model statistics) and reached consensus regarding any discrepant abstracted information. Twelve reports described models developed for prediction of major depressive disorder, 1 for bipolar disorder, 2 for generalized anxiety disorder, 4 for posttraumatic stress disorder, and 24 for psychotic disorders. Most studies reported on sensitivity, specificity, positive predictive value, negative predictive value, and area under the (receiver operating characteristic) curve. Recent studies demonstrate the feasibility of developing risk prediction models for psychiatric disorders (especially psychotic disorders). The field must now advance by (1) conducting more large

  7. Burden of Mental Illness

    MedlinePlus

    ... this? Submit What's this? Submit Button Burden of Mental Illness Recommend on Facebook Tweet Share Compartir Depression: According ... anxiety disorder, are the most common class of mental disorders present in the general population. 5 The estimated ...

  8. Depression

    MedlinePlus

    ... Watch for changes in school work, sleep, and behavior. If you wonder whether your child might be depressed, talk with your health care ... families. This may be due to your genes, behaviors you learn at home, or your ... life events, such as job loss, divorce, or death of a spouse or other family ...

  9. Depression

    MedlinePlus

    ... treatment, the depression will lift Where can I go for help? If you are unsure where to go for help, ask your health provider or check ... one’s health professional. Call 911 for emergency services. Go to the nearest hospital emergency room. Call the ...

  10. Depressants

    MedlinePlus

    ... GHB and Rohypnol ® are also misused to facilitate sexual assault. Affect on mind Depressants used therapeutically do what they are prescribed for to put you to sleep, relieve anxiety and muscle spasms, and prevent seizures. They also: cause amnesia, leaving no memory of events that occur ...

  11. Manic patients exhibit more utilitarian moral judgments in comparison with euthymic bipolar and healthy persons.

    PubMed

    Kim, Sung Hwa; Kim, Tae Young; Ryu, Vin; Ha, Ra Yeon; Lee, Su Jin; Ha, Kyooseob; Cho, Hyun-Sang

    2015-04-01

    Both emotional and cognitive processes are involved in moral judgments. Ventromedial prefrontal lesions are related to impaired prosocial emotions and emotional dysregulation, and patients with these lesions exhibit increased utilitarian judgments of emotionally salient personal moral dilemmas. Bipolar patients experiencing manic episode also have impaired emotional regulation and behavioral control. We investigated the characteristics of moral judgment in manic and euthymic patients with bipolar disorder using the 50 hypothetical moral dilemma task (17 non-moral, 20 personal, and 13 impersonal). Our study included 27 manic bipolar patients, 26 euthymic bipolar patients, and 42 healthy controls. Subjects were instructed to determine whether or not each dilemma was morally acceptable, and their reaction times were recorded. Manic patients showed significantly greater utilitarian judgment than euthymic patients and normal controls for personal moral dilemmas. However, there were no significant between-group differences for the non-moral and impersonal moral dilemmas. Our results suggest that increased utilitarian judgments of personal moral dilemmas may be a state-related finding observed only in manic patients. This difference in moral judgment assessments may reflect the decision-making characteristics and underlying neurobiological mechanisms of bipolar disorder, especially during the manic state.

  12. Pattern of healthcare resource utilization and direct costs associated with manic episodes in Spain

    PubMed Central

    2010-01-01

    Background Although some studies indicate that bipolar disorder causes high health care resources consumption, no study is available addressing a cost estimation of bipolar disorder in Spain. The aim of this observational study was to evaluate healthcare resource utilization and the associated direct cost in patients with manic episodes in the Spanish setting. Methods Retrospective descriptive study was carried out in a consecutive sample of patients with a DSM-IV diagnosis of bipolar type I disorder with or without psychotic symptoms, aged 18 years or older, and who were having an active manic episode at the time of inclusion. Information regarding the current manic episode was collected retrospectively from the medical record and patient interview. Results Seven hundred and eighty-four evaluable patients, recruited by 182 psychiatrists, were included in the study. The direct cost associated with healthcare resource utilization during the manic episode was high, with a mean cost of nearly €4,500 per patient, of which approximately 55% corresponded to the cost of hospitalization, 30% to the cost of psychopharmacological treatment and 10% to the cost of specialized care. Conclusions Our results show the high cost of management of the patient with a manic episode, which is mainly due to hospitalizations. In this regard, any intervention on the management of the manic patient that could reduce the need for hospitalization would have a significant impact on the costs of the disease. PMID:20426814

  13. A systematic review of the frequency and severity of manic symptoms reported in studies that compare phenomenology across children, adolescents and adults with bipolar disorders.

    PubMed

    Ryles, Faye; Meyer, Thomas D; Adan-Manes, Jaime; MacMillan, Iain; Scott, Jan

    2017-12-01

    In the last two decades, there has been a significant increase in the diagnosis of Bipolar Disorder (BD) in children. The notion of prepubertal onsets of BD is not without controversy, with researchers debating whether paediatric cases have a distinct symptom profile or follow a different illness trajectory from other forms of BD. The latter issue is difficult to address without long-term prospective follow-up studies. However, in the interim, it is useful to consider the phenomenology observed in groups of cases with different ages of onset and particularly to compare manic symptoms in children diagnosed with BD compared to cases presenting with BD in adolescence and adulthood. This review systematically explores the phenomenology of manic or hypomanic episodes in groups defined by age at onset of BD (children, adolescents and adults; or combined age groups e.g. children and adolescents versus adults). Literature reviews of PubMed and Scopus were conducted to identify publications which directly compared the frequency or severity of manic symptoms in individuals with BD presenting with a first episode of mania in childhood, adolescence or adulthood. Of 304 studies identified, 55 texts warranted detailed review, but only nine studies met eligibility criteria for inclusion. Comparison of manic symptoms across age groups suggested that irritability is a key feature of BD with an onset in childhood, activity is the most prominent in adolescent-onset BD and pressure of speech is more characteristic of adult-onset BD. However, none of the eligible studies made a direct comparison of phenomenology in children versus adults. Assessment procedures varied in quality and undermined the reliability of cross-study comparisons. Other limitations were: the scarcity of comparative studies, the geographic bias (most studies originated in the USA), the failure to fully consider the impact of psychiatric comorbidities on recorded symptoms and methodological heterogeneity. Despite

  14. Depression, post-traumatic stress disorder, and functional disability in survivors of critical illness in the BRAIN-ICU study: a longitudinal cohort study.

    PubMed

    Jackson, James C; Pandharipande, Pratik P; Girard, Timothy D; Brummel, Nathan E; Thompson, Jennifer L; Hughes, Christopher G; Pun, Brenda T; Vasilevskis, Eduard E; Morandi, Alessandro; Shintani, Ayumi K; Hopkins, Ramona O; Bernard, Gordon R; Dittus, Robert S; Ely, E Wesley

    2014-05-01

    Critical illness is associated with cognitive impairment, but mental health and functional disabilities in survivors of intensive care are inadequately characterised. We aimed to assess associations of age and duration of delirium with mental health and functional disabilities in this group. In this prospective, multicentre cohort study, we enrolled patients with respiratory failure or shock who were undergoing treatment in medical or surgical ICUs in Nashville, TN, USA. We obtained data for baseline demographics and in-hospital variables, and assessed survivors at 3 months and 12 months with measures of depression (Beck Depression Inventory II), post-traumatic stress disorder (PTSD, Post-Traumatic Stress Disorder Checklist-Event Specific Version), and functional disability (activities of daily living scales, Pfeffer Functional Activities Questionnaire, and Katz Activities of Daily Living Scale). We used linear and proportional odds logistic regression to assess the independent associations between age and duration of delirium with mental health and functional disabilities. This study is registered with ClinicalTrials.gov, number NCT00392795. We enrolled 821 patients with a median age of 61 years (IQR 51-71), assessing 448 patients at 3 months and 382 patients at 12 months after discharge. At 3 months, 149 (37%) of 406 patients with available data reported at least mild depression, as did 116 (33%) of 347 patients at 12 months; this depression was mainly due to somatic rather than cognitive-affective symptoms. Depressive symptoms were common even among individuals without a history of depression (as reported by a proxy), occurring in 76 (30%) of 255 patients with data at 3 months and 62 (29%) of 217 individuals at 12 months. Only 7% of patients (27 of 415 at 3 months and 24 of 361 at 12 months) had symptoms consistent with post-traumatic distress disorder. Disabilities in basic activities of daily living (ADL) were present in 139 (32%) of 428 patients at 3 months

  15. Chemistry, Pharmacology, and Medicinal Property of Sage (Salvia) to Prevent and Cure Illnesses such as Obesity, Diabetes, Depression, Dementia, Lupus, Autism, Heart Disease, and Cancer.

    PubMed

    Hamidpour, Mohsen; Hamidpour, Rafie; Hamidpour, Soheila; Shahlari, Mina

    2014-04-01

    For a long time, sage (Salvia) species have been used in traditional medicine for the relief of pain, protecting the body against oxidative stress, free radical damages, angiogenesis, inflammation, bacterial and virus infection, etc., Several studies suggest that sage species can be considered for drug development because of their reported pharmacology and therapeutic activities in many countries of Asia and Middle East, especially China and India. These studies suggest that Salvia species, in addition to treating minor common illnesses, might potentially provide novel natural treatments for the relief or cure of many serious and life-threatening diseases such as depression, dementia, obesity, diabetes, lupus, heart disease, and cancer. This article presents a comprehensive analysis of the botanical, chemical, and pharmacological aspects of sage (Saliva).

  16. Chemistry, Pharmacology, and Medicinal Property of Sage (Salvia) to Prevent and Cure Illnesses such as Obesity, Diabetes, Depression, Dementia, Lupus, Autism, Heart Disease, and Cancer

    PubMed Central

    Hamidpour, Mohsen; Hamidpour, Rafie; Hamidpour, Soheila; Shahlari, Mina

    2014-01-01

    For a long time, sage (Salvia) species have been used in traditional medicine for the relief of pain, protecting the body against oxidative stress, free radical damages, angiogenesis, inflammation, bacterial and virus infection, etc., Several studies suggest that sage species can be considered for drug development because of their reported pharmacology and therapeutic activities in many countries of Asia and Middle East, especially China and India. These studies suggest that Salvia species, in addition to treating minor common illnesses, might potentially provide novel natural treatments for the relief or cure of many serious and life-threatening diseases such as depression, dementia, obesity, diabetes, lupus, heart disease, and cancer. This article presents a comprehensive analysis of the botanical, chemical, and pharmacological aspects of sage (Saliva). PMID:24860730

  17. Repeated low-dose organophosphate DFP exposure leads to the development of depression and cognitive impairment in a rat model of Gulf War Illness.

    PubMed

    Phillips, Kristin F; Deshpande, Laxmikant S

    2016-01-01

    Approximately 175,000-250,000 of the returning veterans from the 1991 Persian Gulf War exhibit chronic multi-symptom illnesses that includes neurologic co-morbidities such as depression, anxiety and cognitive impairments. Amongst a host of causative factors, exposure to low levels of the nerve agent Sarin has been strongly implicated for expression of Gulf War Illness (GWI). Nerve agents similar to pesticides are organophosphate (OP) compounds. There is evidence from civilian population that exposure to OPs such as in agricultural workers and nerve agents such as the survivors and first-responders of the Tokyo subway Sarin gas attack suffer from chronic neurological problems similar to GWI symptoms. Given this unique chemical profile, OPs are ideal to study the effects of nerve agents and develop models of GWI in civilian laboratories. In this study, we used repeated low-dose exposure to OP agent diisopropyl fluorophosphate (DFP) over a 5-day period to approximate the duration and level of Sarin exposure during the Persian Gulf War. We tested the rats at 3-months post DFP exposure. Using a battery of behavioral assays, we observed the presence of symptoms of chronic depression, anxiety and memory problems as characterized by increased immobility time in the Forced Swim Test, anhedonia in the Sucrose Preference Test, anxiety in the Elevated Plus Maze, and spatial memory impairments in the Object Location Test, respectively. Chronic low dose DFP exposure was also associated with hippocampal neuronal damage as characterized by the presence of Fluoro-Jade staining. Given that OP exposure is considered a leading cause of GWI related morbidities, this animal model will be ideally suited to study underlying molecular mechanisms for the expression of GWI neurological symptoms and identify drugs for the effective treatment of GWIs.

  18. Temperament and character profiles in bipolar I, bipolar II and major depressive disorder: Impact over illness course, comorbidity pattern and psychopathological features of depression.

    PubMed

    Zaninotto, Leonardo; Souery, Daniel; Calati, Raffaella; Di Nicola, Marco; Montgomery, Stuart; Kasper, Siegfried; Zohar, Joseph; Mendlewicz, Julien; Robert Cloninger, C; Serretti, Alessandro; Janiri, Luigi

    2015-09-15

    Studies comparing temperament and character traits between patients with mood disorders and healthy individuals have yielded variable results. The Temperament and Character Inventory (TCI) was administered to 101 bipolar I (BP-I), 96 bipolar II (BP-II), 123 major depressive disorder (MDD) patients, and 125 HS. A series of generalized linear models were performed in order to: (a) compare the TCI dimensions across groups; (b) test any effect of the TCI dimensions on clinical features of mood disorders; and (c) detect any association between TCI dimensions and the psychopathological features of a major depressive episode. Demographic and clinical variables were also included in the models as independent variables. Higher Harm Avoidance was found in BP-II and MDD, but not in BP-I. Higher Self-Transcendence was found in BP-I. Our models also showed higher Self-Directedness in HS, either vs MDD or BP-II. No association was found between any TCI dimension and the severity of symptoms. Conversely, a positive association was found between Harm Avoidance and the overall burden of depressive episodes during lifetime. The cross-sectional design and the heterogeneity of the sample may be the main limitations of our study. In general, our sample seems to support the view of a similar profile of temperament and character between MDD and BP-II, characterized by high Harm Avoidance and low Self-Directedness. In contrast, patients with BP-I only exhibit high Self-Transcendence, having a near-normal profile in terms of Harm Avoidance or Self-Directedness. Copyright © 2015 Elsevier B.V. All rights reserved.

  19. Depression.

    PubMed

    McCarron, Robert M; Vanderlip, Erik R; Rado, Jeffrey

    2016-10-04

    This issue provides a clinical overview of depression, focusing on screening, diagnosis, treatment, and practice improvement. The content of In the Clinic is drawn from the clinical information and education resources of the American College of Physicians (ACP), including MKSAP (Medical Knowledge and Self-Assessment Program). Annals of Internal Medicine editors develop In the Clinic in collaboration with the ACP's Medical Education and Publishing divisions and with the assistance of additional science writers and physician writers.

  20. Vitamin D Intoxication, with Hypernatraemia, Potassium and Water Depletion, and Mental Depression

    PubMed Central

    Anderson, D. C.; Cooper, A. F.; Naylor, G. J.

    1968-01-01

    Two elderly patients suffering from manic-depressive psychosis/depressive reaction had concurrently hypercalcaemia from vitamin D intoxication. They developed hypernatraemia with severe potassium and water depletion. Hypercalcaemia was pronounced, but both patients recovered quickly and their depressive symptoms resolved following water and potassium repletion and corticosteroid therapy. ImagesFig. 1Fig. 2 PMID:5723727

  1. Selecting, training and supervising nurses to treat depression in the medically ill: experience and recommendations from the SMaRT oncology collaborative care trials.

    PubMed

    Wanat, Marta; Walker, Jane; Hodges, Laura; Richardson, Alison; Sharpe, Michael

    2015-01-01

    Collaborative care programs to treat comorbid depression in the medically ill often have general (nonpsychiatric) nurses care managers. In this paper, we aim to provide practical recommendations for their selection, training and supervision. Based on more than 10 years of experience of selecting, training and supervising general nurses to deliver a highly effective collaborative care programme called "Depression Care for People with Cancer," we describe the problems encountered and the solutions adopted to optimize the selection, training and supervision of nurse care managers. To select nurses for the role of care manager, we found that role plays enabled us to assess nurses' ability to interact with distressed patients and their capacity for self-reflection better than simple interviews. To train the nurses, we found that a structured program that mirrored the treatment manual and included simulated practice was best. To achieve effective supervision, we found that having sessions led by senior psychiatrists facilitated both constructive feedback to the nurses and effective review of the management of cases. We recommend that the selection, training and supervision of general nurses use the strategies outlined if they are to maximize the benefit that patients achieve from collaborative care programs. Copyright © 2015 Elsevier Inc. All rights reserved.

