Affective Disorders In Patients Research Articles

Psychosocial Factors Associated with Knowledge about Affective Disorders in Patients with Depression

Background: Increasing importance is attributed to the knowledge that patients have concerning their illness. For psychiatric disorders, imparting information about the illness has become a standard part of treatment. Despite the great clinical relevance of knowledge about depression, only few empirical studies on this subject have been carried out. This study aimed to identify psychosocial factors associated with greater or lesser knowledge about affective disorders. Methods: Sixty-one in-patients with depression were recruited and tested with the Knowledge about Depression and Mania Inventory. Results: Almost all patients sought specific information about their disorder prior to admission to hospital. There were large differences in patients’ knowledge about the disorder and their choice of information source. Older and less educated patients had less knowledge about affective disorders. Patients with less illness knowledge also have a less favourable illness concept, poorer interpersonal relationships and more passive coping strategies. Conclusions: The results show that knowledge about affective disorders is a central illness characteristic that has numerous implications for the ability to cope with the disorder, as well as for psychotherapeutic management. The results contribute to a clarification of the relationship between psychoeducation and psychotherapy.

Affective Disorders in Patients with HIV Infection

At the beginning of the AIDS pandemic, affective disorders (such as depressed mood) were seen in a considerable number of HIV-1-infected individuals. These disorders were a result of the poor physical condition of the patients, brain involvement by the virus (e.g. encephalopathy) or a reaction to disadvantageous living conditions (losing friends, jobs, etc.). In the era of highly active antiretroviral therapy (HAART), mental illness related to physical weakness is declining, as is the incidence of HIV-1-associated encephalopathy. However, depressed mood and fatigue caused by efavirenz (a standard component of HAART) is becoming increasingly important, particularly in individuals who are infected long-term with HIV-1. Whatever the cause of affective disorders, their presence has been shown to negatively influence adherence to HAART and HIV-1 disease progression. Specialist knowledge of HIV-1 infection, and HAART and its psychiatric complications (particularly in subgroups of patients such as drug abusers and older people), is needed to care adequately for patients. Furthermore, prospective studies are needed to more fully differentiate between the various aetiologies of affective disorders seen in individuals living with HIV/AIDS and to determine their incidence and prevalence. Such information is important to ensure that affective disorders are recognised and adequately treated, which will in turn improve the efficacy of HAART.

Increased Risk of Developing Affective Disorder in Patients with Hypothyroidism: A Register-Based Study

Links between thyroid function and depression have been noted in many contexts. We assessed whether hospitalization with hypothyroidism was a risk factor for developing affective disorder. We conducted a prospective cohort study using historical data from Danish registers. The observational period was 1977-1999. Three study cohorts were identified: all patients with a first hospital admittance with the resulting index discharge diagnoses hypothyroidism, osteoarthritis, or nontoxic goiter. A later hospitalization with a resulting discharge diagnosis of affective disorder was used as event of interest, and rates of readmission were estimated and compared using competing risk models in survival analyses. We identified 165,307 patients discharged with an index diagnosis. In the observational period, 1041 events occurred. An index diagnosis of hypothyroidism was associated with an increased risk of hospitalization with affective disorder when compared to the control diseases. The risk of hospitalization with affective disorder was greatest in the first year after index hospitalization. Patients hospitalized with hypothyroidism have a greater risk of readmission with depression or bipolar disorder than control patients. This renders epidemiologic support to theories linking thyroid dysfunction with mood disturbances.

A Psychophysiological Study of Affective Disorders in Patients during Post-stroke Rehabilitation

Psychophysiological parameters of affective disorders (depression, depersonalization, and alexithymia) were studied in patients who had suffered ischemic stoke. Significant differences from healthy subjects were observed for certain MMPI scores and EEG, neurophysiological, and neuroimaging parameters. The results provide a basis for better understanding of brain function in healthy people and patients with dysfunction of higher cognitive processes.

