Course Of Affective Disorders Research Articles

Social and psychological features of affective disorders in people during crisis periods of life

The study’s relevance is due to the association between mental disorders and environmental instability. A frequent consequence of stress is post-traumatic disorder, which can significantly affect the personality and disrupt adaptation, causing subjective suffering. The purpose of the article is to update information on the structure and dynamics of socio-psychological features of affective personality disorders in the crisis period of life in the Ukrainian population associated with the war. The article uses the following methods: clinical and psychological, psychometric, and statistical (in particular, descriptive statistics) methods. The results of the study demonstrate various courses of bipolar affective disorders of the continuum type with the transformation of their dynamics. The study showed a significant increase in the negative symptoms of affective disorders under the influence of stress. The researchers demonstrated the severity of both depressive and manic phases of affective disorders under the impact of stress factors. The results indicate an exacerbation of the course of affective disorders in people under difficult life circumstances. The findings have theoretical significance and are promising for further research on typologisation, classification and identifying clinical and biological manifestations to represent the specifics of pathogenesis.

Features of the course of affective diseases in hyperthymic persons

Introduction Hyperthymia was studied by many eminent psychiatrists considering it mainly within the framework of the subsyndromic course of affective disorders (Akiskal H.S., Angst J., Benazzi F.). Statistical data on the prevalence of hyperthymic personalities are scarce, which is associated with rare requests for help and diagnosis of this condition within the framework of character traits. Given the above, the study of the psychopathological and dynamic features of hyperthymia seems to be very relevant, since previously hyperthymic characterological features were not always taken into account in the diagnosis of the disease, the selection of drugs and the prediction of remission. Objectives Determination of the clinical features of the course of an affective disease in patients with hyperthymic features. Methods The sample consisted of, 48 patients (39 women, 9 men) who were on inpatient or outpatient treatment at the clinic since 2019 to 2022. Patients were examined by clinical-psychopathological, clinical-anamnestic methods due to the presence of a phase affective state. Results The subjects were diagnosed with two diseases - bipolar affective disorder and cyclothymia. There were 2 variants of affective phases - affective-mixed and “double” mania. In bipolar disorder, there were anxiety-hypochondriacal depressions (10 patients, 38.5%), polymorphic depressions (4 patients, 15.4%), asthenic hypomania (5 patients, 19.2%), hypochondriacal manias (3 patients, 11. 5%), alternating states (4 patients, 15.4%), “double” manias (8 patients, 23.5%). In cyclothymia, anxiety-hypochondriac depression (8 patients, 57.1%), somatoform decompensation (2 patients, 14.3%) and asthenic hypomania (4 patients, 28.6%) were observed. Conclusions Thus, bipolar disorder was the most common among hyperthymic individuals. Anxiety-hypochondriacal depression prevailed in both nosologies. Manic and hypomanic states were most often observed in patients with bipolar disorder (“double” manias - exclusively in bipolar disorder). Disclosure of Interest None Declared

Treatment of insomnia - effect of trazodone and hypnotics on sleep.

Sedative antidepressants are commonly used drugs in the treatment of insomnia. However, some recommendations claim that only hypnotics have been proven effective in the treatment of sleep initiation and maintenance disorders. The aim of this article is to compare the effect of hypnotics and trazodone on sleep, and to analyse the evidence for the use of trazodone in the treatment of insomnia. Three studies investigated the effects of trazodone on sleep in primary insomnia, 5 studies on insomnia in the course of affective disorders and 6 studies on insomnia in other indications (PTSD, Alzheimer's disease, alcohol and opiate dependence, somatoform disorder, and insomnia during pregnancy). In the treatment of insomnia, trazodone is less effective than hypnotics in the treatment of sleep onset insomnia (i.e., disorders of falling asleep). For this indication it needs to be administered earlier than hypnotics, at least 1 hour before bedtime. It is, however, very effective in the treatment of sleep-maintenance insomnia, especially in patients with comorbid mental disorders or patients treated with activating antidepressants. Hypnotics and trazodone have the opposite effect on deep sleep. Trazodone increases the duration of deep sleep, which is associated with better sleep quality as assessed by patients. In contrast, hypnotics decrease slow-wave activityin sleep EEG, which is the biomarker of deep sleep. The main mechanism through which trazodone promotes sleep is its antagonistic effect on 5-HT2 serotonin receptors, while hypnotics are agonists of gamma-aminobutyric acid GABAA receptors, and other sedative antidepressants block H1 histamine receptors. This is associated with a low risk of weight gain, which is rare with trazodone treatment.