  2. Promotora assisted depression and self-care management among predominantly Latinos with concurrent chronic illness: Safety net care system clinical trial results.

    PubMed

    Ell, Kathleen; Aranda, María P; Wu, Shinyi; Oh, Hyunsung; Lee, Pey-Jiuan; Guterman, Jeffrey

    2017-10-01

    The study evaluated depression and self-care management among patients with diabetes and/or heart disease in a 12-month randomized trial conducted in Los Angeles County Department of Health Services (LAC-DHS) community clinics. We compared LAC-DHS clinic usual care (UC) versus A-Helping-Hand (AHH) intervention in which bilingual promotoras, hired and supervised by the research project, provided 6 weekly psychoeducational sessions followed by boosters. Of 1957 screened, 348 depressed patients (PHQ-9 score≥10) were enrolled, randomized to AHH (n=178) or UC (n=170) after baseline interview assessing mental health, treatment receipt, co-morbid illness, self-care management, and environmental stressors. Comprehensive assessments were repeated at 6 and 12months by an independent interviewer blind to the study group. Patients (85% diabetes, 4% heart disease, 11% both) were predominantly female (85%), Latino (99%), born outside of the US (91%). Study attrition at 12months was 30% (AHH 31%, UC 28%, P=0.51). No baseline characteristics were associated with attrition. Half of AHH patients received 4 or more sessions. Intend-to-treat analysis found study groups did not vary significantly at 6 and 12months. Before-after paired t-tests showed significant improvements in most measures in each group. During the trial, LAC-DHS activated healthcare improvements including depression screening, referral to clinic staff including community health workers (with the same role as the promotoras) to improve patient care management. Both patient groups performed equally well which may be a function of the enhanced healthcare model. Future research should replicate the promotora-integrated care model with other groups and care settings with similar comorbid conditions. Copyright © 2017 Elsevier Inc. All rights reserved.

  3. Abnormal neural activities in first-episode, treatment-naïve, short-illness-duration, and treatment-response patients with major depressive disorder: a resting-state fMRI study.

    PubMed

    Guo, Wen-bin; Liu, Feng; Xue, Zhi-min; Yu, Yan; Ma, Chao-qiong; Tan, Chang-lian; Sun, Xue-li; Chen, Jin-dong; Liu, Zhe-ning; Xiao, Chang-qing; Chen, Hua-fu; Zhao, Jing-ping

    2011-12-01

    Abnormality of limbic-cortical networks was postulated in depression. Using a regional homogeneity (ReHo) approach, we explored the regional homogeneity (ReHo) of the brain regions in patients with first-episode, treatment-naïve, short-illness-duration, and treatment-response depression in resting state to test the abnormality hypothesis of limbic-cortical networks in major depressive disorder (MDD). Seventeen patients with treatment-response MDD and 17 gender-, age-, and education-matched healthy subjects participated in the resting-state fMRI scans. Our findings suggested the abnormality of limbic-cortical networks in first-episode, treatment-naïve, short-illness-duration, and treatment-response MDD patients, and added an expanding literature to the abnormality hypothesis of limbic-cortical networks in MDD. Copyright © 2011 Elsevier B.V. All rights reserved.

  4. Reexamining associations between mania, depression, anxiety and substance use disorders: results from a prospective national cohort.

    PubMed

    Olfson, M; Mojtabai, R; Merikangas, K R; Compton, W M; Wang, S; Grant, B F; Blanco, C

    2017-02-01

    Separate inheritance of mania and depression together with high rates of clinical overlap of mania with anxiety and substance use disorders provide a basis for re-examining the specificity of the prospective association of manic and depression episodes that is a hallmark of bipolar disorder. We analyzed information from 34 653 adults in Waves 1 and 2 of the National Epidemiologic Survey on Alcohol and Related Conditions, a longitudinal nationally representative survey of US adults interviewed 3 years apart. Psychiatric disorders were assessed by a structured interview. We used logistic regression analyses to estimate the strength of associations between Wave 1 manic episodes and Wave 2 depression, anxiety and substance use disorders controlling for background characteristics and lifetime Wave 1 disorders. Corresponding analyses examined associations between Wave 1 major depressive episode with manic episodes and other psychiatric disorders. In multivariable models, Wave 1 manic episodes significantly increased the odds of Wave 2 major depressive episodes (adjusted odds ratio (AOR): 1.7; 95% confidence interval: 1.3-2.2) and any anxiety disorder (AOR: 1.8; 1.4-2.2), although not of substance use disorders (AOR: 1.2; 0.9-1.5). Conversely, Wave 1 major depressive episodes significantly increased risk of Wave 2 manic episodes (AOR: 2.2; 1.7-2.9) and anxiety disorders (AOR: 1.7; 1.5-2.0), although not substance use disorders (AOR: 1.0; 0.9-1.2). Adults with manic episodes have an approximately equivalent relative risk of developing depression episodes and anxiety disorders. Greater research and clinical focus is warranted on connections between manic episodes and anxiety disorders.

  5. Survival prediction in terminally ill cancer patients by clinical estimates, laboratory tests, and self-rated anxiety and depression.

    PubMed

    Gripp, Stephan; Moeller, Sibylle; Bölke, Edwin; Schmitt, Gerd; Matuschek, Christiane; Asgari, Sonja; Asgharzadeh, Farzin; Roth, Stephan; Budach, Wilfried; Franz, Matthias; Willers, Reinhardt

    2007-08-01

    To study how survival of palliative cancer patients relates to subjective prediction of survival, objective prognostic factors (PFs), and individual psychological coping. Survival was estimated according to three categories (< 1 month, 1 to 6 months, and > 6 months) by two physicians (A and B) and the institutional tumor board (C) for 216 patients recently referred for palliative radiotherapy. After 6 months, the accuracy of these estimates was assessed. The prognostic relevance of clinical symptoms, performance status, laboratory tests, and self-reported emotional distress (Hospital Anxiety and Depression Scale) was investigated. In 61%, 55%, and 63% of the patients, prognoses were correctly estimated by A, B, and C, respectively. kappa statistic showed fair agreement of the estimates, which proved to be overly optimistic. Accuracy of the three estimates did not improve with increasing professional experience. In particular, the survival of 96%, 71%, and 87% of patients who died in less than 1 month was overestimated by A, B, and C, respectively. On univariate analysis, 11 of 27 parameters significantly affected survival, namely performance status, primary cancer, fatigue, dyspnea, use of strong analgesics, brain metastases, leukocytosis, lactate dehydrogenase (LDH), depression, and anxiety. On multivariate analysis, colorectal and breast cancer had a favorable prognosis, whereas brain metastases, Karnofsky performance status less than 50%, strong analgesics, dyspnea, LDH, and leukocytosis were associated with a poor prognosis. This study revealed that physicians' survival estimates were unreliable, especially in the case of patients near death. Self-reported emotional distress and objective PFs may improve the accuracy of survival estimates.

  6. Progress in the development of MANIC: a monolithic nulling interferometer for characterizing extrasolar environments

    NASA Astrophysics Data System (ADS)

    Hicks, Brian A.; Cook, Timothy A.; Lane, Benjamin F.; Chakrabarti, Supriya

    2010-07-01

    We present progress in the development of the monolithic achromatic nulling interference coronagraph (MANIC), an optic designed for enabling direct detection and characterization of exoplanetary systems around nearby stars. MANIC is a fully symmetric implementation of a rotational shearing interferometer consisting of fused quartz prisms and a symmetric beamsplitter optically contacted in an arrangement that geometrically flips the fields in the TR and RT arms about orthogonal axes such that upon recombination, a centro-symmetric, theoretically achromatic null is produced. In addition to a small inner working angle (<~ 1λ/D), built-in alignment and stability are inherent benefits of the compact monolithic design, which make MANIC a competitive alternative to conventional discrete element nullers proposed for imaging exoplanetary environments. Following MANIC's initial fabrication, the path error between its TR and RT arms was measured. This measurement was used to fabricate compensator plates of varying thicknesses that were bonded to the optic to reduce dispersion imbalance, thereby improving broadband nulling performance. In performing this correction, initial OPD was reduced from 949 +/- 44 nm to 63 +/- 10 nm, which in the absence of any other asymmetries, corresponds to an increase in a 107 R-band (λc = 648 nm) nulling bandpass from monochromatic to 25%, or at the 106 level, from 5% to 50%. Current benchtop laser and polychromatic nulling strategies are described. The potential science return from using MANIC on a sub-orbital platform is discussed.

  7. Effectiveness and cost-effectiveness of a minimal psychological intervention to reduce non-severe depression in chronically ill elderly patients: the design of a randomised controlled trial [ISRCTN92331982].

    PubMed

    Lamers, F; Jonkers, C C M; Bosma, H; Diederiks, J P M; van Eijk, J Th M

    2006-06-21

    Depression is a prevalent disorder in chronically ill elderly persons. It may decrease quality of life, and increase functional disability, medical costs, and healthcare utilisation. Because patients may slip into a downward spiral, early recognition and treatment of depression is important. Depression can be treated with antidepressants or psychological interventions; the latter can also be applied by trained paraprofessionals. In this paper, we describe the design of the DELTA study (Depression in Elderly with Long-Term Afflictions). The first objective of the DELTA study is to evaluate the effectiveness and cost-effectiveness of a minimal psychological intervention (MPI) to reduce depression in chronically ill elderly patients. The second objective is to evaluate whether a potential effect of the MPI may differ between types of chronic illnesses. The tailor-made intervention is administered by nurses, who are trained in the principles of cognitive behavioural therapy and self-management. DELTA is a two-armed randomised controlled trial, comparing MPI to usual care. A total number of 180 patients with diabetes mellitus type II (DM) and 180 patients with chronic obstructive pulmonary disease (COPD), who in addition suffer from non-severe depression, will be included in the study. In our study, non-severe depression is defined as having minor depression, mild major depression or moderate major depression. The primary outcome measure is depression using the Beck Depression Inventory. Secondary outcome measures include quality of life, daily functioning, self-efficacy, autonomy, and participation. In the economic evaluation, cost-effectiveness and cost-utility ratios will be calculated. Furthermore, a process evaluation will be carried out. Analyses will include both univariate and multivariate techniques and according to the intention to treat principle. The economic evaluation will be done from a societal perspective and data of the process evaluation will be

  8. Cost-Effectiveness of a Collaborative Care Depression and Anxiety Treatment Program in Patients with Acute Cardiac Illness.

    PubMed

    Celano, Christopher M; Healy, Brian; Suarez, Laura; Levy, Douglas E; Mastromauro, Carol; Januzzi, James L; Huffman, Jeff C

    2016-01-01

    To use data from a randomized trial to determine the cost-effectiveness of a collaborative care (CC) depression and anxiety treatment program and to assess effects of the CC program on health care utilization. The CC intervention's impact on health-related quality of life, depression-free days (DFDs), and anxiety-free days (AFDs) over the 24-week postdischarge period was calculated and compared with the enhanced usual care (EUC) condition using independent samples t tests and random-effects regression models. Costs for both the CC and EUC conditions were calculated on the basis of staff time, overhead expenses, and treatment materials. Using this information, incremental cost-effectiveness ratios were calculated. A cost-effectiveness acceptability plot was created using nonparametric bootstrapping with 10,000 replications, and the likelihood of the CC intervention's cost-effectiveness was assessed using standard cutoffs. As a secondary analysis, we determined whether the CC intervention led to reductions in postdischarge health care utilization and costs. The CC intervention was more costly than the EUC intervention ($209.86 vs. $34.59; z = -11.71; P < 0.001), but was associated with significantly greater increases in quality-adjusted life-years (t = -2.49; P = 0.01) and DFDs (t = -2.13; P = 0.03), but not AFDs (t = -1.92; P = 0.057). This translated into an incremental cost-effectiveness ratio of $3337.06 per quality-adjusted life-year saved, $13.36 per DFD, and $13.74 per AFD. Compared with the EUC intervention, the CC intervention was also associated with fewer emergency department visits but no differences in overall costs. This CC intervention was associated with clinically relevant improvements, was cost-effective, and was associated with fewer emergency department visits in the 24 weeks after discharge. Copyright © 2016. Published by Elsevier Inc.

  9. Importance of Depression in Diabetes.

    ERIC Educational Resources Information Center

    Lustman, Patrick J.; Clouse, Ray E.; Anderson, Ryan J.

    Depression doubles the likelihood of comorbid depression, which presents as major depression in 11% and subsyndromal depression in 31% of patients with the medical illness. The course of depression is chronic, and afflicted patients suffer an average of one episode annually. Depression has unique importance in diabetes because of its association…

  10. Brain-derived neurotrophic factor increase during treatment in severe mental illness inpatients

    PubMed Central

    Nuernberg, G L; Aguiar, B; Bristot, G; Fleck, M P; Rocha, N S

    2016-01-01

    Meta-analytical evidence suggests that brain-derived neurotrophic factor (BDNF) is altered in various psychiatric disorders. However, meta-analyses may be hampered by the heterogeneity of BDNF assays, lack of BDNF standard values and heterogeneity among the populations included in the studies. To address these issues, our study aimed to test, in a ‘true-to-life' setting, the hypothesis that the serum BDNF level is nonspecifically reduced in acute severe mental illness (SMI) patients and increases during inpatient treatment. Consecutive samples of 236 inpatients with SMI and 100 healthy controls were recruited. SMI includes schizophrenia and severe mood disorders, and is characterized in the sample by the presence of at least 2 years of psychiatric treatment and disability. Generalized estimating equations were used to analyze BDNF serum levels at admission and upon discharge controlled by confounding factors. BDNF levels increased significantly between admission and discharge in SMI patients. BDNF levels showed significant reductions compared with controls both at admission and upon discharge. In addition, BDNF levels showed no difference among SMI patient diagnostic subgroups (unipolar depression, bipolar depression, schizophrenia and manic episode). The increase but non-restoration of BDNF levels, even with the general acute improvement of clinical scores, may reflect the progression of the disorder characteristically seen in these patients. BDNF levels could be considered as a marker for the presence of a nonspecific psychiatric disorder and possibly a transdiagnostic and nonspecific marker of disease activity. PMID:27959329

  11. Measures of the DSM-5 mixed-features specifier of major depressive disorder.

    PubMed

    Zimmerman, Mark

    2017-01-12

    During the past two decades, a number of studies have found that depressed patients frequently have manic symptoms intermixed with depressive symptoms. While the frequency of mixed syndromes are more common in bipolar than in unipolar depressives, mixed states are also common in patients with major depressive disorder. The admixture of symptoms may be evident when depressed patients present for treatment, or they may emerge during ongoing treatment. In some patients, treatment with antidepressant medication might precipitate the emergence of mixed states. It would therefore be useful to systematically inquire into the presence of manic/hypomanic symptoms in depressed patients. We can anticipate that increased attention will likely be given to mixed depression because of changes in the DSM-5. In the present article, I review instruments that have been utilized to assess the presence and severity of manic symptoms and therefore could be potentially used to identify the DSM-5 mixed-features specifier in depressed patients and to evaluate the course and outcome of treatment. In choosing which measure to use, clinicians and researchers should consider whether the measure assesses both depression and mania/hypomania, assesses all or only some of the DSM-5 criteria for the mixed-features specifier, or assesses manic/hypomanic symptoms that are not part of the DSM-5 definition. Feasibility, more so than reliability and validity, will likely determine whether these measures are incorporated into routine clinical practice.

  12. Screening for Depression

    MedlinePlus

    Depression and Bipolar Support Alliance Crisis Hotline Information Coping with a Crisis Suicide Prevention Information Psychiatric Hospitalization ... sign-up Education info, training, events Mood Disorders Depression Bipolar Disorder Anxiety Screening Center Co-occurring Illnesses/ ...