Validity of the Hospital Anxiety and Depression Scale for Use With Patients With Noncardiac Chest Pain

Consecutive patients seen in the first-heart-aid service of a university hospital and given a diagnosis of noncardiac chest pain completed the self-report Hospital Anxiety and Depression Scale. Patients with a score >or=8 on either the anxiety or depression subscale (N=266, mean age=55.81 years, SD=13.03, 143 male patients) were compared with patients scoring <8 (N=78, mean age=60.55 years, SD=10. 84, 50 male patients) by means of the Mini International Neuropsychiatric Interview. Panic disorder and/or depression identified by the diagnostic interview were highly prevalent in the group with a score >or=8 (73.3% versus 3.9% in the comparison group). The Hospital Anxiety and Depression Scale is an adequate screening instrument for the detection of affective disorders in patients with noncardiac chest pain.

Enduring increased risk of developing depression and mania in patients with dementia

Objective: To investigate the time relation between dementia and major affective disorders (major depression and mania). Methods: Register linkage study of the Danish Hospital Register and the Danish Psychiatric Central...

Mitochondrial DNA polymorphisms in bipolar disorder

Background: Previous studies suggested mitochondrial abnormality in bipolar disorder: (1) possible contribution of parent-of-origin effect in transmission of bipolar disorder; (2) abnormal brain phosphorus metabolism detected by phosphorus-31 magnetic resonance spectroscopy; (3) comorbidity of affective disorders in patients with mitochondrial encephalopathy; (4) increased levels of the 4977bp deletion of mitochondrial DNA (mtDNA) in the postmortem brains. We investigated mtDNA polymorphisms in association with bipolar disorder. Methods: Twelve PCR fragments including all tRNA genes were examined by the single-strand conformation polymorphism method in 43 bipolar patients. All observed polymorphisms were sequenced. Association of these polymorphisms with bipolar disorder was examined by restriction fragment length polymorphism method in 135 bipolar patients and 187 controls. Results: In total, we found 28 polymorphisms including 14 polymorphisms that have not been reported previously. The A10398G polymorphism was significantly associated with bipolar disorder (10398A genotype: 33.1% in bipolar, 22.2% in the control, P<0.05). Although this difference was not significant after Bonferroni correction, the CA haplotype of the 5178 and 10398 polymorphisms was still significantly associated with bipolar disorder (CA haplotype: 33.6% in bipolar, 16.8% in control, P<0.001). Three rare mutations substituting evolutionary conserved bases; A5539G in tRNA Trp gene, A5747G in the origin of L-strand replication, and A8537G in ATPase subunit-6 and -8 genes, were found in patients with family history in which maternal transmission was suspected. Discussion: The 5178C/10398A haplotype in mtDNA may be a risk factor of bipolar disorder (odds ratio, 2.4). Pathophysiological significance of rare mtDNA mutations needs to be verified in the future. This finding may imply the pathophysiological significance of mtDNA in bipolar disorder.

Subgenual cingulate cortex volume in first-episode psychosis.

Gray matter volume and glucose utilization have been reported to be reduced in the left subgenual cingulate of subjects with familial bipolar or unipolar depression. It is unclear whether these findings are secondary to recurrent illness or are part of a familial/genetic syndrome. The authors' goal was to clarify these findings. Volumetric analyses were performed by using magnetic resonance imaging in 41 patients experiencing their first episode of affective disorder or schizophrenia and in 20 normal comparison subjects. The left subgenual cingulate volume of the patients with affective disorder who had a family history of affective disorder was smaller than that of patients with affective disorder with no family history of the illness and the normal comparison subjects. Patients with schizophrenia did not differ from comparison subjects in left subgenual cingulate volume. Left subgenual cingulate abnormalities are present at first hospitalization for psychotic affective disorder in patients who have a family history of affective disorder.

Affective Disorders in Patients with Multiple Sclerosis

Affective disorders are commonly seen in the multiple sclerosis (MS) population. Symptoms of MS overlap heavily with symptoms of major depression; however, the diagnosis of major depression is sought using the same clinical criteria as in the general population. Treatment with pharmacological intervention appears to have a high rate of success, although controlled studies are lacking. Both tricyclic antidepressants and selective serotonin (5-hydroxytryptamine; 5-HT) reuptake inhibitors are commonly used in MS clinics and are generally well tolerated for treatment of major depression. Data concerning the efficacy of pharmacological intervention are limited yet compelling, and we consider antidepressants an indispensable component of our drug armamentarium. Treatment of mania and bipolar disorder in the MS population is more problematic, primarily due to a paucity of literature on the subject. We have found both lithium and valproic acid (sodium valproate) to be effective and well tolerated in these patients. Pharmacological treatment of more nonspecific types of mood instability in affected patients with MS appears to be reasonably effective as well, and in this situation we have successfully used both antidepressants and mood stabilisers.

