PO-68 | Bipolar disorder spectrum and psychopathology in cluster headache compared to migraine: a cross-sectional study in a hospital headache clinic

Background: The impact of the comorbidity between Obsessive-Compulsive Disorder (OCD) and Bipolar Disorder Spectrum (BDS) remains to be clarified. The objective of this study was to examine the lifetime prevalence of OCD, the strength of the association of OCD with comorbid BDS and the role of comorbidity of OCD with BDS in the impairment of health-related quality of life (HRQoL) in an Italian community survey.Methods: The study is a community survey. The sample (N = 2,267; women: 55.3%) was randomly selected after stratification by sex and four age groups from the municipal records of the adult population of one urban, one suburban, and at least one rural area in six Italian regions. Physicians using a semi-structured interview (Advanced Tools and Neuropsychiatric Assessment Schedule, ANTAS-SCID) made Diagnostic and Statistical Manual of Mental Disorders – 4th revision (DSM-IV) diagnoses of OCD, Major Depressive Disorder (MDD) and Bipolar Disorder (BD). HR-QoL was measured by the Health Survey Short Form (SF-12). Lifetime Hypomania and subthreshold hypomania were screened by the Mood Disorder Questionnaire (MDQ). BDS was defined as the sum of people shown to be positive for hypomania by the MDQ—with or without a mood disorder diagnosis—plus people with a BD-DSMIV diagnosis even if negative for hypomania at the MDQ.Results: Overall, 44 subjects were diagnosed with OCD, 6 with MDD and 1 with BD. The lifetime prevalence of OCD was 1.8% in men (n = 18) and 2.0% in women (n = 26). MDD with lifetime subthreshold hypomania (i.e., people screened positive at the MDQ, even without diagnosed mania or hypomania at the interview) was associated with OCD (OR = 18.15, CI 95% 2.45–103.67); MDD without subthreshold hypomania (and screened negative at the MDQ) was not (OR = 2.33, CI 95% 0.69–7.01). People with BDS were strongly associated with OCD (OR = 10.5, CI 95% 4.90–12.16,). People with OCD and BDS showed significantly poorer HR-QoL than people with OCD without BDS (F = 9.492; P < 0.003).Discussion: The study found a strong association between BDS and OCD. BDS comorbid with OCD was associated with more severe impairment of HR-QoL than OCD without comorbid BDS. Identification of symptoms of hypomania, including subthreshold symptoms, may therefore be important in people with OCD as they might predict a course with poorer HR-QoL.

Factors influencing excessive daytime sleepiness in obstructive sleep apnea: A retrospective cohort analysis integrating psychological assessment with polysomnography.

Performance of the Mood Disorder Questionnaire (MDQ) according to bipolar subtype and symptom severity

BackgroundThe bipolar disorder spectrum describes a continuum of symptoms comprising a complex range of bipolar subtypes which includes from purely depressive to purely manic symptoms. Modern psychiatric classifications have categorized this spectrum as mood disorders, often leading clinicians to perceive depressive and manic symptoms as residing at opposite ends of the spectrum. Some researchers believe that rather than mood changes, changes in energy and motor activity are the vital symptoms in mania and depression. This multi-dimensionality and heterogeneity within the bipolar disorder spectrum pose significant challenges for understanding its illness course and making clinical decisions. Efforts to address this problem by finding an appropriate models and seeking promising prognostic factors such as symptoms profiles, biomarkers, and epidemiological information have ended in limited success. Given the intricate interplay between these symptoms, elucidating the antecedent factors and illness course variables for bipolar spectrum disorders becomes essential, as their associations are not always straightforward.Aims & ObjectivesIn this study, we aimed to investigate factors associating with subsequent mood symptoms using data collected upon admission among patients with bipolar spectrum disorders including major depressive disorder, persistent depressive disorder, bipolar II disorder and bipolar I disorder. We hypothesized that baseline symptom profiles and demographic data may associate with the future course of manic/depressive symptoms respectively.MethodsData were collected from patients who were admitted to the psychiatry ward of Hokkaido University Hospital from 2010 to 2022 and were diagnosed with major depressive disorder, persistent depressive disorder, bipolar II disorder, bipolar I disorder, and organic mood disorders excluding any type of dementia (n=259). All the patients were evaluated by Young Mania Rating Scale (YMRS) and Hamilton Depression Rating Scale (HAM-D) at admission and 4 weeks after admission. Other psychometric scales such as Mood Disorder Questionnaire (MDQ), diagnostic criteria for bipolar spectrum disorder proposed by Ghaemi et al., and Patient Health Questionnaire-9 (PHQ-9) were also surveyed on admission. Several linear regression models were applied to the baseline data to predict the score change. This study protocol was approved by the Hokkaido University Institutional Review Board.ResultsLinear regression models revealed that subsequent HAM-D total score was associated with baseline demographic data and some of the core item of HAM-D. We found similar result with the association between baseline of each YMRS items and YMRS total score 4 weeks after. The models for YMRS and HAM-D had scarcely shared common risk variables for emotional dysregulation. We consequently analyzed association between each YMRS items and HAM-D items by using dimensionality reduction approach, which demonstrated significant correlations between these psychometric items. In addition, these associations may be well influenced by the sex differences.Discussion & ConclusionFrom the analysis, subsequent manic symptoms using YMRS may be well described by the baseline variables related with mania. On the other hand, deducting the factors associated with subsequent depressive symptoms using HAM-D was relatively challenging, suggesting that depressive and manic symptoms could not be opposite poles.