  13. Dimensions of Manic Symptoms in Youth: Psychosocial Impairment and Cognitive Performance in the IMAGEN Sample

    ERIC Educational Resources Information Center

    Stringaris, Argyris; Castellanos-Ryan, Natalie; Banaschewski, Tobias; Barker, Gareth J.; Bokde, Arun L.; Bromberg, Uli; Büchel, Christian; Fauth-Bühler, Mira; Flor, Herta; Frouin, Vincent; Gallinat, Juergen; Garavan, Hugh; Gowland, Penny; Heinz, Andreas; Itterman, Bernd; Lawrence, Claire; Nees, Frauke; Paillere-Martinot, Marie-Laure; Paus, Tomas; Pausova, Zdenka; Rietschel, Marcella; Smolka, Michael N.; Schumann, Gunter; Goodman, Robert; Conrod, Patricia

    2014-01-01

    Background: It has been reported that mania may be associated with superior cognitive performance. In this study, we test the hypothesis that manic symptoms in youth separate along two correlated dimensions and that a symptom constellation of high energy and cheerfulness is associated with superior cognitive performance. Method: We studied 1755…

  14. Dimensions of Manic Symptoms in Youth: Psychosocial Impairment and Cognitive Performance in the IMAGEN Sample

    ERIC Educational Resources Information Center

    Stringaris, Argyris; Castellanos-Ryan, Natalie; Banaschewski, Tobias; Barker, Gareth J.; Bokde, Arun L.; Bromberg, Uli; Büchel, Christian; Fauth-Bühler, Mira; Flor, Herta; Frouin, Vincent; Gallinat, Juergen; Garavan, Hugh; Gowland, Penny; Heinz, Andreas; Itterman, Bernd; Lawrence, Claire; Nees, Frauke; Paillere-Martinot, Marie-Laure; Paus, Tomas; Pausova, Zdenka; Rietschel, Marcella; Smolka, Michael N.; Schumann, Gunter; Goodman, Robert; Conrod, Patricia

    2014-01-01

    Background: It has been reported that mania may be associated with superior cognitive performance. In this study, we test the hypothesis that manic symptoms in youth separate along two correlated dimensions and that a symptom constellation of high energy and cheerfulness is associated with superior cognitive performance. Method: We studied 1755…

  15. Dimensions of manic symptoms in youth: psychosocial impairment and cognitive performance in the IMAGEN sample

    PubMed Central

    Stringaris, Argyris; Castellanos-Ryan, Natalie; Banaschewski, Tobias; Barker, Gareth J; Bokde, Arun L; Bromberg, Uli; Büchel, Christian; Fauth-Bühler, Mira; Flor, Herta; Frouin, Vincent; Gallinat, Juergen; Garavan, Hugh; Gowland, Penny; Heinz, Andreas; Itterman, Bernd; Lawrence, Claire; Nees, Frauke; Paillere-Martinot, Marie-Laure; Paus, Tomas; Pausova, Zdenka; Rietschel, Marcella; Smolka, Michael N; Schumann, Gunter; Goodman, Robert; Conrod, Patricia

    2014-01-01

    Background It has been reported that mania may be associated with superior cognitive performance. In this study, we test the hypothesis that manic symptoms in youth separate along two correlated dimensions and that a symptom constellation of high energy and cheerfulness is associated with superior cognitive performance. Method We studied 1755 participants of the IMAGEN study, of average age 14.4 years (SD = 0.43), 50.7% girls. Manic symptoms were assessed using the Development and Wellbeing Assessment by interviewing parents and young people. Cognition was assessed using the Wechsler Intelligence Scale For Children (WISC-IV) and a response inhibition task. Results Manic symptoms in youth formed two correlated dimensions: one termed exuberance, characterized by high energy and cheerfulness and one of undercontrol with distractibility, irritability and risk-taking behavior. Only the undercontrol, but not the exuberant dimension, was independently associated with measures of psychosocial impairment. In multivariate regression models, the exuberant, but not the undercontrolled, dimension was positively and significantly associated with verbal IQ by both parent- and self-report; conversely, the undercontrolled, but not the exuberant, dimension was associated with poor performance in a response inhibition task. Conclusions Our findings suggest that manic symptoms in youth may form dimensions with distinct correlates. The results are in keeping with previous findings about superior performance associated with mania. Further research is required to study etiological differences between these symptom dimensions and their implications for clinical practice. PMID:24865127

  16. The Structure of Cognitive Abilities in Youths with Manic Symptoms: A Factorial Invariance Study

    ERIC Educational Resources Information Center

    Beaujean, A. Alexander; Freeman, Megan Joseph; Youngstrom, Eric; Carlson, Gabrielle

    2012-01-01

    This study compared the structure of cognitive ability (specifically, verbal/crystallized ["Gc"] and visual-spatial ability ["Gv"]), as measured in the Wechsler Intelligence Scale for Children, in youth with manic symptoms with a nationally representative group of similarly aged youth. Multigroup confirmatory factor analysis…

  17. Manic episodes: the direct cost of a three-month period following hospitalisation.

    PubMed

    Olié, J P; Lévy, E

    2002-09-01

    Few data exist to estimate the burden of manic episodes on healthcare systems or the therapeutic strategies used. This study was undertaken to identify treatment strategies chosen, and to assess the "real-world" direct medical cost of treating manic episodes necessitating hospitalisation. Case record data were reviewed during the three months following hospitalisation for a manic episode in France. Healthcare resource utilisation was assessed, direct costs calculated, and treatment strategies analysed. A total of 137 patients files (51.8% female; mean age: 35 years) were reviewed and data on 185 hospitalisations collected. The mean duration of hospitalisation was 47 days over the study period. The most common treatment strategy during hospitalisation was the combination of a mood stabilizer with a neuroleptic drug (64% of patients at day 30). Anticonvulsants including valproate (39%) and carbamazepine (20%) were more common than lithium (42%). Treatment received during hospitalisation was generally continued after discharge, with a trend away from neuroleptics and towards mood stabilizers. The mean direct costs incurred over the three-month study period was Euro 22297, with 98.6% of those costs due to hospitalisation. These results confirm that the costs of treating a manic episode are high, and overwhelmingly due to the cost of hospitalisation.

  18. Mania and Intellectual Disability: The Course of Manic Symptoms in Persons with Intellectual Disability

    ERIC Educational Resources Information Center

    Gonzalez, Melissa; Matson, Johnny L.

    2006-01-01

    Our aim was to extend the literature by examining the presence of manic symptoms in persons with intellectual deficits with and without bipolar disorder for 3 years. Three groups (bipolar, psychopathology other than bipolar disorder, and no Axis I diagnosis) were formed with 14 participants in each group. Initially, the presence of mania symptoms…

  19. Mania and Intellectual Disability: The Course of Manic Symptoms in Persons with Intellectual Disability

    ERIC Educational Resources Information Center

    Gonzalez, Melissa; Matson, Johnny L.

    2006-01-01

    Our aim was to extend the literature by examining the presence of manic symptoms in persons with intellectual deficits with and without bipolar disorder for 3 years. Three groups (bipolar, psychopathology other than bipolar disorder, and no Axis I diagnosis) were formed with 14 participants in each group. Initially, the presence of mania symptoms…

  20. Facilitating Online Discussions at a Manic Pace: A New Strategy for an Old Problem

    ERIC Educational Resources Information Center

    Curry, John H.; Cook, Jonene

    2014-01-01

    For novice and experienced instructors alike, facilitating online discussions can seem like a daunting prospect. Many ask themselves how to do so in an effective and meaningful way that actually adds to the course experience rather than seeming like mere busywork. The MANIC discussion strategy is one that promotes deeper student interaction with…

  1. Evidence That Psychotic Symptoms Are Prevalent in Disorders of Anxiety and Depression, Impacting on Illness Onset, Risk, and Severity—Implications for Diagnosis and Ultra–High Risk Research

    PubMed Central

    Wigman, Johanna T. W.; van Nierop, Martine; Vollebergh, Wilma A. M.; Lieb, Roselind; Beesdo-Baum, Katja; Wittchen, Hans-Ullrich; van Os, Jim

    2012-01-01

    Background: It is commonly assumed that there are clear lines of demarcation between anxiety and depressive disorders on the one hand and psychosis on the other. Recent evidence, however, suggests that this principle may be in need of updating. Methods: Depressive and/or anxiety disorders, with no previous history of psychotic disorder, were examined for the presence of psychotic symptoms in a representative community sample of adolescents and young adults (Early Developmental Stages of Psychopathology study; n = 3021). Associations and consequences of psychotic symptomatology in the course of these disorders were examined in terms of demographic distribution, illness severity, onset of service use, and risk factors. Results: Around 27% of those with disorders of anxiety and depression displayed one or more psychotic symptoms, vs 14% in those without these disorders (OR 2.23, 95% CI 1.89–2.66, P < .001). Presence as compared with nonpresence of psychotic symptomatology was associated with younger age (P < .0001), male sex (P < .0058), and poorer illness course (P < .0002). In addition, there was greater persistence of schizotypal (P < .0001) and negative symptoms (P < .0170), more observable illness behavior (P < .0001), greater likelihood of service use (P < .0069), as well as more evidence of familial liability for mental illness (P < .0100), exposure to trauma (P < .0150), recent and more distant life events (P < .0006–.0244), cannabis use (P < .0009), and any drug use (P < .0008). Conclusion: Copresence of psychotic symptomatology in disorders of anxiety and depression is common and a functionally and etiologically highly relevant feature, reinforcing the view that psychopathology is represented by a network or overlapping and reciprocally impacting dimensional liabilities. PMID:22258882

  2. Illness Progression as a Function of Independent and Accumulating Poor Prognosis Factors in Outpatients With Bipolar Disorder in the United States

    PubMed Central

    Altshuler, Lori L.; Leverich, Gabriele S.; Nolen, Willem A.; Kupka, Ralph; Grunze, Heinz; Frye, Mark A.; Suppes, Trisha; McElroy, Susan L.; Keck, Paul E.; Rowe, Mike

    2014-01-01

    Objective: Many patients with bipolar disorder in the United States experience a deteriorating course of illness despite naturalistic treatment in the community. We examined a variety of factors associated with this pattern of illness progression. Method: From 1995 to 2002, we studied 634 adult outpatients with bipolar disorder (mean age of 40 years) emanating from 4 sites in the United States. Patients gave informed consent and completed a detailed questionnaire about demographic, vulnerability, and course-of-illness factors and indicated whether their illness had shown a pattern of increasing frequency or severity of manic or depressive episodes. Fifteen factors previously linked in the literature to a poor outcome were examined for their relationship to illness progression using Kruskal-Wallis test, followed by a 2-sample Wilcoxon rank sum (Mann-Whitney) test, χ2, and logistical regression. Results: All of the putative poor prognosis factors occurred with a high incidence, and, with the exception of obesity, were significantly (P < .05) associated with illness progression. These factors included indicators of genetic and psychosocial risk and loss of social support, early onset, long delay to first treatment, anxiety and substance abuse comorbidity, rapid cycling in any year, and the occurrence of more than 20 prior episodes prior to entering the network. A greater number of factors were linearly associated with the likelihood of a progressively worsening course. Conclusions: Multiple genetic, psychosocial, and illness factors were associated with a deteriorating course of bipolar disorder from onset to study entry in adulthood. The identification of these factors provides important targets for earlier and more effective therapeutic intervention in the hope of achieving a more benign course of bipolar disorder. PMID:25834764

  3. [Formal changes of thought in schizophrenic, schizophreniform, and manic schizoaffective disorders].

    PubMed

    Cuesta Zorita, M J; Peralta Martín, V

    1992-01-01

    The aim of the present study was to verify the hypothesis that there are formal thought disorders more specific to schizophrenic disorders. The sample was composed of 82 admitted patients who were chosen for two reasons: presence of schizophrenic symptoms and they fulfilled the RDC criteria for schizophrenic or schizoaffective manic disorders. They were subdivided in three groups according to the RDC and DSM-III-R criteria. The first group were twenty eight patients who fulfilled both criteria to schizophrenic disorders, the second group 28 whose fulfilled the RDC but not DSM-III-R criteria of schizophrenic disorder, and the third group were 26 schizoaffective manics in RDC but with diverse diagnoses in DSM-III-R. A factorial analysis was carried out with oblique rotation and one-way analyses of variance of the factors between the diagnostic groups. It resulted in six factors which explained 70% of the variance and were named: disorganization, negative, stylistic, tangential, manic and semantic factors. The schizophrenic patients and significantly loaded in the negative factor with respect to the other groups, and were significantly loaded in the tangential factor with respect to schizophreniform group. The schizoaffective manics were significantly loaded in manic factor respect to the other groups. Therefore there were symptomatological constellations more specific to schizophrenic disorders. Also, significative correlations were found between the disorganization factor and the SANS attention subscale and a lack of correlations between this factor and the positive symptoms. The existence of a new disorganization syndrome was confirmed, which supplements the positive-negative dichotomous model that has been proposed by some authors.

  4. Environment and vulnerability to major psychiatric illness: a case control study of early parental loss in major depression, bipolar disorder and schizophrenia.

    PubMed

    Agid, O; Shapira, B; Zislin, J; Ritsner, M; Hanin, B; Murad, H; Troudart, T; Bloch, M; Heresco-Levy, U; Lerer, B

    1999-03-01

    The current focus on identifying genes which predispose to psychiatric illness sharpens the need to identify environmental factors which interact with genetic predisposition and thus contribute to the multifactorial causation of these disorders. One such factor may be early parental loss (EPL). The putative relationship between early environmental stressors such as parental loss and psychopathology in adult life has intrigued psychiatrists for most of this century. We report a case control study in which rates of EPL, due to parental death or permanent separation before the age of 17 years were evaluated in patients with major depression (MD), bipolar disorder (BPD) and schizophrenia (SCZ), compared to individually matched, healthy control subjects (MD-Control, 79 pairs; BPD-Control, 79 pairs; SCZ-Control, 76 pairs). Loss of parent during childhood significantly increased the likelihood of developing MD during adult life (OR=3.8, P=0.001). The effect of loss due to permanent separation (P=0.008) was more striking than loss due to death, as was loss before the age of 9 years (OR=11.0, P=0.003) compared to later childhood and adolescence. The overall rate of EPL was also increased in BPD (OR=2.6, P=0.048) but there were no significant findings in any of the subcategories of loss. A significantly increased rate of EPL was observed in schizophrenia patients (OR=3.8, P=0.01), particularly before the age of 9 years (OR=4.3, P=0.01). Comparison of psychosocial, medical and clinical characteristics of subjects with and without a history of EPL, within the larger patient groups from which the matched samples were drawn (MD, n=136; BPD, n=107; SCZ, n=160), yielded few significant findings. Among the controls (n=170), however, subjects who had experienced EPL, reported lower incomes, had been divorced more frequently, were more likely to be living alone, were more likely to smoke or have smoked cigarettes and reported more physical illness (P=0.03-0.001). Long term

  5. The impacts of the global financial crisis on hospitalizations due to depressive illnesses in Taiwan: A prospective nationwide population-based study.

    PubMed

    Bonnie Lee, Chiachi; Liao, Chen-Mao; Lin, Chih-Ming

    2017-10-15

    In the third quarter of 2008, a major financial crisis hit many developed countries. Taiwan suffered its own share: a rise in unemployment and a severe decline in gross domestic product. This study is to address the health consequences of this crisis on different socioeconomic populations in Taiwan. A sample of 6,225,766 men and 5,417,651 women, was obtained and their admissions data over 2007-2012 were retrieved. Stratified into three income levels, the sample was examined on the 147,921 episodes of hospitalization due to depressive illnesses (DIs) over that period by an interrupted time series analysis for monthly incidence rates of DI hospitalizations RESULTS: The adjusted incidence rates of hospitalization (AIRH) for DIs among the low income were 10 times that of the high income group. The AIRHs were generally higher in all of three female income groups than they were in the three male income groups. The low income men and women showed increases (of 18.0% and 14.2%, respectively) beginning in April 2008 that sustained for two years. The high income women exhibited a 5.0% monthly rise in the rate of DI hospitalizations. Our time series models can control some confounding factors, but the ecological fallacy remained. This study provides evidence that the economic recession resulted in increased rates of DI hospitalization in Taiwan, especially among the low income population. Women of higher incomes may have suffered a more enduring impact. Copyright © 2017 Elsevier B.V. All rights reserved.

  6. Prevalence and characteristics of undiagnosed bipolar disorders in patients with a major depressive episode: the BRIDGE study.