Clinical correlates of insomnia in patients with chronic illness.

Patients with chronic insomnia are more likely to develop affective disorders, cardiac morbidity, and other adverse health outcomes, yet many clinicians tend to trivialize the complaint of insomnia or to attribute it only to psychiatric causes. To estimate the prevalence and longitudinal course of insomnia in patients with documented chronic medical illness and/or depression and to quantify the associations between specific chronic conditions and insomnia. The presence of mild or severe insomnia was based on responses to a sleep questionnaire completed by 3445 patients with at least 1 of 5 physician-identified chronic conditions (hypertension, diabetes, congestive heart failure, myocardial infarction, or depression) at baseline; a subsample of 1814 patients completed follow-up questionnaires at 2 years. Using multivariate techniques, we evaluated the relationship between chronic conditions, patient-reported comorbidities, and insomnia (complaints of initiating and maintaining sleep), adjusting for sociodemographics and health habits. Sixteen percent of study patients had severe and 34% had mild insomnia at baseline. At 2-year follow-up, 59% (95% confidence interval, 55%-63%) of patients with mild insomnia and 83% (95% confidence interval, 78%-88%) of patients with severe insomnia at baseline still had sleep problems. Odds ratios corresponding to mild and severe insomnia for key risk factors were as follows: current depressive disorder, 2.6 and 8.2; subthreshold depression, 2.2 and 3.4; congestive heart failure, 1.6 and 2.5; obstructive airway disease, 1.6 and 1.5; back problems, 1.4 and 1.5; hip impairment, 2.2 and 2.7; and prostate problems, 1.6 and 1.4. The majority of insomnia-comorbidity associations observed at baseline persisted at 2-year follow-up. Patients with insomnia require follow-up, as the majority continue to be bothered by difficulty initiating and maintaining sleep. In addition to detecting affective disorders in patients with insomnia, clinicians should focus on medical conditions that disturb sleep, especially cardiopulmonary disease, painful musculoskeletal conditions, and prostate problems.

P-12-19 - Outcomes including withdrawal phenomena detected from a naturalistic comparison of fluoxetine and paroxetine used in the treatment of affective disorders in patients with learning disabilities

P-12-19 - Outcomes including withdrawal phenomena detected from a naturalistic comparison of fluoxetine and paroxetine used in the treatment of affective disorders in patients with learning disabilities

Multiple sclerosis: the role of the pineal gland in its timing of onset and risk of psychiatric illness.

The incidence of multiple sclerosis (MS) is age-dependent being rare prior to age 10, unusual prior to age 15, with a peak in the mid 20s. It has been suggested, therefore, that the clinical manifestation of MS is dependent upon having passed the pubertal period. Since pineal melatonin secretion declines from childhood to puberty and as melatonin is an immunomodulator, we have proposed that the dramatic decline in melatonin secretion just prior to the onset of the physical manifestations of puberty may disrupt immune responses resulting in either reactivation of the infective agent or in an increased susceptibility to post-pubertal infection. The fall in melatonin secretion during pre-puberty may also increase the susceptibility of these patients to affective disorder which is associated with lower melatonin secretion and the presence of a phase-advance of their biological rhythms. We predicted, therefore, a higher incidence of affective disorder in patients with pubertal or post-pubertal onset of MS compared to those in whom the disease manifested later. To test this hypothesis, we studied the incidence of affective disorder in relation to age of onset of first neurological symptoms in 31 MS patients, 6 of whom manifested symptoms of MS prior to age 18 (mean = 16.8 years). All patients with pubertal onset MS and only 48% of the control group had an affective disorder. The pubertal onset patients also had a significantly lower nocturnal melatonin levels and a lower incidence of pineal calcification on CT scan. These findings thus support the hypothesis implicating the pineal gland in the timing of onset of MS and in the risk for the development of affective disorder.