Pulse steroid therapy in multiple sclerosis and mood changes: An exploratory prospective study

A System-Based Approach to Depression Management in Primary Care Using the Patient Health Questionnaire-9

Introduction: Cluster headache is rare in children and only a few clinical studies have systematically evaluated cluster headache in children. Methods: This study was conducted between August 2019 and December 2021 with the primary aim to evaluate the feasibility and utility of the Cluster Headache Severity Scale in determining the severity of cluster headache in patients aged less than 18 years and monitoring response to prescribed treatment. Secondary objectives were to evaluate the feasibility and utility of Cluster Headache Quality of Life, Cluster Headache Index, and 6-item Headache Impact Test in pediatric cluster headache patients to assess the quality of life, severity, and impact of cluster headache. Results: A total of 32 children (age of onset 11.9 ± 2.3 years, age of diagnosis 13.7 ± 2.4 years, 68% boys) were enrolled. Although 30 cases had their headache episodes occurring during nighttime, only 16 children had a Children's Sleep Habits Questionnaire (CSHQ) score >41 at baseline. All children responded to prednisolone as bridging therapy and 23 of 32 showed adequate pain relief after sumatriptan nasal spray for an acute attack. The average time taken for completion of Cluster Headache Index, Cluster Headache Severity Scale, Cluster Headache Quality of Life, and Headache Impact Test-6 scores were 5.2 ± 0.7, 5.1 ± 0.8, 27.4 ± 3.5, and 6.2 ± 0.8 minutes, respectively. The interrater reliability was good for Cluster Headache Severity Scale, Cluster Headache Quality of Life, and Headache Impact Test-6 (Cronbach α 0.93, 0.81, and 0.89, respectively). There was a strong positive correlation between the Cluster Headache Severity Scale score with Headache Impact Test-6 score and Cluster Headache Quality of Life score (correlation coefficient r = 0.90 and 0.98). Conclusion: Majority of pediatric cluster headache patients are likely to respond to prednisolone and sumatriptan. Cluster Headache Severity Scale, Cluster Headache Quality of Life, and Headache Impact Test-6 can be used for pediatric cluster headache patients for treatment monitoring.

Background: Bipolar spectrum disorder (BSD) has been shown to be difficult to assess in general and is further complicated by the presence of substance use disorder (SUD). Objective: To review the specificity of the Mood Disorder Questionnaire (MDQ) in detecting BSD among substance abusers. Method: A retrospective chart review was conducted using 183 SUD patients who were screened using the MDQ and later assessed by a psychiatrist specializing in BSD. Results: Among SUD patients scoring positive results on the MDQ for the presence of BSD, the BSD diagnosis could only be confirmed in 23% of the sample by an expert psychiatrist. Conclusions: The MDQ reports low specificity in detecting BSD among SUD populations. Scientific Significance: Physicians should question individuals on substance use behaviors if BSD is suspected due to high rates of comorbidity and diagnostic challenges.

Borderline personality disorder and its association with bipolar spectrum and binge eating disorder in college students from South India

Most of the clinical characteristics of cluster headache (CH) have been established through the observation of men with CH. Epidemiological data of CH in women are scarce especially in the Asian population. Here, we sought to assess the prevalence and clinical characteristics of women with CH in comparison to men in a prospective CH registry. Data used in this study were obtained from the Korean Cluster Headache Registry, a prospective, cross-sectional, multicenter headache registry that collected data from consecutive patients diagnosed with CH. Demographics and clinical characteristics were compared between the sexes. In total, 250 patients were enrolled in this study; 41 (16.4%) were women (male to female ratio 5.1:1). Mean age of onset did not differ between women and men (30.7±15.5 vs 29.0±11.1years). The clinical features of CH in women and men were similar, with no differences in pain severity, duration, and attack frequency. Among autonomic features, facial and forehead sweating was significantly rare in women (4.9%) compared to men with CH (33.0%). Headache-related disability assessed by Headache Impact Test-6 did not differ between the sexes; however, depression scale assessed by Patients Health Questionnaire-9 (11.0±8.5 vs 7.0±5.8, P=.009) and stress (Perceived Stress Scale 4, 7.5±3.4 vs 6.4±3.0, P=.045) were significantly higher in women with CH. Although decreasing male preponderance was suggested in recent Western CH studies, CH in women is still far less prevalent than in men in the Korean population. Clinical and demographic characteristics were similar between the sexes. However, psychiatric comorbidities might be highly associated in women with CH.