    PubMed

    Angst, Jules; Azorin, Jean-Michel; Bowden, Charles L; Perugi, Giulio; Vieta, Eduard; Gamma, Alex; Young, Allan H

    2011-08-01

    Major depressive disorder, the most common psychiatric illness, is often chronic and a major cause of disability. Many patients with major depressive episodes who have an underlying but unrecognized bipolar disorder receive pharmacologic treatment with ineffective regimens that do not include mood stabilizers. To determine the frequency of bipolar disorder symptoms in patients seeking treatment for a major depressive episode. Multicenter, multinational, transcultural, cross-sectional, diagnostic study. The study arose from the initiative Bipolar Disorders: Improving Diagnosis, Guidance and Education (BRIDGE). Community and hospital psychiatry departments. Participants included 5635 adults with an ongoing major depressive episode. The frequency of bipolar disorder was determined by applying both DSM-IV-TR criteria and previously described bipolarity specifier criteria. Variables associated with bipolarity were assessed using logistic regression. A total of 903 patients fulfilled DSM-IV-TR criteria for bipolar disorder (16.0%; 95% confidence interval, 15.1%-17.0%), whereas 2647 (47.0%; 95% confidence interval, 45.7%-48.3%) met the bipolarity specifier criteria. Using both definitions, significant associations (odds ratio > 2; P < .001) with bipolarity were observed for family history of mania/hypomania and multiple past mood episodes. The bipolarity specifier additionally identified significant associations for manic/hypomanic states during antidepressant therapy, current mixed mood symptoms, and comorbid substance use disorder. The bipolar-specifier criteria in comparison with DSM-IV-TR criteria were valid and identified an additional 31% of patients with major depressive episodes who scored positive on the bipolarity criteria. Family history, illness course, and clinical status, in addition to DSM-IV-TR criteria, may provide useful information for physicians when assessing evidence of bipolarity in patients with major depressive episodes. Such an assessment is

  7. Spanish-Language Measures of Mania and Depression

    ERIC Educational Resources Information Center

    Ruggero, Camilo J.; Johnson, Sheri L.; Cuellar, Amy K.

    2004-01-01

    Efforts to better understand bipolar spectrum disorders across ethnic groups are often hampered by the lack of commonly used self-report instruments to assess mania and depression in individuals who speak languages other than English. This article describes the translation into Spanish of 2 self-report measures of manic symptoms (i.e., the…

  8. Bipolar depression as the prelude to schizoaffective disorder.

    PubMed

    Goldwert, M

    1992-12-01

    Contending that the mind of a creative person is often characterized by thin boundaries between the ego and the unconscious, this paper proposes how, on the manic side of bipolar depression, a creative ego may temporarily make great strides in intellectuality and creativity. However, as this process proceeds, a creative ego may lose its boundaries with the unconscious, and a schizoaffective disorder may emerge.

  9. Repression of a lithium pump as a consequence of lithium ingestion by manic-depressive subjects.

    PubMed

    Meltzer, H L; Kassir, S; Dunner, D L; Fieve, R R

    1977-10-20

    The lithium pump in human erythrocyte membranes, which is responsible for extrusion of lithium against a concentration gradient, has been found to be reversibly repressed during periods of lithium carbonate administration. The pump activity of patients prior to lithium therapy is not different from controls. The onset of repression may require several days to several weeks and occurs at specific individual threshold levels of lithium carbonate dosage. Reactivation of the lithium pump occurs sometime after the dosage is discontinued. We postulate that repression of the lithium pump results from systemically available factors which alter membrane structure, and suggest that is such changes also occur in the central nervous system, they may provide insight into one means by which lithium produces its psychotropic affects.

  10. A longitudinal study of hypomania and depression symptoms in pregnancy and the postpartum period.

    PubMed

    Heron, Jessica; Haque, Sayeed; Oyebode, Femi; Craddock, Nick; Jones, Ian

    2009-06-01

    Childbirth is a potent precipitant of severe episodes of bipolar disorder. We investigate mood longitudinally through pregnancy and the postpartum period, using the Highs Scale and the Edinburgh Postnatal Depression Scale (EPDS), to examine if the postpartum period is a time of increased risk for hypomanic symptoms in the general population. A total of 446 women were recruited at 12 weeks of pregnancy from the Birmingham Women's Hospital and four midwife-led community clinics. Women completed the Highs Scale and the Edinburgh Postnatal Depression Scale at 12 weeks of pregnancy, one week postpartum, and eight weeks postpartum. Cases of probable depression, as defined by an EPDS score of 13 or greater, did not significantly increase from pregnancy to the postpartum period. The prevalence of 'the highs' was eightfold higher in the postpartum week than during pregnancy. Consistent with the increased rates of severe manic illness following childbirth, we find that more minor hypomanic states are also increased. We consider the clinical relevance of postpartum hypomanic symptoms and the implications of these findings for research into postpartum-onset mood symptoms.

  11. UNIPOLAR MANIA - A SEPARATE ENTITY?

    PubMed Central

    Srinivasan, K.; Ray, R.; Gopinath, P.S.

    1985-01-01

    SUMMARY Twelve unipolar manics satisfying the inclusion criteria of having had three episodes of mania without a depressive episode were compared against bipolar manics on clinical psychopathology, demographic variables and family history of psychiatric morbidity. We Found no differences between the two groups on any of the variables studied and concluded that unipolar mania is clinically homogenous with bipolar manic depressive illness. PMID:21927128

  12. Dissociable patterns of abnormal frontal cortical activation during anticipation of an uncertain reward or loss in bipolar versus major depression

    PubMed Central

    Almeida, Jorge RC; Forbes, Erika E; LaBarbara, Edmund J; Phillips, Mary L

    2013-01-01

    Objectives Recent research has found abnormalities in reward-related neural activation in bipolar disorder (BD), during both manic and euthymic phases. However, reward-related neural activation in currently depressed individuals with BD and that in currently depressed individuals with major depressive disorder (MDD) have yet to be directly compared. Here, we studied these groups, examining the neural activation elicited during a guessing task in fronto-striatal regions identified by previous studies. Methods We evaluated neural activation during a reward task using fMRI in two groups of depressed individuals, one with bipolar I disorder (BD-I) (n = 23) and one with MDD (n = 40), with similar levels of illness severity, and a group of healthy individuals (n = 37). Results Reward expectancy-related activation in the anterior cingulate cortex was observed in the healthy individuals, but was significantly reduced in depressed patients (BD-I and MDD together). Anticipation-related activation was increased in the left ventrolateral prefrontal cortex in the BD-I depressed group compared with the other two groups. There were no significant differences in prediction error-related activation in the ventral striatum across the three groups. Conclusions The findings extend previous research which has identified dysfunction within the ventrolateral prefrontal cortex in BD, and show that abnormally elevated activity in this region during anticipation of either reward or loss may distinguish depressed individuals with BD-I from those with MDD. Altered activation of the anterior cingulate cortex during reward expectancy characterizes both types of depression. These findings have important implications for identifying both common and distinct properties of the neural circuitry underlying BD-I and MDD. PMID:24148027

  13. Mental Illness

    MedlinePlus

    ... questionnaire to help answer these questions. Determining which mental illness you have Sometimes it's difficult to find out ... insurance companies to reimburse for treatment. Classes of mental illness The main classes of mental illness are: Neurodevelopmental ...

  14. DSM-5-defined 'mixed features' and Benazzi's mixed depression: which is practically useful to discriminate bipolar disorder from unipolar depression in patients with depression?

    PubMed

    Takeshima, Minoru; Oka, Takashi

    2015-02-01

    Irritability, psychomotor agitation, and distractibility in a major depressive episode (MDE) should not be counted as manic/hypomanic symptoms of DSM-5-defined mixed features; however, this remains controversial. The practical usefulness of this definition in discriminating bipolar disorder (BP) from major depressive disorder (MDD) in patients with depression was compared with that of Benazzi's mixed depression, which includes these symptoms. The prevalence of both definitions of mixed depression in 217 patients with MDE (57 bipolar II disorder, 35 BP not otherwise specified, and 125 MDD cases), and their operating characteristics regarding BP diagnosis were compared. The prevalence of both Benazzi's mixed depression and DSM-5-defined mixed features was significantly higher in patients with BP than it was in patients with MDD, with the latter being quite low (62.0% vs 12.8% [P < 0.0001], and 7.6% vs 0% [P < 0.0021], respectively). The area under the receiver operating curve for BP diagnosis according to the number of all manic/hypomanic symptoms was numerically larger than that according to the number of manic/hypomanic symptoms excluding the above-mentioned three symptoms (0.798; 95% confidence interval, 0.736-0.859 vs 0.722; 95% confidence interval, 0.654-0.790). The sensitivity/specificity of DSM-5-defined mixed features and Benazzi's mixed depression for BP diagnosis were 5.1%/100% and 55.1%/87.2%, respectively. DSM-5-defined mixed features were too restrictive to discriminate BP from MDD in patients with depression compared with Benazzi's definition. To confirm this finding, studies that include patients with BP-I and using tools to assess manic/hypomanic symptoms during MDE are necessary. © 2014 The Authors. Psychiatry and Clinical Neurosciences © 2014 Japanese Society of Psychiatry and Neurology.

  15. Transition to Mania During Treatment of Bipolar Depression

    PubMed Central

    Perlis, Roy H; Ostacher, Michael J; Goldberg, Joseph F; Miklowitz, David J; Friedman, Edward; Calabrese, Joseph; Thase, Michael E; Sachs, Gary S

    2010-01-01

    Some individuals with bipolar disorder transition directly from major depressive episodes to manic, hypomanic, or mixed states during treatment, even in the absence of antidepressant treatment. Prevalence and risk factors associated with such transitions in clinical populations are not well established, and were examined in the Systematic Treatment Enhancement Program for Bipolar Disorder study, a longitudinal cohort study. Survival analysis was used to examine time to transition to mania, hypomania, or mixed state among 2166 bipolar I and II individuals in a major depressive episode. Cox regression was used to examine baseline clinical and sociodemographic features associated with hazard for such a direct transition. These features were also examined for interactive effects with antidepressant treatment. In total, 461/2166 subjects in a major depressive episode (21.3%) transitioned to a manic/hypomanic or mixed state before remission, including 289/1475 (19.6%) of those treated with antidepressants during the episode. Among the clinical features associated with greatest transition hazard were greater number of past depressive episodes, recent or lifetime rapid cycling, alcohol use disorder, previous suicide attempt, and history of switch while treated with antidepressants. Greater manic symptom severity was also associated with risk for manic transition among both antidepressant-treated and antidepressant-untreated individuals. Three features, history of suicide attempt, younger onset age, and bipolar subtype, exhibited differential effects between individuals treated with antidepressants and those who were not. These results indicate that certain clinical features may be associated with greater risk of transition from depression to manic or mixed states, but the majority of them are not specific to antidepressant-treated patients. PMID:20827274

  16. The manic syndrome: factors which may predict a patient's response to lithium, carbamazepine and valproate.

    PubMed Central

    Dilsaver, S C; Swann, A C; Shoaib, A M; Bowers, T C

    1993-01-01

    Studies suggest that 80% to 90% of all patients in the manic state respond to lithium provided that they are relatively free of dysphoria ("pure mania"). In contrast, less than 40% of individuals in the manic state who cycle rapidly or are substantially dysphoric ("dysphoric mania") respond to lithium. These patients appear to be more responsive to carbamazepine and valproate. The authors conclude that carbamazepine and valproate are the drugs of choice if one desires to treat a rapidly cycling individual or patient with dysphoric mania with just one agent. However, they emphasize that a prospective study designed to identify the predictors of response of primary mania to lithium, carbamazepine and valproate is required. Studies assessing the relative value of lithium, carbamazepine or valproate as prophylactic agents in the care of patients with specific subtypes of mania are also needed. These studies would address the most important issues confronting researchers interested in the drug treatment of mania. PMID:8461283

  17. Textmania: text messaging during the manic phase of bipolar I disorder.

    PubMed

    Emeagwali, Nkiruka Anwulika; Bailey, Rahn K; Azim, Fatima

    2012-05-01

    Advancements in modern technology have brought tremendous changes in human behavior. One such change is in modes of communication such as text messaging, or texting. This form of communication has emerged as one of the dominant modes of communication in the world. This report presents a differential pattern of texting seen during the manic episode of a young adult with bipolar I disorder. We observed all the DSM IV manic symptoms; interestingly the patient's predominant medium for communication was texting. The patient reported a dramatic increase in the quantity of both texting and sex-texting (or sexting) in addition to a decrease in quality of the message content. In addition, there was a substantial increase in the number of people with whom the patient engaged in simultaneous texting conversations. This case provides evidence for the need to consider non-traditional forms of communication when evaluating a patient's communication pattern during mania.

  18. Eukaryotic expression, purification, crystallization and preliminary X-ray analysis of murine Manic Fringe

    SciTech Connect

    Jinek, Martin; Conti, Elena

    2006-08-01

    The catalytic domain of the murine glycosyltransferase Manic Fringe was expressed in insect cells. Removal by site-directed mutagenesis of two N-glycosylation sites present in the protein was essential to obtain crystals that diffracted to 1.8 Å resolution. Fringe proteins are Golgi-resident β1,3-N-acetylglucosaminyltransferases that regulate development in metazoa through glycosylation of the Notch receptor and its ligands. The catalytic domain of murine Manic Fringe was expressed in the baculovirus/insect-cell system as a secreted protein. Mass-spectrometric analysis of the purified protein indicated the presence of two N-linked glycans. Abolishing the glycosylation sites by site-directed mutagenesis was necessary in order to obtain orthorhombic crystals that diffracted to 1.8 Å resolution. For phasing, a highly redundant data set was collected using a crystal soaked with halide salts.

  19. Depressive symptoms in early- and late-onset older bipolar patients compared with younger ones.

    PubMed

    García-López, Aurelio; Ezquiaga, Elena; De Dios, Consuelo; Agud, Jose Luis

    2017-02-01

    The aim of this study was to determine clinical and outcome differences between older bipolar patients with early onset (EO) and late onset (LO) of the illness and between younger and EO older patients with a bipolar disorder under long-term treatment in an outpatient clinical setting. Three hundred ninety-five bipolar I and II outpatients were followed up for up to 7.7 years. Of these, 213 younger (<50 years) and 88 older (>60 years) patients were included. In the older subsample, 50 EO patients (onset <50 years) versus 38 LO patients (≥50 years) were analyzed. Likewise, younger versus EO older patients were compared. The likelihood of LO older patients of being bipolar II was higher than for EO older patients. They were also diagnosed earlier than EO older patients. No other clinical differences at baseline and at the prospective follow-up were found. Compared with younger patients, EO older patients had more frequent depressive symptoms at baseline, suffered more major depressive episodes in the previous year and in the prospective follow-up, received more antidepressants at baseline, had higher rates of medical comorbid conditions and were less likely to be tobacco smokers. Older patients constitute a meaningful proportion of bipolar patients under treatment. EO older patients suffered significantly from more frequent depressive symptoms than younger ones. LO older patients were predominantly bipolar II. So as bipolar illness progressed, depressive symptomatology became more frequent and manic episodes were less severe. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

  20. The Bipolar Illness Onset study: research protocol for the BIO cohort study.

    PubMed

    Kessing, Lars Vedel; Munkholm, Klaus; Faurholt-Jepsen, Maria; Miskowiak, Kamilla Woznica; Nielsen, Lars Bo; Frikke-Schmidt, Ruth; Ekstrøm, Claus; Winther, Ole; Pedersen, Bente Klarlund; Poulsen, Henrik Enghusen; McIntyre, Roger S; Kapczinski, Flavio; Gattaz, Wagner F; Bardram, Jakob; Frost, Mads; Mayora, Oscar; Knudsen, Gitte Moos; Phillips, Mary; Vinberg, Maj

    2017-06-23

    Bipolar disorder is an often disabling mental illness with a lifetime prevalence of 1%-2%, a high risk of recurrence of manic and depressive episodes, a lifelong elevated risk of suicide and a substantial heritability. The course of illness is frequently characterised by progressive shortening of interepisode intervals with each recurrence and increasing cognitive dysfunction in a subset of individuals with this condition. Clinically, diagnostic boundaries between bipolar disorder and other psychiatric disorders such as unipolar depression are unclear although pharmacological and psychological treatment strategies differ substantially. Patients with bipolar disorder are often misdiagnosed and the mean delay between onset and diagnosis is 5-10 years. Although the risk of relapse of depression and mania is high it is for most patients impossible to predict and consequently prevent upcoming episodes in an individual tailored way. The identification of objective biomarkers can both inform bipolar disorder diagnosis and provide biological targets for the development of new and personalised treatments. Accurate diagnosis of bipolar disorder in its early stages could help prevent the long-term detrimental effects of the illness.The present Bipolar Illness Onset study aims to identify (1) a composite blood-based biomarker, (2) a composite electronic smartphone-based biomarker and (3) a neurocognitive and neuroimaging-based signature for bipolar disorder. The study will include 300 patients with newly diagnosed/first-episode bipolar disorder, 200 of their healthy siblings or offspring and 100 healthy individuals without a family history of affective disorder. All participants will be followed longitudinally with repeated blood samples and other biological tissues, self-monitored and automatically generated smartphone data, neuropsychological tests and a subset of the cohort with neuroimaging during a 5 to 10-year study period. The study has been approved by the Local

  1. Dimensions of manic symptoms in youth: psychosocial impairment and cognitive performance in the IMAGEN sample.

    PubMed

    Stringaris, Argyris; Castellanos-Ryan, Natalie; Banaschewski, Tobias; Barker, Gareth J; Bokde, Arun L; Bromberg, Uli; Büchel, Christian; Fauth-Bühler, Mira; Flor, Herta; Frouin, Vincent; Gallinat, Juergen; Garavan, Hugh; Gowland, Penny; Heinz, Andreas; Itterman, Bernd; Lawrence, Claire; Nees, Frauke; Paillere-Martinot, Marie-Laure; Paus, Tomas; Pausova, Zdenka; Rietschel, Marcella; Smolka, Michael N; Schumann, Gunter; Goodman, Robert; Conrod, Patricia

    2014-12-01

    It has been reported that mania may be associated with superior cognitive performance. In this study, we test the hypothesis that manic symptoms in youth separate along two correlated dimensions and that a symptom constellation of high energy and cheerfulness is associated with superior cognitive performance. We studied 1755 participants of the IMAGEN study, of average age 14.4 years (SD = 0.43), 50.7% girls. Manic symptoms were assessed using the Development and Wellbeing Assessment by interviewing parents and young people. Cognition was assessed using the Wechsler Intelligence Scale For Children (WISC-IV) and a response inhibition task. Manic symptoms in youth formed two correlated dimensions: one termed exuberance, characterized by high energy and cheerfulness and one of undercontrol with distractibility, irritability and risk-taking behavior. Only the undercontrol, but not the exuberant dimension, was independently associated with measures of psychosocial impairment. In multivariate regression models, the exuberant, but not the undercontrolled, dimension was positively and significantly associated with verbal IQ by both parent- and self-report; conversely, the undercontrolled, but not the exuberant, dimension was associated with poor performance in a response inhibition task. Our findings suggest that manic symptoms in youth may form dimensions with distinct correlates. The results are in keeping with previous findings about superior performance associated with mania. Further research is required to study etiological differences between these symptom dimensions and their implications for clinical practice. © 2014 The Authors. Journal of Child Psychology and Psychiatry published by John Wiley & Sons Ltd on behalf of Association for Child and Adolescent Mental Health.