Longitudinal course of affective disorders in patients presenting with catatonia in a psychiatric emergency setting

IntroductionCatatonia, a complex psychomotor syndrome and psychiatric emergency, is encountered across various psychiatric disorders. Most findings have been derived in the context of schizohrenia, warranting more comprehensive understanding in affective disorders.ObjectivesTo evaluate the longitudinal course of affective disorders presenting with catatonia and factors influencing the same.MethodsMedical records of 439 patients presenting with catatonia to the psychiatry emergency from 2014 to 2017 were reviewed till June 2020. 135 patients with a final diagnosis of affective disorder (67 bipolar and 68 unipolar) were identified. Poisson regression and survival analysis were used for longitudinal data.Results77.6% of bipolar patients were initially diagnosed under psychotic spectrum disorders compared to 3% in unipolar. Bipolar patients had a significantly younger age of first catatonic episode, earlier illness onset, and longer duration of illness. Survival analysis showed no significant difference between groups in time to recurrence of mood episode, readmission or catatonia relapse, with both groups demonstrating a greater likelihood of catatonia relapse in first 20 months. Poisson regression showed that bipolar patients had fewer catatonic relapses longitudinally over 2.5-6.5 years (RR: 0.64, CI: 0.43-0.96), but warranted more electroconvulsive therapy sessions for catatonic relapses (RR: 2.33, CI: 1.49-3.50), with fewer episodes resolving with lorazepam (RR: 0.62, CI: 0.40-0.95) compared to unipolar patients over same time period.ConclusionsBipolar disorders appear to have an earlier onset but fewer episodes of catatonia over illness course. Poorer lorazepam response and higher number of ECT sessions for catatonia resolution longitudinally suggest a differential treatment response of catatonia in bipolar disorder.DisclosureNo significant relationships.

Neurocognitive function in patients at high risk of schizophrenia with positive thought disorders

IntroductionThe course of affective disorders varies significantly in clinical practice. There are many symptoms that are not related to affective disorders that cannot be described in other nosologies. In the present study such pathopsychological phenomena similar to psychotic symptoms and related to symptoms of “schizophrenia risk” were designated as positive thought disorders (PTD). These symptoms are understood as manifestations of delusional and hallucinatory register.ObjectivesAim of the study is to identify and validate the differences of neurocognitive functions among patients with positive thought disorders and at high risk of schizophrenia and patients without thought disorders.MethodsIn the research there were 17 patients with high risk of schizophrenia dominated by PTD (affective disorders, personality disorders, schizophrenic spectrum disorders) and 18 patients without thought disorders (affective disorders, personality disorders) in the research. Patients aged 17-25 years.ResultsAccording to the results of the The Complex Figure test, the group with a high risk of schizophrenia had significantly low results on the “simultaneity” scale and points for copying the figure (p-value 0.04 and p-value 0.03). According to the results of the Verbal fluency test, the main group had significantly lower indices on the “loss of instruction” scale and on the number of repetitions (p-value 0.021 and p-value 0.009).ConclusionsIn the group of patients with a high risk of schizophrenia with positive thought disorders there are neurocognitive features in the form of reduced inhibitory control and a lack of simultaneity. The most sensitive methods are the Complex figure test and Verbal fluency Test.Conflict of interestThe reported study was funded by RFBR, project number 20-013-00772