To assess the risk of depression in patients with chronic rhinosinusitis (CRS) in a tertiary care center and the effect of treatment on depression scores. This prospective cohort study was conducted at King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia, between November 2021 and June 2022 and included adult patients (≥14 years) with CRS. The validated Arabic or English Sinonasal Outcome Test (SNOT-22) and Patient Health Questionnaire-9 (PHQ-9) were used before treatment and 3 to 6 months after surgery and maximal medical treatment. PHQ-9 scores were compared at baseline and follow-up visits. The relationship between changes in SNOT-22 and PHQ-9 scores were assessed using Spearman's correlation and simple linear regression. Overall, 38 participants with a mean ± SD age of 32.7 ± 12 years were enrolled. CRS with nasal polyps (55.26%) was the most frequently seen condition, followed by allergic fungal CRS (31.58%) and CRS without nasal polyps (13.16%). Six patients (15.7%) had PHQ-9 scores ≥10, indicating they had major depressive disorder. PHQ-9 and SNOT-22 scores improved significantly after treatment (3.7 ± 5.8 vs 6.5 ± 6.9 pretreatment, P = .001; 20.7 ± 20.5 vs 45.6 ± 28.9 pretreatment, P < .0001, respectively). Mean ± SD change in PHQ-9 and SNOT-22 scores was -2.7 ± 7 and -24.9 ± 29.8, respectively. SNOT-22 and PHQ-9 scores were positively correlated (r = .522, P < .001). PHQ-9 score change was significantly associated with SNOT-22 score change (β = .178, 95% confidence interval 0.12-0.23, P < .0001). CRS affects the quality of life and psychological well-being of patients. Patient-centered care with maximal medical and surgical treatment help overcome its deleterious consequences.

To evaluate the psychological impact and depression prevalence in patients with Stargardt disease. We conducted a case-control study including 39 patients with Stargardt disease and 32 age- and sex-matched healthy controls. All participants underwent a complete ophthalmologic examination and completed the Patient Health Questionnaire-9 (PHQ-9) and the Zung Depression Inventory questionnaire. Results were analyzed using IBM SPSS 22.0 software. The patient group consisted of 19 men and 20 women with mean age of 36.9 ± 5.4 years and control group of 19 men and 13 women with mean age of 42.5 ± 10.1 years. The mean values of PHQ-9 and Zung scores for patients and healthy individuals were 10.9 ± 4.9, 46.7 ± 11.1, 6.7 ± 5.4, and 41.1 ± 8.5, respectively. There were statistically significant differences between the 2 groups in PHQ-9 scores (independent samples t test: p = 0.001), but not in Zung scores (Mann-Whitney test: p = 0.053). The PHQ-9 and Zung scores appeared to be moderately but significantly correlated (Pearson coefficient 0.44, p&lt;0.0001). In addition, PHQ-9 score seems to be raised along with age, whereas both scores are low when best-corrected visual acuity is high. Patients with Stargardt disease exhibited more depressive symptoms compared to healthy individuals according mainly to PHQ-9 scores. Moderate depression was significantly correlated visual function decline.

Objective: To assess the depression prevalence and its potential correlation with visual loss in patients with retinitis pigmentosa. Methods: Fifty-five patients with retinitis pigmentosa and 32 age- and sex-matched healthy individuals were recruited in this case-control study. All participants underwent a complete ophthalmological examination, which included measurement Best-corrected visual acuity (BCVA), slit lamp examination and fundoscopy, and completed the Patient Health Questionnaire-9 (PHQ-9) and the Zung Depression Inventory questionnaire. The diagnosis and the evaluation of retinitis pigmentosa were based on spectral domain optical coherence tomography (SD-OCT) and fundus autofluorescence (FAF) examination with dilated pupils. Results: The patients’ group consisted of 44 males and 11 females with mean age of 41.4 ± 7.6 years old, whereas the controls’ group included 19 males and 13 females with mean age of 42.5 ± 10.1 years old. BCVA differed significantly between the two groups, as expected (Mann-Whitney test: p<0.0001). The mean values of PHQ-9 and Zung scores in patients with retinitis pigmentosa classified them as moderately depressive or normal, respectively. The control group was characterized as mildly depressive or normal, according to PHQ-9 and Zung scores, respectively. Both scores were increased among patients (10.0 ± 3.9 and 45.2 ± 2.1, respectively) compared to the control group (6.7 ± 5.4 and 41.1 ± 8.5, respectively) and these increments were statistically significant (Mann- Whitney test: p=0.005 and p=0.024, respectively). PHQ-9 and Zung scores appeared to be weakly but significantly correlated (Spearman’s coefficient=-0.29, p=0.006). The increased age seemed to be responsible for the depressive symptoms, according to the PHQ-9 score but not with respect to the Zung score. Conclusion: Patients with retinitis pigmentosa exhibited more frequently and intensely depressive symptoms in PHQ-9 scores, compared to the healthy individuals. Moderate depression was significantly correlated visual function decline and increasing age. Ophthalmologists should be aware of the emotional disorders and encourage the patients to receive psychological support.