  2. The real world cost and health resource utilization associated to manic episodes: The MANACOR study.

    PubMed

    Hidalgo-Mazzei, Diego; Undurraga, Juan; Reinares, María; Bonnín, Caterina del Mar; Sáez, Cristina; Mur, María; Nieto, Evaristo; Vieta, Eduard

    2015-01-01

    Bipolar disorder is a relapsing-remitting condition affecting approximately 1-2% of the population. Even when the treatments available are effective, relapses are still very frequent. Therefore, the burden and cost associated to every new episode of the disorder have relevant implications in public health. The main objective of this study was to estimate the associated health resource consumption and direct costs of manic episodes in a real world clinical setting, taking into consideration clinical variables. Bipolar I disorder patients who recently presented an acute manic episode based on DSM-IV criteria were consecutively included. Sociodemographic variables were retrospectively collected and during the 6 following months clinical variables were prospectively assessed (YMRS,HDRS-17,FAST and CGI-BP-M). The health resource consumption and associate cost were estimated based on hospitalization days, pharmacological treatment, emergency department and outpatient consultations. One hundred sixty-nine patients patients from 4 different university hospitals in Catalonia (Spain) were included. The mean direct cost of the manic episodes was €4,771. The 77% (€3,651) was attributable to hospitalization costs while 14% (€684) was related to pharmacological treatment, 8% (€386) to outpatient visits and only 1% (€50) to emergency room visits. The hospitalization days were the main cost driver. An initial FAST score>41 significantly predicted a higher direct cost. Our results show the high cost and burden associated with BD and the need to design more cost-efficient strategies in the prevention and management of manic relapses in order to avoid hospital admissions. Poor baseline functioning predicted high costs, indicating the importance of functional assessment in bipolar disorder. Copyright © 2014 SEP y SEPB. Published by Elsevier España. All rights reserved.

  3. A case of adrenoleukodystrophy presenting with manic symptoms in a patient on steroids for Addison's disease.

    PubMed

    Jyothi, K S; George, Cyriac; Shaji, K S

    2016-01-01

    Adrenoleukodystrophy (ALD) is an X-linked disorder with diverse clinical presentations. A 30-year-old male, previously diagnosed with Addison's disease, on steroid supplementation for 18 years, presented to us with manic symptoms for 4 years. He was found to have white matter hypodensities in computed tomography head and had white matter signal changes in magnetic resonance imaging, and therefore a diagnosis of ALD was made.

  4. Magnesium, C-reactive protein, and cortisol in drug-naïve patients with short illness-duration, first episode major depressive disorder: possible immunomodulatory role for magnesium.

    PubMed

    Cubała, Wiesław Jerzy; Landowski, Jerzy; Dziadziuszko, Małgorzata; Chrzanowska, Anna; Wielgomas, Bartosz

    2016-04-01

    Plasma magnesium concentration alterations, hypercortisolaemia, and systemic inflammation are observed in major depressive disorder (MDD). This exploratory study examined whether, and to what extent, plasma magnesium is related to C-reactive protein (CRP) levels and cortisolaemia in MDD. The concentrations of plasma magnesium, salivary CRP, and baseline plasma cortisol were studied in 20, treatment-naïve MDD patients with short-illness-duration, first affective episodes and 20 matched controls. Depressed patients showed a basal score higher than 20 on the Hamilton Rating Scale for Depression (HAMD-17). Significantly higher magnesium (p = 0.016) and baseline cortisol (p = 0.01) concentrations were observed in MDD as compared to controls. No significant difference in CRP concentrations between the MDD and control groups was observed. A significant negative correlation was seen between magnesium and CRP in MDD (p<0.01), whereas no correlation was found in controls. A significant positive correlation was found between cortisol and CRP, both in MDD subjects (p = 0.008) and controls (p = 0.004). No significant correlations were observed between magnesium and cortisol levels. The study supports data for hypercortisolaemia in MDD, but provides no evidence of primary hypomagnesaemia or elevated CRP levels in drug-naïve MDD patients with short-illness-duration. The study supports the hypothesis linking hypercortisolaemia to systemic inflammation, with hypermagnesaemia exerting an immunomodulatory action at early stages of the disease.

  5. Psychotic depression, posttraumatic stress disorder, and engagement in cognitive-behavioral therapy within an outpatient sample of adults with serious mental illness.

    PubMed

    Gottlieb, Jennifer D; Mueser, Kim T; Rosenberg, Stanley D; Xie, Haiyi; Wolfe, Rosemarie S

    2011-01-01

    Depression with psychotic features afflicts a substantial number of people and has been characterized by significantly greater impairment, higher levels of dysfunctional beliefs, and poorer response to psychopharmacologic and psychosocial interventions than nonpsychotic depression. Those with psychotic depression also experience a host of co-occurring disorders, including posttraumatic stress disorder (PTSD), which is not surprising given the established relationships between trauma exposure and increased rates of psychosis and between PTSD and major depression. To date, there has been very limited research on the psychosocial treatment of psychotic depression; and even less is known about those who also suffer from PTSD. The purpose of this study was to better understand the rates and clinical correlates of psychotic depression in those with PTSD. Clinical and symptom characteristics of 20 individuals with psychotic depression and 46 with nonpsychotic depression, all with PTSD, were compared before receiving cognitive-behavioral therapy for PTSD treatment or treatment as usual. Patients with psychotic depression exhibited significantly higher levels of depression and anxiety, a weaker perceived therapeutic alliance with their case managers, more exposure to traumatic events, and more negative beliefs related to their traumatic experiences, as well as increased levels of maladaptive cognitions about themselves and the world, compared with participants without psychosis. Implications for cognitive-behavioral therapy treatment aimed at dysfunctional thinking for this population are discussed. © 2011 Elsevier Inc. All rights reserved.

  6. Affect recognition across manic and euthymic phases of bipolar disorder in Han-Chinese patients.

    PubMed

    Pan, Yi-Ju; Tseng, Huai-Hsuan; Liu, Shi-Kai

    2013-11-01

    Patients with bipolar disorder (BD) have affect recognition deficits. Whether affect recognition deficits constitute a state or trait marker of BD has great etiopathological significance. The current study aims to explore the interrelationships between affect recognition and basic neurocognitive functions for patients with BD across different mood states, using the Diagnostic Analysis of Non-Verbal Accuracy-2, Taiwanese version (DANVA-2-TW) as the index measure for affect recognition. To our knowledge, this is the first study examining affect recognition deficits of BPD across mood states in the Han Chinese population. Twenty-nine manic patients, 16 remitted patients with BD, and 40 control subjects are included in the study. Distinct association patterns between affect recognition and neurocognitive functions are demonstrated for patients with BD and control subjects, implicating alternations in emotion associated neurocognitive processing. Compared to control subjects, manic patients but not remitted subjects perform significantly worse in the recognition of negative emotions as a whole and specifically anger, after adjusting for differences in general intellectual ability and basic neurocognitive functions. Affect recognition deficit may be a relatively independent impairment in BD rather than consequences arising from deficits in other basic neurocognition. The impairments of manic patients in the recognition of negative emotions, specifically anger, may further our understanding of core clinical psychopathology of BD and have implications in treating bipolar patients across distinct mood phases.

  7. Depression: discrete or continuous?

    PubMed

    Bowins, Brad

    2015-01-01

    Elucidating the true structure of depression is necessary if we are to advance our understanding and treatment options. Central to the issue of structure is whether depression represents discrete types or occurs on a continuum. Nature almost universally operates on the basis of continuums, whereas human perception favors discrete categories. This reality might be formalized into a 'continuum principle': natural phenomena tend to occur on a continuum, and any instance of hypothesized discreteness requires unassailable proof. Research evidence for discrete types falls far short of this standard, with most evidence supporting a continuum. However, quantitative variation can yield qualitative differences as an emergent property, fostering the appearance of discreteness. Depression as a continuum is best characterized by duration and severity dimensions, with the latter understood in terms of depressive inhibition. In the absence of some degree of cognitive, emotional, social, and physical inhibition, depression should not be diagnosed. Combining the dimensions of duration and severity provides an optimal way to characterize the quantitative and related qualitative aspects of depression and to describe the overall degree of dysfunction. The presence of other symptom types occurs when anxiety, hypomanic/manic, psychotic, and personality continuums interface with the depression continuum.

  8. Manic tendencies are not related to being an entrepreneur, intending to become an entrepreneur, or succeeding as an entrepreneur.

    PubMed

    Johnson, Sheri L; Freeman, Michael A; Staudenmaier, Paige J

    2015-03-01

    Popular literature suggests a relationship between entrepreneurship and manic tendencies, yet little scientific research has evaluated whether manic tendencies foster entrance into entrepreneurial roles, intent to become an entrepreneur, or success as an entrepreneur. In study 1, 225 undergraduates and business school students/affiliates took an online survey to assess engagement and intent as entrepreneurs, as well as manic tendencies, including family diagnoses as reported on the Family Index of Risk for Mania, subsyndromal manic tendencies as assessed with the Hypomanic Personality Scale, and self-reported diagnoses. In study 2, the sample of entrepreneurs identified in study 1 was enriched by recruiting a larger group of established entrepreneurs from the community. Entrepreneurs (n=210) completed items concerning their success in entrepreneurship, and we examined whether the three measures of manic tendencies were related to success. There was no evidence that those vulnerable to mania, regardless of definition, were more likely to be entrepreneurs, to intend to become entrepreneurs, or to succeed as entrepreneurs. The studies were limited by self-report measures and relatively small samples. More nuanced models may explain the frequent clinical observations of manic traits among entrepreneurs. Copyright © 2014 Elsevier B.V. All rights reserved.

  9. Rapid response to methylphenidate as an add-on therapy to mirtazapine in the treatment of major depressive disorder in terminally ill cancer patients: a four-week, randomized, double-blinded, placebo-controlled study.

    PubMed

    Ng, Chong Guan; Boks, Marco P M; Roes, Kit C B; Zainal, Nor Zuraida; Sulaiman, Ahmad Hatim; Tan, Seng Beng; de Wit, Niek J

    2014-04-01

    This is a 4 week, randomized, double-blind, placebo-controlled study to examine the effects of methylphenidate as add-on therapy to mirtazapine compared to placebo for treatment of depression in terminally ill cancer patients. It involved 88 terminally ill cancer patients from University of Malaya Medical Centre, Kuala Lumpur, Malaysia. They were randomized and treated with either methylphenidate or placebo as add on to mirtazapine. The change in Montgomery-Åsberg Depression Rating Scale (MADRS) score from baseline to day 3 was analyzed by linear regression. Changes of MADRS and Clinical Global Impression-Severity Scale (CGI-S) over 28 days were analyzed using mixed model repeated measures (MMRM). Secondary analysis of MADRS response rates, defined as 50% or more reduction from baseline score. A significantly larger reduction of Montgomery-Åsberg Depression Rating Scale (MADRS) score in the methylphenidate group was observed from day 3 (B=4.14; 95% CI=1.83-6.45). Response rate (defined as 50% or more reduction from baseline MADRS score) in the methylphenidate treated group was superior from day 14. Improvement in Clinical Global Impression-Severity Scale (CGI-S) was greater in the methylphenidate treated group from day 3 until day 28. The drop-out rates were 52.3% in the methylphenidate group and 59.1% in the placebo group (relative risk=0.86, 95%CI=0.54-1.37) due to cancer progression. Nervous system adverse events were more common in methylphenidate treated subjects (20.5% vs 9.1%, p=0.13). In conclusions, methylphenidate as add on therapy to mirtazapine demonstrated an earlier antidepressant response in terminally ill cancer patients, although at an increased risk of the nervous system side effects. Copyright © 2014 Elsevier B.V. and ECNP. All rights reserved.

  10. [Treatment of manic phases of bipolar disorder: critical synthesis of international guidelines].

    PubMed

    Geoffroy, P A; Bellivier, F; Henry, C

    2014-09-01

    Bipolar disorder (BD) is the seventh leading cause of disability per year of life among all diseases in the population aged 15 to 44. It is a group of heterogeneous diseases, with frequent comorbid psychiatric or somatic disorders, variable treatment response and frequent residual symptoms between episodes. The major impairment associated with this disorder is related to the high relapse and recurrence rates, the functional impact of comorbidities and cognitive impairment between episodes. The prognosis of the disease relies on the efficacy of relapse and recurrence prevention interventions. Given the heterogeneity of the disorder, relapse and recurrence prevention needs to develop a personalized care plan from the start of the acute phase. In such a complex situation, guideline-driven algorithms of decision are known to improve overall care of patients with bipolar disorder, compared to standard treatment decisions. Although guidelines do not account for all the situations encountered with patients, this systematic approach contributes to the development of personalized medicine. We present a critical review of recent international recommendations for the management of manic phases. We summarize treatment options that reach consensus (monotherapy and combination therapy) and comment on options that differ across guidelines. The synthesis of recent international guidelines shows a consensus for the initial treatment for manic phases. For acute and long-term management, the anti-manic drugs proposed are traditional mood stabilizers (lithium or valproate) and atypical antipsychotics (APA - olanzapine, risperidone, aripiprazole and quetiapine). All guidelines indicate stopping antidepressant drugs during manic phases. International guidelines also present with some differences. First, as monotherapy is often non sufficient in clinical practice, combination therapy with a traditional mood stabilizer and an APA are disputed either in first line treatment for severe

  11. Psychometric properties of a Chinese version of the Stigma Scale: examining the complex experience of stigma and its relationship with self-esteem and depression among people living with mental illness in Hong Kong.