Associations between resilience and quality of life in patients experiencing a depressive episode

Despite the obvious assumption that resilience affects the course of affective disorders, studies investigating resilience in people experiencing a depressive episode are scarce. The current study explored whether resilience might differently impact quality of life (QoL) in these patients as compared to healthy control subjects. To this end, 60 patients and 75 control subjects were included into a cross-sectional study. In patients, psychopathology was assessed by means of the Montgomery Asberg Depression Rating Scale (MADRS). The Resilience Scale (RS-25) and the WHOQOL-BREF were used in both patients and control subjects to assess resilience and QoL. Depressive patients indicated significantly lower degrees of resilience and QoL compared to healthy subjects. However, there was evidence that patients experiencing a depressive episode do not inevitably have low RS-25 scores. In healthy subjects, a moderate correlation was found between resilience and all WHOQOL-BREF domains, whereas in patients, resilience correlated moderately with global and psychological QoL and with environment. The mediation analysis revealed that the difference in QoL between patients and healthy subjects was partially mediated by resilience. The present study confirms the assumption that resilience is not merely characterized by the absence of psychopathology but is important for the QoL of patients experiencing a depressive episode.

Skin autofluorescence of advanced glycation end products and course of affective disorders in the lifelines cohort study, a prospective investigation

BackgroundSkin autofluorescence (SAF), indicating concentration of advanced glycation end products in the skin and oxidative stress, is cross-sectionally associated with affective disorders. Prospective studies of oxidative stress markers will help to clarify the pathophysiological role of oxidative stress. MethodsData of a population-based cohort study were used. Presence of major depressive disorder, dysthymia, generalised anxiety disorder, panic disorder or social phobia was assessed at baseline and at 5-year follow-up with the Mini-International Neuropsychiatric Interview. Associations between SAF at baseline and incidence and persistence/recurrence of affective disorders were assessed with logistic regression. ResultsOf 43,267 participants with no disorder at baseline, 2885 (6.7%) developed an incident disorder during follow-up. In 1360 of 3648 participants (37.3%) with an affective disorder at baseline, a persisting/recurrent disorder was present at follow-up. A modest association existed between SAF and incident affective disorders (OR=1.07 [95%CI 1.03–1.12], P<.001), specifically major depressive disorder (OR=1.11 [95%CI 1.04–1.19], P=.003); this association lost statistical significance after adjustment for sociodemographic factors. Associations between SAF and persistence/recurrence were not significant. LimitationsMany confounders might also act as intermediate: extensive adjustment for confounders caused overfitting and possibly masked effects of SAF on course of affective disorders. Relatively small sample sizes for analyses of SAF and persistence/recurrence of affective disorders resulted in a low power. ConclusionsIncreased SAF modestly raises the odds of incident affective disorders, particularly major depressive disorder, providing evidence that oxidative stress plays a role in subsequent occurrence of affective disorders. However, significance of effects faded after adjustment for socioeconomic status.

The role of environmental stress and DNA methylation in the longitudinal course of bipolar disorder

BackgroundStressful life events influence the course of affective disorders, however, the mechanisms by which they bring about phenotypic change are not entirely known.MethodsWe explored the role of DNA methylation in response to recent stressful life events in a cohort of bipolar patients from the longitudinal PsyCourse study (n = 96). Peripheral blood DNA methylomes were profiled at two time points for over 850,000 methylation sites. The association between impact ratings of stressful life events and DNA methylation was assessed, first by interrogating methylation sites in the vicinity of candidate genes previously implicated in the stress response and, second, by conducting an exploratory epigenome-wide association analysis. Third, the association between epigenetic aging and change in stress and symptom measures over time was investigated.ResultsInvestigation of methylation signatures over time revealed just over half of the CpG sites tested had an absolute difference in methylation of at least 1% over a 1-year period. Although not a single CpG site withstood correction for multiple testing, methylation at one site (cg15212455) was suggestively associated with stressful life events (p < 1.0 × 10−5). Epigenetic aging over a 1-year period was not associated with changes in stress or symptom measures.ConclusionsTo the best of our knowledge, our study is the first to investigate epigenome-wide methylation across time in bipolar patients and in relation to recent, non-traumatic stressful life events. Limited and inconclusive evidence warrants future longitudinal investigations in larger samples of well-characterized bipolar patients to give a complete picture regarding the role of DNA methylation in the course of bipolar disorder.