ECT-induced interictal delirium in patients with a history of a CVA.

Earlier works have documented a high incidence of affective disorders in patients with a history of a cerebrovascular accident (CVA). In general, electroconvulsive therapy (ECT) has been reported to be effective in treating depressed patients with a history of CVA. Recent works have shown that preexisting structural brain changes may predispose patients to develop interictal ECT-induced delirium. However, the incidence of ECT-induced interictal delirium in patients with a history of CVA has not been directly studied. In this pilot study, the authors examined the incidence of ECT-induced interictal delirium in 14 depressed CVA patients compared with 14 elderly depressed controls (without a history of CVA). Interestingly, the overall incidence of delirium was identical in both groups (28.5%). However, consistent with previous works, some patients who had had a recent CVA involving the caudate nucleus appeared more likely to develop delirium. Thirteen of the 14 depressed CVA patients (92%) showed a moderate to significant improvement in their depressive symptoms from ECT. None of the patients developed significant cardiac complications during ECT.

Stress, depression, and mania: relationship between perceived role of stressful events and clinical and biochemical characteristics

We investigated the perceived role of stressful events in episodes of major affective disorder in patients studied in the NIMH Clinical Research Branch Collaborative Program on the Psychobiology of Depression (Biological Studies). Using items from the Schedule for Affective Disorders and Schizophrenia (SADS), episodes were divided into environment-sensitive (high perceived role of stressful events) and autonomous (minimal or no perceived role of stressful events). Patients with environment-sensitive episodes had fewer previous episodes and a longer index episode. The groups did not differ with respect to age, gender, education, socioeconomic group, diagnosis, severity of illness, or eventual response to treatment. Unipolar depressed patients with environment-sensitive episodes had lower CSF 5-HIAA than those with autonomous episodes. Among bipolar depressed patients, those with autonomous episodes had elevated excretion of O-methylated catecholamine metabolites and of epinephrine, while those with environment-sensitive episodes had normal excretion of catecholamines and metabolites. Manic subjects with environment-sensitive episodes had elevated norepinephrine excretion, while this was normal in manics with autonomous episodes. Relationships between environmental sensitivity of affective episodes and neurotransmitter function therefore appear to be related to the type of episode.

Cognitive Deficits and Emotional Dysfunction in Multiple Sclerosis

This issue of theArchivescontains two reviews prepared on behalf of the Cognitive Function Study Group of the National Multiple Sclerosis Society. These articles are a response to the need for more and better information on the mental and emotional effects of multiple sclerosis, but they also serve as an example of an approach that could be useful in other neurologic disorders. See also pp 94 and 98. The varied conclusions and varied methodology used by investigators to study cognitive dysfunction and affective disorders in patients with multiple sclerosis and other neurologic disorders, while providing useful information, have made it difficult or impossible to compare studies. In addition, since most of the studies are based on highly selected samples, the results are applicable only in very restricted, often poorly defined, subsets of patients. Both articles review important clinical research areas and include recommendations regarding research standards that, if implemented,

Lack of association between HLA antigens and bulimia

Bulimia is an eating disorder characterized by binge eating that is associated with behavior intended to promote weight loss, such as selfinduced vomiting, laxative abuse, excessive exercise, and prolonged fasting. The lifetime prevalence of major affective disorders in bulimic patients is high (Hudson et al. 1987), and a relatively frequent occurrence of affective disorders in patients’ families has been described (Stem et al. 1984). Recently, a monozygotic twin pair with both bulimia and major depressive disorder has been reported (Brewerton et al. 1986), and a high concordance of bulimia in monozygotic twins and a low concordance in dizygotic twins has been observed (Fichter and Nogel 1988). Thus, family and twin studies suggest a genetic predisposition for affective disorders and bulimia, respectively. One method of demonstrating such a genetic factor is to show an association between a disease and the human leukocyte antigen (HLA) system (see review, Gershon et al. 1987). In patients with the classic eating disorder anorexia nervosa, a high frequency of the antigen HLA-B16 (B38 + B39) and the haplotype HLA-A26,B38 has been described by Biederman et al. (1984), however, their finding could not be reproduced by a more recent study (Kiss et al. 1988). To our knowledge, an association between HLA and bulimia has not been investigated to date.