    PubMed

    Ho, Andy H Y; Potash, Jordan S; Fong, Ted C T; Ho, Vania F L; Chen, Eric Y H; Lau, Robert H W; Au Yeung, Friendly S W; Ho, Rainbow T H

    2015-01-01

    Stigma of mental illness is a global public health concern, but there lacks a standardized and cross-culturally validated instrument for assessing the complex experience of stigma among people living with mental illness (PLMI) in the Chinese context. This study examines the psychometric properties of a Chinese version of the Stigma Scale (CSS), and explores the relationships between stigma, self-esteem and depression. A cross-sectional survey was conducted with a community sample of 114 Chinese PLMI in Hong Kong. Participants completed the CSS, the Chinese Self-Stigma of Mental Illness Scale, the Chinese Rosenberg Self-Esteem Scale, and the Chinese Patient Health Questionnaire-9. An exploratory factor analysis was conducted to identify the underlying factors of the CSS; concurrent validity assessment was performed via correlation analysis. The original 28-item three-factor structure of the Stigma Scale was found to be a poor fit to the data, whereas a revised 14-item three-factor model provided a good fit with all 14 items loaded significantly onto the original factors: discrimination, disclosure and positive aspects of mental illness. The revised model also displayed moderate to good internal consistency and good construct validity. Further findings revealed that the total stigma scale score and all three of its subscale scores correlated negatively with self-esteem; but only total stigma, discrimination and disclosure correlated positively with depression. The CSS is a short and user-friendly self-administrated questionnaire that proves valuable for understanding the multifaceted stigma experiences among PLMI as well as their impact on psychiatric recovery and community integration in Chinese communities. Copyright © 2014 Elsevier Inc. All rights reserved.

  12. Breast cancer and depression.

    PubMed

    Somerset, Wendy; Stout, Steven C; Miller, Andrew H; Musselman, Dominique

    2004-07-01

    Major depression and depressive symptoms, although commonly encountered in patients with medical illnesses, are frequently underdiagnosed and undertreated in women with breast cancer. Depression and its associated symptoms diminish quality of life, adversely affect compliance with medical therapies, and reduce survival. Treatment of depression in women with breast cancer improves their dysphoria and other depressive symptoms, enhances quality of life, and may increase longevity. In this review, studies that investigate pathophysiologic alterations in patients with cancer and comorbid depression are discussed, and the few studies on treatment of depression and related symptoms in women with breast cancer are examined.

  13. Hypomanic shift observed during rTMS treatment of patients with unipolar depressive disorder: four case reports

    PubMed Central

    2013-01-01

    Objective Repetitive transcranial magnetic stimulation (rTMS) can enhance the excitement of the brain through adjusting the biological activities of the cerebral cortex and has wide biological effects, making it one basic mechanism of therapy for depression. In the treatment of unipolar depressive disorder, almost in every treatment method, hypomanic and manic shifts can be observed. There is still a lack of data regarding manic and hypomanic symptoms triggered by rTMS applications. Method We describe four cases with unipolar depression in which high-frequency rTMS over the left dorsolateral prefrontal cortex applied as an add-on antidepressive strategy may have induced a hypomanic episode. Results In these cases, 25 Hz rTMS combined with antidepressants may have contributed to the occurrence of hypomanic symptoms. Conclusion Using an intensive methodology of rTMS may induce hypomanic or manic symptoms. PMID:23618105

  14. Major depression, dysthymia and depressive personality disorder.

    PubMed

    Hirschfeld, R M

    1994-12-01

    The separation of persistent depression into meaningful and useful subcategories, including major depression, dysthymia, recurrent brief depression, and depressive personality disorder, is the subject of much debate. Depressions can be grouped on the basis of their type and severity of symptoms, aetiology, clinical course, or their association with other psychiatric illnesses. Several investigators have conducted epidemiologic and family studies to evaluate the prevalence of depressive disorders, their diagnostic stability over time, and the amount of overlap among the disorders. Although progress has been made toward a better understanding of the different disorders, insufficient evidence exists to support the hypothesis that these disorders are separate and distinct from one another. However, preliminary data suggest that depressive personality disorder is separate from the other disorders. Additionally, several questions have been raised, particularly the extent to which differentiation between the depressive disorders, specifically major depression and dysthymia, has an impact on treatment decisions.

  15. Growing up with an ill parent: An examination of family characteristics and parental illness features.

    PubMed

    Stoeckel, Maggie; Weissbrod, Carol

    2015-12-01

    Existing literature suggests that the children of ill parents are vulnerable to a variety of psychosocial difficulties such as depression and anxiety. The purpose of the current study is to investigate the impact of family characteristics (parental involvement, familial support, stress experienced as a result of parental illness) and parental illness features (severity, duration, recovery status, frequency of symptoms, course) on the psychosocial functioning (depression, anxiety, life satisfaction) of late adolescents who have grown up with an ill parent but no longer live with their parents. Participants were 71 college students with a parent who experienced a chronic medical condition while they were growing up. Participants provided information regarding family characteristics, parental illness features, and the impact of parental illness. Impact of parental illness was assessed using the Impact of Illness Scale. Participants also completed measures of depression, anxiety, and life satisfaction. Participants' reported impact of parent illness was positively correlated with participant depression and anxiety. Several family characteristics and parental illness features were significantly associated with participant psychosocial functioning. In particular, lower parental involvement was correlated with greater participant depression and anxiety, as well as lower life satisfaction. These findings extend our understanding of the impact of parental illness on late adolescents' psychosocial functioning. Results could have clinical applications for psychosocial interventions in children and families coping with chronic illness. (PsycINFO Database Record (c) 2015 APA, all rights reserved).

  16. Do You Have Major Depression?

    MedlinePlus

    ... of this page please turn Javascript on. Feature: Depression Do You Have Major Depression? Past Issues / Fall 2009 Table of Contents Simple ... member may have major depression. —NIMH Types of Depression Just like other illnesses, such as heart disease, ...

  17. Development of Alcohol and Drug Use in Youth With Manic Symptoms.

    PubMed

    Horwitz, Sarah McCue; Storfer-Isser, Amy; Young, Andrea S; Youngstrom, Eric A; Taylor, H Gerry; Frazier, Thomas W; Arnold, L Eugene; Fristad, Mary A; Birmaher, Boris; Findling, Robert L

    2017-02-01

    This analysis examined alcohol and drug use over a 6-year follow-up of children in the Longitudinal Assessment of Manic Symptoms (LAMS) study. LAMS screened 6- to 12.9-year-old children visiting 9 child outpatient mental health (MH) clinics, using the Parent General Behavior Inventory 10-item mania scale. All children with scores ≥12 and a matched group with scores ≤12 were invited to enroll. Children were assessed every 6 months. Assessments included demographics, family, MH history, child diagnoses, child stress, and alcohol and drug use. Univariate, bivariate, and interval censored survival analyses were conducted. Of those >9 years at baseline, 34.9% used alcohol at least once, with 11.9% regular users; 30.1% used drugs at least once, with 16.2% regular users. Predictors of any alcohol use were parental marital status, older age at study entry, a primary diagnosis of disruptive behavior disorders at baseline, and number of impactful child life events. Predictors of regular alcohol use included parental marital status, age, and sustained high mania symptoms over the first 24 months of follow-up. Predictors of any drug use were single parent, parental substance use, and stressful child life events. Predictors of regular drug use were parental marital status, stressful child life events, and a baseline disruptive behavior disorder diagnosis. Baseline medications decreased the risk of regular drug use. Longitudinal data on youth with elevated manic symptoms suggest that comorbid disruptive behavior disorder, manic symptom burden, family environment, and stress are predictors of initiation and regular use of substances. Copyright © 2016 American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.

  18. Metabolic depression in hibernation and major depression: an explanatory theory and an animal model of depression.

    PubMed

    Tsiouris, John A

    2005-01-01

    therapeutic effects by normalizing the fluctuation of activities in the different signaling systems, which are down-regulated during hibernation and depression and up-regulated during exodus from hibernation and the hypomanic or manic phase of mood disorders. The ways individuals cognitively perceive, understand, communicate, and react to the vegetative symptoms of depression, from downregulation in energy production, and in the absence of known medical causes, produce the other characteristics of depression including guilt, helplessness, hopelessness, suicidal phenomena, agitation, panic attacks, psychotic symptoms, and sudden switch to hypomanic or manic episodes. The presence of one or more of these characteristics depends on the person's neuropsychological function, its social status between the others, and the other's response to the person. Neurobiological changes associated with metabolic depression during entrance, maintenance, and exodus from hibernation in bears is suggested as a natural animal model of human depression and mood disorders.

  19. Augmentative Asenapine in a Recurrent Manic Catatonic Patient with Partial Response to Clozapine

    PubMed Central

    Buoli, Massimiliano; Dobrea, Cristina; Caldiroli, Alice; Cremaschi, Laura; Altamura, A. Carlo

    2013-01-01

    Catatonia is a severe but treatable neuropsychiatric syndrome known since the middle of the nineteenth century. It has been considered for a long time as a subtype of schizophrenia, even though this association occurs only in 10% of cases. In contrast, it is frequently observed in bipolar patients. First-line treatment consists of benzodiazepines, while in case of resistance electroconvulsive therapy (ECT) and clozapine have shown positive results. In addition, recent studies reported the efficacy of some atypical antipsychotics. The present case shows the clinical response to augmentative asenapine in a catatonic manic patient with a partial response to clozapine. PMID:24171130

  20. [Treatment of depressive mixed states].

    PubMed

    Dubois, M; Dassa, D; Belzeaux, R; Fakra, E; Cermolacce, M; Corréard, N; Kaladjian, A; Azorin, J-M

    2013-12-01

    Mixed states are a frequent mood state characterized by the mixture of manic and depressive symptoms. Their clinical description has been studied for centuries but has known a renewal of interest recently. Several authors intend to redefine its diagnostic criteria to develop an appropriate therapeutic strategy. Current recommendations suggest to treat mixed depression as a mixed state whatever the dominant polarity is, and therefore according to the rules of therapeutic management of the manic state. Mood stabilizers and antipsychotic medications are indicated and have proven their effectiveness. Lithium, which was considered controversial, now appears to have some therapeutic value, especially in the prevention of suicidal behavior. The depressive component of mixed states, even pronounced, should not be an argument for a prescription of antidepressants, at the risk of aggravating clinical components such as irritability and impulsivity and increasing the danger of suicide attempt. Furthermore, electroconvulsivetherapy represents a real alternative ; psychotherapies have their place in relapse prevention and psychoeducation, but not during acute phases. Finally, an accurate assessment and appropriate management of suicide risk should be a constant concern for the clinicians. Copyright © 2013 L’Encéphale. Published by Elsevier Masson SAS.. All rights reserved.

  1. Onset polarity and illness course in bipolar I and II disorders: The predictive role of broadly defined mixed states.

    PubMed

    Tundo, Antonio; Musetti, Laura; Benedetti, Alessandra; Berti, Benedetta; Massimetti, Gabriele; Dell'Osso, Liliana

    2015-11-01

    Several studies investigating bipolar disorders have shown that polarity of onset can predict differences in symptomatology, course, and prognosis. Frequently, however, research on the topic has examined only bipolar I inpatients and has not included patients with mixed onset. The aim of the present naturalistic study was to evaluate the clinical characteristics and illness course of a consecutive sample (407 outpatients, 58.7% with bipolar I (BD-I) and 41.3% with bipolar II (BD-II) disorder) according to polarity of onset: depressive (DP-o); manic/hypomanic (HM-o); or mixed--broadly defined to include agitated depression for BD-II--onset (MX-o). As compared with patients in the other two groups: a) DP-o patients (67.3%) were more frequently affected by BD-II and had lower ratings for psychotic symptoms; b) HM-o patients (17%) had a higher rate of family history for psychosis and a lower rate of suicide attempts; and c) patients in the MX-o group (15.7%) more frequently showed substance abuse and had a higher number of mixed recurrences per year. In the BD-II group, MX-o patients more frequently attempted suicide. The present study's main limitations are those of retrospective assessment of onset polarity and lack of treatment-impact evaluations over illness course. In conclusion, we confirm clinical expression differences in bipolar disorder in function of polarity of onset and underscore the importance of carefully considering broadly defined mixed state when examining polarity of onset. Further investigations are required to confirm the present study's results. Copyright © 2015 Elsevier Inc. All rights reserved.

  2. Darwin's illness revealed

    PubMed Central

    Campbell, A.; Matthews, S.

    2005-01-01

    After returning from the Beagle in 1836, Charles Darwin suffered for over 40 years from long bouts of vomiting, gut pain, headaches, severe tiredness, skin problems, and depression. Twenty doctors failed to treat him. Many books and papers have explained Darwin's mystery illness as organic or psychosomatic, including arsenic poisoning, Chagas' disease, multiple allergy, hypochondria, or bereavement syndrome. None stand up to full scrutiny. His medical history shows he had an organic problem, exacerbated by depression. Here we show that all Darwin's symptoms match systemic lactose intolerance. Vomiting and gut problems showed up two to three hours after a meal, the time it takes for lactose to reach the large intestine. His family history shows a major inherited component, as with genetically predisposed hypolactasia. Darwin only got better when, by chance, he stopped taking milk and cream. Darwin's illness highlights something else he missed—the importance of lactose in mammalian and human evolution. PMID:15811889

  3. Functional brain organization in bipolar affective patients during manic phase and after recovery: a digit dichotic listening study.

    PubMed

    Kaprinis, G; Nimatoudis, J; Karavatos, A; Kandylis, D; Kaprinis, S

    1995-06-01

    To study the functional organization of the cerebral hemispheres in patients with bipolar psychosis using a verbal dichotic listening test for pairs of digits 26 patients were tested twice, during the acute expression of manic phase and after recovery. The patient group during the manic phase did not support the expected right-ear advantage of normal subjects on verbal dichotic tests but showed a statistically significant left-ear advantage, which shifted after recovery toward the typical normal asymmetry. Comparing patients during the manic phase and after recovery showed that the left-ear advantage as well as the shift in right-ear advantage after recovery was due to the reduction of left-ear performance. From the over-all neuropsychological findings for these patients mania may be hypothesized to be characterized by overactivation of the right hemisphere. This phaenomenon seems associated with acuteness of the symptoms of the psychotic disorder.

  4. Depression symptom ratings in geriatric patients with bipolar mania.

    PubMed

    Sajatovic, Martha; Al Jurdi, Rayan; Gildengers, Ariel; Greenberg, Rebecca L; Tenhave, Thomas; Bruce, Martha L; Mulsant, Benoit; Young, Robert C

    2011-11-01

    Given the paucity of information available regarding standardized ratings of depression symptoms in bipolar manic states, and in particular those in older adults, we explored depression ratings in symptomatic participants in a multicenter study of treatment of bipolar I disorder in late life. Baseline data was obtained from the first 100 patients enrolled in an NIMH-funded, 9-week, randomized, double-blind RCT comparing treatment with lithium or valproate in patients of age 60 years and older with Type I Bipolar mania or hypomania. This multi-site study was conducted at six academic medical centers in the United States and enrolled inpatients and outpatients with a total Young Mania Rating Scale (YMRS) score of 18 or greater. Depressive symptoms were evaluated with the Hamilton Depression Rating Scale (HAM-D) and the Montgomery-Asberg Depression Rating Scale (MADRS). The criterion for at least moderate bipolar depressive symptoms was the European College of Neuropsychopharmacology (ECNP) Consensus Meeting definition of HAM-D 17 total score >20. Eleven percent of patients had mixed symptoms defined by depression scale severity according to ECNP criterion. In the overall sample, total scores on the two depression scales were highly correlated. Total YMRS scores of this mixed symptom group were similar to the remainder of the sample. These preliminary findings suggest that moderate to severe depressive symptoms occur in about one in ten bipolar manic elders. Future studies are needed to further evaluate symptom profiles, clinical correlates, and treatments for bipolar older adults with combined manic and depressive symptoms. Copyright © 2011 John Wiley & Sons, Ltd.