Predictors of suicidal behaviour in adolescents with depressive disorders

A review of recent publications is devoted to risk factors for suicidal behavior in adolescents with depressive disorders. The authors summarized Russian and international studies on the clinical course of affective disorders, in particular bipolar disorders, their clinical heterogeneity and incompleteness in adolescence. Particular attention is given to the complexity of early identification of predictors of suicidal behavior in depressive disorders due to comprehensiveness of exogenous and endogenous effects characteristic of adolescence. The role of genetic loading for affective disorders, problems of children having parents with affective disorders, social and psychological factors (violence in families, school bullying etc.) and risks of suicidal behavior are described. It is of great significance to investigate premorbid adjustment, subaffective manifestations of disorders in adolescence to predict the trajectory of the disease, its complications in the form of suicidal behavior and opportunities for early intervention.

The association between the longitudinal course of common mental disorders and subsequent physical activity status in young adults: A 30-year birth cohort study

Low physical activity is a major public health concern. There has been extensive research examining the role of physical activity as a potentially modifiable risk factor for the onset of mental illness. However, fewer studies have reported how mental disorders affect future physical activity. Using data from a large birth cohort, the current study explored the association between the longitudinal course of common mental disorders (affective disorders, anxiety disorders, and substance use disorders, as well as any common mental disorder) and subsequent physical activity status among young adults living in Australia. Prospective data from the Mater-University of Queensland Study of Pregnancy, consisting of 1611 young adults, were analyzed. The longitudinal course of mental disorder diagnoses between ages 21 and 30 was derived from the Composite International Diagnostic Interview. Physical activity status at age 30 was estimated using International Physical Activity Questionnaire long form. Logistic regression was used to examine the association between the longitudinal course of common mental disorders between 21 and 30 years and subsequent physical activity status at age 30. After adjusting for confounding factors, there was no association between the longitudinal course of affective disorders, anxiety disorders, substance use disorders, or any common mental disorder at ages 21 and 30 and physical activity status at age 30. Our findings suggest that there is no longitudinal association between the common mental disorder diagnoses and physical activity status among young adults living in Australia.

The predictive specificity of psychological vulnerability markers for the course of affective disorders

High scores on markers of psychological vulnerability have been associated with a worse course of affective disorders. However, little is known about the specificity of those associations in predicting the course of different depressive and anxiety disorders. We examined the impact of psychological vulnerability on the short- and long-term course of depressive and anxiety disorders. Participants from the Netherlands Study of Depression and Anxiety with a current diagnosis of depression or anxiety (n = 1256) were reassessed after 2 and 6 years. Diagnostic status and chronic duration (>85% of the time) of symptoms were the outcomes. Predictors were neuroticism, extraversion, locus of control, cognitive reactivity (rumination and hopelessness reactivity), worry and anxiety sensitivity. High neuroticism, low extraversion and external locus of control predicted chronicity of various affective disorders. Rumination, however, predicted chronicity of depressive but not anxiety disorders. Worry specifically predicted chronicity of GAD and anxiety sensitivity predicted chronicity of panic disorder and social anxiety disorder. These patterns were present both at short-term and at long-term, without losing predictive accuracy. Psychological vulnerabilities that are theoretically specific to certain disorders indeed selectively predict the course of these disorders. General markers of vulnerability predicted the course of multiple affective disorders. This pattern of results supports the notion of specific as well as transdiagnostic predictors of the course of affective disorders and is consistent with hierarchical models of psychopathology.