Limited research exists regarding the influence of preoperative depression on postoperative mental health, physical function, and pain in lumbar decompression (LD) patients. This study aims to evaluate the association of depressive symptoms as measured by the Patient Health Questionnaire-9 (PHQ-9) with other mental health and physical function clinical outcomes among patients undergoing LD. A prospectively maintained surgical registry was reviewed for primary LD from March 2016 to May 2019. Patients were stratified into 3 preoperative PHQ-9 score subgroups. Higher PHQ-9 scores indicated greater depressive symptoms. We assessed demographic and perioperative characteristics among subgroups with appropriate statistical testing. We also evaluated outcome instruments and postoperative improvement for the following outcomes: PHQ-9, Short Form 12 (SF-12), Veterans RAND 12-Item (VR-12), Patient-Reported Outcomes Measurement Information System Physical Function (PROMIS-PF), visual analog scale (VAS) leg, and VAS back. The 351-subject cohort was 70.4% men with an average age of 47 years; 186 subjects had minimal preoperative depressive symptoms (PHQ-9 <5), 94 had moderate (5≤ PHQ-9 ≤10), and 71 had severe (PHQ-9 >10). Subgroups with more severe symptoms of depression had worse mental health outcome scores (PHQ-9, 12-Mental Health Composite Score [12-MCS], and VR-12-MCS) and a positive linear association with greater pre- to postoperative mental health improvements at all timepoints. Subgroups with more severe symptoms of depression had worse PROMIS-PF scores at all timepoints, though VAS pain scores had no depression symptom association by 1 year. Patients with more severe preoperative depressive symptoms, as evaluated by PHQ-9, have a greater improvement in PHQ-9, SF-12, and VR-12 scores, but more severe PHQ-9 scores are associated with worse overall physical function scores. This study demonstrates the relevance of preoperative depressive symptoms and their necessity in future risk factor models. Severity of preoperative PHQ-9 acts as a significant risk factor to postoperative pain and mental and physical health improvement.

Preoperative depression is associated with increased perioperative pain, worse physical function, reduced quality of life, and inferior outcomes. Few studies have evaluated depressive symptoms between genders for individuals undergoing minimally invasive transforaminal lumbar interbody fusion (MIS TLIF). The purpose of this investigation was to assess the severity of Patient Health Questionnaire-9 (PHQ-9) scores among patients with depressive symptoms before and after single-level MIS TLIF. A prospective surgical registry was retrospectively reviewed for spine surgeries between March 2016 and December 2018. We included patients with at least mild depressive symptoms (PHQ-9 scores ≥ 5) who underwent primary, single-level MIS TLIF and compared genders using χ2 tests and t tests. Genders were stratified by depressive symptom severity: mild (5-9), moderate (10-14), and moderately severe (≥15) and then analyzed at preoperative and postoperative intervals: 6 weeks, 12 weeks, 6 months, and 1 year. Finally, PHQ-9 scores were validated with a Pearson correlation test against the 12-item Short Form (SF-12) Mental Composite Score (MCS) and the Veterans RAND (VR-12) MCS. Of 75 subjects, 44.0% were women and the mean age was 49.9 years. The preoperative distribution among PHQ-9 subgroups was 38.7%, 26.6%, and 34.7% for mild, moderate, and moderately severe depressive symptoms, respectively. Among PHQ-9 stratifications both genders demonstrated intermittent statistically significant improvements in PHQ-9 scores. The moderately severe PHQ-9 subgroup had improvement at all postoperative time points. The PHQ-9 scores demonstrated a strong correlation with the SF-12 MCS and VR-12 MCS at all postoperative evaluations. At baseline and by the final 1-year follow-up there were no statistically significant PHQ-9 score differences between genders within any depressive symptom stratifications. Whereas some contend that men and women have substantial mental health differences, this study is aligned with growing evidence that demonstrates similar depressive symptoms between genders. 3. Men and women may be at an equivalent risk for perioperative depressive symptoms.