  5. Bipolar polygenic loading and bipolar spectrum features in major depressive disorder.

    PubMed

    Wiste, Anna; Robinson, Elise B; Milaneschi, Yuri; Meier, Sandra; Ripke, Stephan; Clements, Caitlin C; Fitzmaurice, Garrett M; Rietschel, Marcella; Penninx, Brenda W; Smoller, Jordan W; Perlis, Roy H

    2014-09-01

    Family and genetic studies indicate overlapping liability for major depressive disorder and bipolar disorder. The purpose of the present study was to determine whether this shared genetic liability influences clinical presentation. A polygenic risk score for bipolar disorder, derived from a large genome-wide association meta-analysis, was generated for each subject of European-American ancestry (n = 1,274) in the Sequential Treatment Alternatives to Relieve Depression study (STAR*D) outpatient major depressive disorder cohort. A hypothesis-driven approach was used to test for association between bipolar disorder risk score and features of depression associated with bipolar disorder in the literature. Follow-up analyses were performed in two additional cohorts. A generalized linear mixed model including seven features hypothesized to be associated with bipolar spectrum illness was significantly associated with bipolar polygenic risk score [F = 2.07, degrees of freedom (df) = 7, p = 0.04]. Features included early onset, suicide attempt, recurrent depression, atypical depression, subclinical mania, subclinical psychosis, and severity. Post-hoc univariate analyses demonstrated that the major contributors to this omnibus association were onset of illness at age ≤ 18 years [odds ratio (OR) = 1.2, p = 0.003], history of suicide attempt (OR = 1.21, p = 0.03), and presence of at least one manic symptom (OR = 1.16, p = 0.02). The maximal variance in these traits explained by polygenic score ranged from 0.8% to 1.1%. However, analyses in two replication cohorts testing a five-feature model did not support this association. Bipolar genetic loading appeared to be associated with bipolar-like presentation in major depressive disorder in the primary analysis. However, the results were at most inconclusive because of lack of replication. Replication efforts were challenged by different ascertainment and assessment strategies in the different cohorts. The methodological approach

  6. SHANK3 overexpression causes manic-like behaviour with unique pharmacogenetic properties.

    PubMed

    Han, Kihoon; Holder, J Lloyd; Schaaf, Christian P; Lu, Hui; Chen, Hongmei; Kang, Hyojin; Tang, Jianrong; Wu, Zhenyu; Hao, Shuang; Cheung, Sau Wai; Yu, Peng; Sun, Hao; Breman, Amy M; Patel, Ankita; Lu, Hui-Chen; Zoghbi, Huda Y

    2013-11-07

    Mutations in SHANK3 and large duplications of the region spanning SHANK3 both cause a spectrum of neuropsychiatric disorders, indicating that proper SHANK3 dosage is critical for normal brain function. However, SHANK3 overexpression per se has not been established as a cause of human disorders because 22q13 duplications involve several genes. Here we report that Shank3 transgenic mice modelling a human SHANK3 duplication exhibit manic-like behaviour and seizures consistent with synaptic excitatory/inhibitory imbalance. We also identified two patients with hyperkinetic disorders carrying the smallest SHANK3-spanning duplications reported so far. These findings indicate that SHANK3 overexpression causes a hyperkinetic neuropsychiatric disorder. To probe the mechanism underlying the phenotype, we generated a Shank3 in vivo interactome and found that Shank3 directly interacts with the Arp2/3 complex to increase F-actin levels in Shank3 transgenic mice. The mood-stabilizing drug valproate, but not lithium, rescues the manic-like behaviour of Shank3 transgenic mice raising the possibility that this hyperkinetic disorder has a unique pharmacogenetic profile.

  7. SHANK3 overexpression causes manic-like behavior with unique pharmacogenetic properties

    PubMed Central

    Han, Kihoon; Holder, J. Lloyd; Schaaf, Christian P.; Lu, Hui; Chen, Hongmei; Kang, Hyojin; Tang, Jianrong; Wu, Zhenyu; Hao, Shuang; Cheung, Sau Wai; Yu, Peng; Sun, Hao; Breman, Amy M.; Patel, Ankita; Lu, Hui-Chen; Zoghbi, Huda Y.

    2014-01-01

    Mutations in SHANK3 and large duplications of the region spanning SHANK3 both cause a spectrum of neuropsychiatric disorders, suggesting that proper SHANK3 dosage is critical for normal brain function. SHANK3 overexpression per se has not been established as a cause of human disorders, however, because 22q13 duplications involve several genes. Here we report that Shank3 transgenic mice modeling a human SHANK3 duplication exhibit manic-like behavior and seizures consistent with synaptic excitatory/inhibitory imbalance. We also identified two patients with hyperkinetic disorders carrying the smallest SHANK3-spanning duplications reported so far. These findings suggest SHANK3 overexpression causes a hyperkinetic neuropsychiatric disorder. To probe the mechanism underlying the phenotype, we generated a Shank3 in vivo interactome and found that Shank3 directly interacts with the Arp2/3 complex to increase F-actin levels in Shank3 transgenic mice. The mood-stabilizing drug valproate, but not lithium, rescues the manic-like behavior of Shank3 transgenic mice raising the possibility that this hyperkinetic disorder has a unique pharmacogenetic profile. PMID:24153177

  8. Initial and post-treatment total oxidant-antioxidant status and oxidative stress index in male patients with manic episode.

    PubMed

    Kalelioglu, Tevfik; Genc, Abdullah; Karamustafalioglu, Nesrin; Tasdemir, Akif; Can Gungor, Ferda; Cansiz, Alparslan; Incir, Said; Cem Ilnem, M; Emul, Murat

    2014-08-15

    We investigated serum total oxidative and anti-oxidative status in manic patients. Group1 was formed as ECT+antipsychotic, group2 was antipsychotic and healthy volunteers as group3. The anti-oxidative status was significantly lower in group1 than group3. No significant change was found between pre and post-treatment oxidative and anti-oxidative status, whereas significantly increased oxidative stress index has been found in group2. Total anti-oxidative status in manic states seems to be inadequate which remains to be maintained after the treatment. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  9. Precursor manic behavior in the assessment and treatment of episodic problem behavior for a woman with a dual diagnosis.

    PubMed

    Allen, Marissa B; Baker, Jonathan C; Nuernberger, Jodi E; Vargo, Kristina K

    2013-01-01

    A functional analysis examined the relation between consequences that maintained episodic problem behavior (aggression, property destruction, and elopement) in the presence and absence of manic behaviors (MB). Results suggested that the presence of MB was correlated with the sensitivity of problem behavior to attention as a reinforcer during a functional analysis and that problem behaviors were maintained by attention. Noncontingent reinforcement was subsequently implemented and demonstrated to be effective in reducing problem behavior during the presence of manic behaviors. © Society for the Experimental Analysis of Behavior.

  10. Depression in geriatric patients.

    PubMed

    Abbas Asghar-Ali, A; Braun, U K

    2009-02-01

    While the most serious of depressive illnesses in the elderly is major depressive disorder, patients' quality of life can be significantly impacted by dysthmic disorder, sub-threshold depression (minor depression), or a depressive disorder due to a general medical condition, all of which have been shown to be more prevalent than major depression in the community dwelling population of older adults. Older adults are also more likely to develop grief reaction and frequently deal with issues of bereavement. This review will discuss the diagnoses of all relevant depressive diagnoses that primary care physicians are likely to encounter. Among the many different assessment tools that screen for depression the briefest instruments are a two-question screening tool recommended by the U.S. Preventive Services Task Force and, specifically developed for older adults, the Geriatric Depression Scale (GDS) that is available in a short 15- Yes/No-question version. Many medical illnesses are associated with depressive symptoms. The focus in this review is on dementing illnesses/cerebrovascular disease, dementia of the Alzheimer's type, and Parkinson disease. First-line pharmacological therapy of depression includes selective serotonin inhibitors (SSRIs), and serotonin-norepinephrine reuptake inhibitors (SNRIs). Side effects of particular drugs can often be geared towards achieving additional benefits, e.g. weight gain associated with the use of some SSRISs may be helpful for patients with dementia.

  11. Fear of dying in panic attacks predicts suicide attempt in comorbid depressive illness: prospective evidence from the National Epidemiological Survey on Alcohol and Related Conditions.

    PubMed

    Yaseen, Zimri S; Chartrand, Hayley; Mojtabai, Ramin; Bolton, James; Galynker, Igor I

    2013-10-01

    As a group, comorbid anxiety disorders among depressed persons have consistently been found to increase risk of suicide attempt (SA). Growing evidence supports the link between panic attacks (PAs) and suicidality, but prospective evidence is limited and the nature of the linkage remains unclear. The positive-feedback model of suicide suggests that PAs eliciting catastrophic cognitions may drive SA. To prospectively examine the relationship between PAs, panic symptoms and suicidality in individuals meeting DSM-IV criteria for past-year major depressive episodes in a large epidemiological study. In data on 2,864 participants of the National Epidemiological Survey on Alcohol and Related Conditions (NESARC) wave 1 and 2 surveys with depressive disorders, the associations of PAs and panic symptoms with subsequent suicidal ideation (SI) and SAs were assessed using logistic regression. Past-year PAs in wave 1 significantly increased odds for subsequent SI and attempt in the 3-year follow-up interval; however, in multivariate analyses, PAs were not a significant predictor, but PAs featuring fear of dying were. Further, among subjects with PAs, fear of dying during a PA increased the odds of subsequent SA sevenfold, even after controlling for comorbid disorders, demographic factors, and other PA symptoms. PAs characterized by prominent morbid catastrophic cognitions may mediate the transition to SIs and SAs in subjects with depressive episodes. Presence of these symptoms in clinical settings may serve as a warning sign for future suicidality. © 2012 Wiley Periodicals, Inc.

  12. The effectiveness of non-pharmacological interventions in older adults with depressive disorders: A systematic review.

    PubMed

    Apóstolo, João; Bobrowicz-Campos, Elzbieta; Rodrigues, Manuel; Castro, Inês; Cardoso, Daniela

    2016-06-01

    It is widely acknowledged that mental health disorders are common in older adults and that depression is one of the most serious threats to the mental health of older adults. Although best practice guidelines point out that moderate to severe depression should be approached with pharmacotherapy together with complementary therapies, the use of antidepressant drugs in older adults has various disadvantages, such as long response time, side effects, potential risk of dependency and tolerance, poor compliance rates and high probability of drug interactions. In addition, qualitative studies of depressed people with a chronic illness have indicated that both patients and healthcare professionals prefer a psychosocial treatment for depression over a pharmacological one. This review aimed to identify and synthesize the best available evidence related to the effectiveness of non-pharmacological interventions for older adults with depressive disorders. Systematic review of studies with any experimental design considering non-pharmacological interventions for older adults with depressive disorders. An initial search of MEDLINE and CINAHL was undertaken, followed by a second search for published and unpublished studies, from January 2000 to March 2012, of major healthcare-related electronic databases. Studies in English, Spanish and Portuguese were included in the review. This review considered studies that included adult patients, aged over 65 years with any type of depressive disorder, regardless of comorbidities and any previous treatments, but excluded those with manic or psychotic episodes/symptoms. All studies that met the inclusion criteria were assessed for methodological quality by two independent reviewers using a standardized critical appraisal checklist for randomized and quasi-randomized controlled studies from the Joanna Briggs Institute. Data extraction was also conducted by two independent reviewers based on the Joanna Briggs Institute data extraction form for

  13. Disturbances in Hypothalamic-Pituitary-Adrenal Axis and Immunological Activity Differentiating between Unipolar and Bipolar Depressive Episodes

    PubMed Central

    Hoencamp, Erik; Penninx, Brenda W. J. H.

    2015-01-01

    Introduction Differentiating bipolar depression (BD) from unipolar depression (UD) is difficult in clinical practice and, consequently, accurate recognition of BD can take as long as nine years. Research has therefore focused on the discriminatory capacities of biomarkers, such as markers of the hypothalamic-pituitary-adrenal (HPA) axis or immunological activity. However, no previous study included assessments of both systems, which is problematic as they may influence each other. Therefore, this study aimed to explore whether cortisol indicators and inflammatory markers were a) independently associated with and/or b) showed effect modification in relation to a lifetime (hypo)manic episode in a large sample of depressed patients. Methods Data were derived from the Netherlands Study of Depression and Anxiety and comprised 764 patients with a DSM-IV depressive disorder at baseline, of which 124 (16.2%) had a lifetime (hypo)manic episode at the 2-year assessment, or a more recent episode at the 4-year or 6-year assessment. Baseline cortisol awakening response, evening cortisol and diurnal cortisol slope were considered as cortisol indicators, while baseline C-reactive Protein (CRP), Interleukin-6 (IL-6), and Tumor Necrosis Factor Alpha (TNF-α) were included as inflammatory markers. Results In depressed men and women, none of the cortisol indicators and inflammatory markers were (independently) associated with a (hypo)manic episode. However, effect modification was found of diurnal cortisol slope and CRP in relation to a (hypo)manic episode. Further analyses showed that depressed men with high levels of diurnal cortisol slope and CRP had an increased odds (OR=10.99, p=.001) of having a (hypo)manic episode. No significant differences were found in women. Conclusion Our findings suggest that the combination of high diurnal cortisol slope and high CRP may differentiate between UD and BD. This stresses the importance of considering HPA-axis and immunological activity

  14. Voodoo illness.

    PubMed

    Campinha-Bacote, J

    1992-01-01

    Healthcare providers must familiarize themselves with specific culture-bound syndromes and their manifestations in order to provide quality care to culturally diverse clients seeking healthcare services. Voodoo illness is one of several culture-bound syndromes that nurses need to be familiar with, for an inability to understand voodoo illness may result in the client's death (voodoo death).

  15. Freud, his illness, and ourselves.

    PubMed

    Haynal, André

    2008-06-01

    The history of Freud's illness shows that he tried to avoid confrontation with it, and to treat it as unimportant. In his personal letters, the ill body remains outside-as another person, "Konrad," not he himself-and it is not taken into account. Particularly in Freud's correspondence with Ferenczi, we realize to what extent certain phenomena, especially depressive ones, he considered somatic, with a tendency to dismiss them, and this despite important occasional insights, such as about the role played by hate in psychosomatic illnesses. In the post-Freudian development, these topics have been more and more integrated in the dialogue, in the discourse between the analyst and the analysand.

  16. On the downplay of suffering in Nordenfelt's theory of illness.

    PubMed

    Hofmann, Bjørn

    2013-12-01

    In his influential theory of health Nordenfelt bases the concepts of health and illness on the notions of ability and disability. A premise for this is that ability and disability provide a more promising, adequate, and useful basis than well-being and suffering. Nordenfelt uses coma and manic episodes as paradigm cases to show that this is so. Do these paradigm cases (and thus the premise) hold? What consequences does it have for the theory of health and illness if it they do not? These are the key questions in this article, which first presents the relationship between pain and disability in Nordenfelt's theory and the paradigm cases he uses to argue for the primacy of disability over pain. Then, Nordenfelt's concepts of illness are outlined, highlighting its presumptions and arguments. The main point is that if you do not have an action-theoretical perspective, it is not obvious that disability is the core concept for illness. The compelling effect of the paradigm cases presupposes that you see ability as the primary issue. To those who do not share this presumption, people in coma may not be ill. There are alternative well founded arguments for the primacy of first person experiences for the concept of illness. Hence, we need better arguments for the primacy of disability over first person experiences in illness, or first-person experience should be more primarily included in the concept of illness.

  17. Manic Symptoms Due to Methylphenidate Use in an Adolescent with Traumatic Brain Injury

    PubMed Central

    Ekinci, Ozalp; Direk, Meltem Çobanoğullari; Ekinci, Nuran; Okuyaz, Cetin

    2016-01-01

    Almost one-fifth of children who sustain a traumatic brain injury (TBI) are under the risk of attention problems after injury. The efficacy and tolerability of methylphenidate (MPH) in children with a history of TBI have not been completely identified. In this case report, MPH-induced manic symptoms in an adolescent with TBI will be summarized. A male patient aged 17 years was admitted with the complaints of attention difficulties on schoolwork and forgetfullness which became evident after TBI. Long-acting MPH was administered with the dose of 18 mg/day for attention problems. After one week, patient presented with the complaints of talking to himself, delusional thoughts, irritability and sleeplessness. This case highlights the fact that therapeutic dose of MPH may cause mania-like symptoms in children with TBI. Close monitarization and slow dose titration are crucial when considering MPH in children with TBI. PMID:27489389

  18. Treatment of manic episodes: zuclopenthixol and clonazepam versus lithium and clonazepam.

    PubMed

    Gouliaev, G; Licht, R W; Vestergaard, P; Merinder, L; Lund, H; Bjerre, L

    1996-02-01

    For the treatment of acute mania, no single drug is sufficiently effective in daily clinical routine for all patients. Drug combinations are often prescribed but poorly investigated. The present study examined whether a treatment with a neuroleptic drug (zuclopenthixol) combined with a benzodiazepine (clonazepam) was superior to a treatment with lithium and the same benzodiazepine (lithium citrate and clonazepam). Twenty-eight hospitalized patients with a DSM-III-R manic episode were included, randomized to fixed drug doses and observed up to 28 days. Degree of mania, side effects and patients satisfaction with the treatment were registered. Approximately two thirds of the patients improved fully or partially on both drug combinations. Furthermore no statistically significant differences were found regarding acceptance and tolerance of the two drug combinations. The present drug combination are only two among several which deserve a thorough examination in order to prevent a random polypharmacy for treatment of mania.

  19. Number of manic episodes is associated with elevated DNA oxidation in bipolar I disorder.

    PubMed

    Soeiro-de-Souza, Márcio Gerhardt; Andreazza, Ana C; Carvalho, Andre F; Machado-Vieira, Rodrigo; Young, L Trevor; Moreno, Ricardo Alberto

    2013-08-01

    Bipolar disorder (BD) is a major public health problem characterized by progressive functional impairment. A number of clinical variables have been associated with progression of the disease, most notably number of affective episodes and presence of psychotic symptoms, both of which correlate with greater cognitive impairment, lower response rates for lithium, and possibly lower levels of neurotrophic factors. Oxidative damage to cytosine and guanosine (8-OHdG) has been described as a modulator of DNA methylation, but the extent of DNA oxidative damage involvement in BD remains unclear. The aim of this study was to evaluate the extent of DNA oxidative damage to 8-OHdG and 5-methylcytosine (5-HMec), as well as global methylation (5-Mec), in BD patients and healthy controls. Potential association with clinical variables was also investigated. DNA levels of 8-OHdG, 5-HMec and 5-Mec were measured in 50 BD type I patients and 50 healthy controls. DNA 8-OHdG levels were higher in BD patients compared to healthy controls and found to be positively influenced by number of previous manic episodes. BD subjects had lower levels of 5-HMec compared to controls, whereas this measure was not influenced by the clinical features of BD. Number of manic episodes was correlated with higher levels of 8-OHdG, but not of 5-Mec or 5-HMec. Lower demethylation activity (5-HMec) but no difference in global 5-Mec levels was observed in BD. This finding suggests that oxidative damage to 8-OHdG might be a potential marker of disease progression, although further prospective cross-sectional studies to confirm neuroprogression in BD are warranted.

  20. Serum S100B in manic bipolar disorder patients: Systematic review and meta-analysis.

    PubMed

    da Rosa, Maria Inês; Simon, Carla; Grande, Antonio Jose; Barichello, Tatiana; Oses, Jean Pierre; Quevedo, João

    2016-12-01

    Bipolar disorder (BD) is a neuropsychiatric disorder characterized by recurrent episodes of mania/hypomania, affecting more than 1% of the world population. S100B is a calcium-binding protein, mostly produced and secreted by astrocytes in the CNS that participate in several cellular responses. Previous studies have shown that patients with bipolar disorder had higher peripheral S100B levels than healthy individuals, suggesting a potential role for S100B BD. In this study, a systematic and quantitative meta-analysis of studies S100B serum was performed according to the guidelines PRISMA-statement to confirm the increase of serum S100B in patients with manic bipolar disorder. We included in the meta-analysis two studies that reported the mean and standard deviation of serum S100B 52 patients manic BP and 52 control studies. Our results showed higher levels of S100B peripheral TB patients compared with healthy controls. In this meta-analysis, we found evidence that serum S100B are increased in patients with bipolar disorder. In conclusion, several studies have observed morphological abnormalities in the brains of bipolar disorder patients, changes in the peripheral S100B levels in mood disorders were described, and this protein could be a putative marker for damage to the brain. Thus, in this meta-analysis we have found evidence, based on two studies of 52 patients and 52 healthy controls, that the serum concentrations of S100B are increased in bipolar disorder patients. Copyright © 2016 Elsevier B.V. All rights reserved.

  1. Aquatic blues: modeling depression and antidepressant action in zebrafish.

    PubMed

    Nguyen, Michael; Stewart, Adam Michael; Kalueff, Allan V

    2014-12-03

    Depression is a serious psychiatric condition affecting millions of patients worldwide. Unipolar depression is characterized by low mood, anhedonia, social withdrawal and other severely debilitating psychiatric symptoms. Bipolar disorder manifests in alternating depressed mood and 'hyperactive' manic/hypomanic states. Animal experimental models are an invaluable tool for research into the pathogenesis of bipolar/unipolar depression, and for the development of potential treatments. Due to their high throughput value, genetic tractability, low cost and quick reproductive cycle, zebrafish (Danio rerio) have emerged as a promising new model species for studying brain disorders. Here, we discuss the developing utility of zebrafish for studying depression disorders, and outline future areas of research in this field. We argue that zebrafish represent a useful model organism for studying depression and its behavioral, genetic and physiological mechanisms, as well as for anti-depressant drug discovery.

  2. A Ten-Year Look Back at the Association between the Global War on Terrorism (GWOT) and Costly Mental Health Conditions

    DTIC Science & Technology

    2012-12-01

    occupational dysfunction. Significant mood disorder, such as depression or manic symptoms, general medical conditions or substance abuse that might lead to...rate is considered low compared to other mental illness , such as depression and borderline personality disorder (Mueser et al., 1998). Resnick...TREATMENT Bipolar disorder, otherwise known as manic - depressive disorder, is characterized by dramatic mood swings. Bipolar disorder can be mainly

  3. Transient Manic-like Episode Following Bilateral Deep Brain Stimulation of the Nucleus Accumbens and the Internal Capsule in a Patient With Tourette Syndrome.

    PubMed

    Kuhn, Jens; Lenartz, Doris; Huff, Wolfgang; Mai, Jürgen K; Koulousakis, Athanasios; Maarouf, Mohammad; Lee, Sun Hee; Klosterkoetter, Joachim; Sturm, Volker

    2008-04-01

    Objective.  Deep brain stimulation (DBS) increasingly attracts attention as a potential treatment of mental disorders. Beside depression and obsessive-compulsive disorders, DBS has already been shown to be beneficial for Tourette syndrome (TS). Clinical Presentation/Method.  The authors report on the outcome of a patient with treatment-resistant TS who underwent bilateral DBS of the nucleus accumbens and the internal capsule. Results.  Within the 10-month follow-up, a substantial reduction of tics has been observed. Yet, as a side-effect of DBS, the patient developed a transient manic-like episode when primarily stimulated by the most proximally contact in the internal capsule. Conclusions.  This case supports the hypothesis that DBS of the nucleus accumbens and the internal capsule represents an effective therapeutic alternative for otherwise treatment-resistant TS. Yet, future controlled studies are needed to determine optimal stimulation parameters and to reduce negative side-effects such as transient hypomanic episodes. © 2008 International Neuromodulation Society.

  4. Foodborne illness.

    PubMed

    Pigott, David C

    2008-05-01

    While few patients with foodborne illness present with life-threatening symptoms, there are a number of foodborne infectious diseases and toxins that the emergency physician or other health care provider must consider in the evaluation of these patients. Given the frequency of international travel, as well as the risk associated with recurrent outbreaks of foodborne illness from commercial food sources, it is important to recognize various syndromes of foodborne illness, including those which may require specific evaluation and management strategies. This article reviews a number of the most common causes of foodborne illness, as well as several less common pathogens with the potential for causing significant morbidity and mortality if not promptly identified and treated.

  5. Heat Illness

    MedlinePlus

    ... humidity, sweating just isn't enough. Your body temperature can rise to dangerous levels and you can ... Heatstroke - a life-threatening illness in which body temperature may rise above 106° F in minutes; symptoms ...

  6. Foodborne Illness

    MedlinePlus

    ... get sick from contaminated food. Common culprits include bacteria, parasites and viruses. Symptoms range from mild to ... cramps Nausea and vomiting Diarrhea Fever Dehydration Harmful bacteria are the most common cause of foodborne illness. ...

  7. Foodborne Illnesses

    MedlinePlus

    ... Some parasites and chemicals also cause foodborne illnesses. Bacteria Bacteria are tiny organisms that can cause infections of the GI tract. Not all bacteria are harmful to humans. Some harmful bacteria may ...

  8. Depression and HIV disease.

    PubMed

    Valente, Sharon M

    2003-01-01

    Depressive disorders are common among 20% to 32% of people with HIV disease but are frequently unrecognized. Major depression is a recurring and disabling illness that typically responds to medications, cognitive psychotherapy, education, and social support. A large percentage of the emotional distress and major depression associated with HIV disease results from immunosuppression, treatment, and neuropsychiatric aspects of the disease. People with a history of intravenous drug use also have increased rates of depressive disorders. Untreated depression along with other comorbid conditions may increase costly clinic visits, hospitalizations, substance abuse, and risky behaviors and may reduce adherence to treatment and quality of life. HIV clinicians need not have psychiatric expertise to play a major role in depression. Screening tools improve case finding and encourage early treatment. Effective treatments can reduce major depression in 80% to 90% of patients. Clinicians who mistake depressive signs and symptoms for those of HIV disease make a common error that increases morbidity and mortality.

  9. Clinical Significance of Treatment Effects with Aripiprazole versus Placebo in a Study of Manic or Mixed Episodes Associated with Pediatric Bipolar I Disorder

    PubMed Central

    Zhao, Joan; Mankoski, Raymond; Forbes, Robert A.; Marcus, Ronald M.; Carson, William; McQuade, Robert; Findling, Robert L.

    2013-01-01

    Abstract Objective Published studies in adult and pediatric bipolar disorder have used different definitions of treatment response. This analysis aimed to compare different definitions of response in a large sample of children and adolescents. Methods Anexploratory analysis of a 4-week, multicenter, placebo-controlled study assessed patients (n=296; ages, 10–17 years) with an acute manic/mixed episode associated with bipolar I disorder who were randomized to aripiprazole (10 or 30 mg/day) or placebo. The primary efficacy endpoint was mean change from baseline to week 4 in Young Mania Rating Scale (YMRS) total score. Additional assessments included: Clinical Global Impressions–Bipolar Disorder (CGI-BP) Overall and Mania scales, Child Global Assessment Scale (CGAS), and parent and subject General Behavior Inventory. Response was compared across seven operational definitions. Cohen's κ and Spearman's correlation tested relationships between various response definitions or changes in outcome measures and clinically meaningful improvement (defined as a CGI-BP Overall Improvement score of 1 or 2). Results Response rates varied depending upon the operational definition, but were highest for 95% reliable change (statistical method used to determine individual change from previous assessment) and ≥33% reduction in YMRS total score. Response rate definitions with the highest validity in terms of predicting clinically meaningful improvement were: ≥50% reduction on YMRS (κ=0.64), a composite definition of response (YMRS <12.5, Children's Depression Rating Scale-Revised (CDRS-R) ≤40, and CGAS ≥51; κ=0.59), and 95% reliable change on the CGAS or 33% reduction on YMRS (κ=0.56). Parent ratings of symptoms were generally better at detecting symptom improvement than were subject ratings (κ=∼0.4–0.5 vs. ∼0.2 when compared with CGI-BP Overall Improvement score). Conclusions Clinically meaningful definitions of response in acute treatment of a manic

  10. Inter-episode affective intensity and instability: predictors of depression and functional impairment in bipolar disorder.

    PubMed

    Gershon, Anda; Eidelman, Polina

    2015-03-01

    Dysregulated affect is a hallmark feature of acute episodes of bipolar disorder (BD) and persists during inter-episode periods. Its contribution to course of illness is not yet known. The present report examines the prospective influence of inter-episode affect dysregulation on symptoms and functional impairment in BD. Twenty-seven participants diagnosed with inter-episode bipolar I disorder completed daily measures of negative and positive affect for 49 days (±8 days) while they remained inter-episode. One month following this daily assessment period, symptom severity interviews and a measure of functional impairment were administered by telephone. More intense negative affect and positive affect during the inter-episode period were associated with higher depressive, but not manic, symptoms at the one-month follow-up assessment. More intense and unstable negative affect, and more unstable positive affect, during the inter-episode period were associated with greater impairment in home and work functioning at the follow-up assessment. All associations remained significant after controlling for concurrent symptom levels. The findings need to be confirmed in larger samples with longer follow-up periods. A more comprehensive assessment of functional impairment is also warranted. The findings suggest that a persistent affective dysregulation between episodes of BD may be an important predictor of depression and functional impairment. Monitoring daily affect during inter-episode periods could allow for a more timely application of interventions that aim to prevent or reduce depressive symptoms and improve functioning for individuals with BD. Copyright © 2014 Elsevier Ltd. All rights reserved.

  11. Illness perception in Polish patients with chronic diseases: Psychometric properties of the Brief Illness Perception Questionnaire.

    PubMed

    Nowicka-Sauer, Katarzyna; Banaszkiewicz, Dorota; Staśkiewicz, Izabela; Kopczyński, Piotr; Hajduk, Adam; Czuszyńska, Zenobia; Ejdys, Mariola; Szostakiewicz, Małgorzata; Sablińska, Agnieszka; Kałużna, Anna; Tomaszewska, Magda; Siebert, Janusz

    2016-08-01

    The study evaluates the psychometric properties of a Polish translation of the Brief Illness Perception Questionnaire. A total of 276 patients with chronic conditions (58.7% women) completed the Brief Illness Perception Questionnaire and the Hospital Anxiety and Depression Scale. The internal consistency of the Polish Brief Illness Perception Questionnaire measured with Cronbach's alpha was satisfactory (α = 0.74). Structural validity was demonstrated by significant inter-correlations between the Brief Illness Perception Questionnaire components. Discriminant validity was supported by the fact that the Brief Illness Perception Questionnaire enables patients with various conditions to be differentiated. Significant correlations were found between Brief Illness Perception Questionnaire and depression and anxiety levels. The Polish Brief Illness Perception Questionnaire thus evaluated is a reliable and valid tool. © The Author(s) 2015.

  12. Adult Neurogenesis and Mental Illness

    PubMed Central

    Schoenfeld, Timothy J; Cameron, Heather A

    2015-01-01

    Several lines of evidence suggest that adult neurogenesis, the production of new neurons in adulthood, may play a role in psychiatric disorders, including depression, anxiety, and schizophrenia. Medications and other treatments for mental disorders often promote the proliferation of new neurons; the time course for maturation and integration of new neurons in circuitry parallels the delayed efficacy of psychiatric therapies; adverse and beneficial experiences similarly affect development of mental illness and neurogenesis; and ablation of new neurons in adulthood alters the behavioral impact of drugs in animal models. At present, the links between adult neurogenesis and depression seem stronger than those suggesting a relationship between new neurons and anxiety or schizophrenia. Yet, even in the case of depression there is currently no direct evidence for a causative role. This article reviews the data relating adult neurogenesis to mental illness and discusses where research needs to head in the future. PMID:25178407

  13. Lupus and Depression: Know the Signs and How to Get Help

    MedlinePlus

    ... on Twitter Facebook Pinterest Email Print Lupus and depression: Know the signs and how to get help ... treatable illness called clinical depression. Symptoms of clinical depression People are considered clinically depressed when they have ...

  14. Feeling and Time: The Phenomenology of Mood Disorders, Depressive Realism, and Existential Psychotherapy

    PubMed Central

    Ghaemi, S. Nassir

    2007-01-01

    Phenomenological research suggests that pure manic and depressive states are less common than mixtures of the two and that the two poles of mood are characterized by opposite ways of experiencing time. In mania, the subjective experience of time is sped up and in depression it is slowed down, perhaps reflecting differences in circadian pathophysiology. The two classic mood states are also quite different in their effect on subjective awareness: manic patients lack insight into their excitation, while depressed patients are quite insightful into their unhappiness. Consequently, insight plays a major role in overdiagnosis of unipolar depression and misdiagnosis of bipolar disorder. The phenomenology of depression also is relevant to types of psychotherapies used to treat it. The depressive realism (DR) model, in contrast to the cognitive distortion model, appears to better apply to many persons with mild to moderate depressive syndromes. I suggest that existential psychotherapy is the necessary corollary of the DR model in those cases. Further, some depressive morbidities may in fact prove, after phenomenological study, to involve other mental states instead of depression. The chronic subsyndromal depression that is often the long-term consequence of treated bipolar disorder may in fact represent existential despair, rather than depression proper, again suggesting intervention with existential psychotherapeutic methods. PMID:17122410

  15. [Depression, tobacco dependence and nicotine].

    PubMed

    Fakhfakh, R; Lagrue, G

    2002-01-01

    The purpose of the study was to illustrate, through an observation, the association between depression and smoking dependence, as well as the considered anti-depressive properties of nicotine. Fageström Test for Nicotine Dependence was confirmed by the urinary cotinine dosage, and the expired Carbon Monoxide assessed the nicotine dependence. The anxio-depressive co-morbidity was determined through the cross-examination associated to the HAD test (Hospital Anxiety Depression Scale); then, in case of anomaly, by the depression inventory of Beck (13 items) and the structured interview: the Mini International Neuro Psychiatric Interview (MINI). Our patient, born in 1938, with the personal history of manic-depressive psychosis and alcoholic dependence severed in 1987, came to consult in 1995, af