Thrombodynamic parameters of hypercoagulability in patients with affective disorder and schizophrenia in a state of exacerbation

To detect coagulability impairment of blood plasma in patients with schizophrenia or affective disease in a state of exacerbation using a thrombodynamics test. The study included 46 women, 32 with attack-like/shift-like/or continuous schizophrenia (ICD-10: F20.00, F20.01, F20.02), 7 with schizotypal disorder (ICD-10: F21.3-21.4) and 7 with affective disorder (ICD-10: F32.00, F32.3). Thrombodynamics tests were performed on T-2 thrombodynamics analyzer ('Hemacore LLC', Moscow, Russia). For the first time, it was shown that in the patient population (n=46), the thrombodynamic parameters of the blood clot growth rate [initial velocity (Vi), steady-state velocity (Vst) and spontaneous clots adjusted velocity (V)] and clot size at 30 minute of thrombodynamics (Clot Size, CS) were significantly higher than normal values. The mean appearance of spontaneous clots (Tsp) was significantly lower than 30 minutes (p<0.0001) which indicated a rapid, spontaneous clots formation. The mean value of clot lag time (Tlag) and clot density (Density, D) did not differ significantly from normal values. The number of changed thrombodynamic parameters decreased in the following sequence: schizophrenia with different types of courses > schizotypal disorder>affective disorder. This is in good agreement with the fact that the course of affective disorders is more favorable than that in schizophrenia. The thrombodynamics test has a good potential for introduction into medicine to detect hypercoagulability and increased risks of thrombotic complications in patients, as well as to control for normalization of hemostasis with antiaggregant or anticoagulant drugs. Thrombodynamics makes it possible to identify a tendency to hypercoagulable states at an early stage, when other methods are still not sensitive enough. The study identified the hypercoagulability in patients with schizophrenia and affective disorders.

A call for research in early intervention and biological changes during the course of affective disorders: a comment on the review by Robert M. Post.

A call for research in early intervention and biological changes during the course of affective disorders: a comment on the review by Robert M. Post.

Mixed Episodes in Bipolar Disorders--Changes in DSM-5 and Treatment Recommendations

Mixed episodes in the course of affective disorders are challenging for any psychiatrist, because they are often characterized by a complicated and difficult treatment course (e. g. higher suicide rates) and a worse treatment outcome. In DSM-5, one of the main changes is that the diagnosis of a mixed episode was disestablished and replaced with affective episodes with so called "mixed features". This alteration markedly reduces the diagnostic threshold. The available literature on pharmacological treatment of mixed episodes is not sufficient; however, treatment with atypical antipsychotics, especially olanzapine and aripiprazole and the mood stabilizers valproate and carmabazepine has proved to be beneficial.

Acute and Long-term Overall Severity of Bipolar Disorder Related to Sicam-1 and Svcam-1 Serum Levels in Bipolar Depression

Introduction Interplay between nervous and immune systems plays an important part in clinical presentation and course of affective disorders. Aims The aim of the study has been to assess the relation between soluble vascular cell adhesion molecule-1 (sVCAM-1) and soluble intercellular cell adhesion molecule-1 (sICAM-1), in acute and remission phase of bipolar depression, in regard to acute and long-term measures of overall severity of the bipolar disorder. Methods The study has explored serum levels of sVCAM-1 and sICAM-1 in 43 patients with bipolar depression. The adhesion molecules’ levels of patient group have been analyzed in acute and remission phases, in regard to bipolarity index (BPIX) and in regard to global functioning (measured by Global Assesment of Functioning Scale- GAF) Results The acute serum levels of sICAM-1 have been associated to BPIX. Moreover, sVCAM-1 serum selevels have been associated to BPIX in both phases of the disorder. In addition, acute sVCAM-1 levels have been associted to GAF score in accute phase. Conclusions Our results suggest that cellular adhesion is an important factor in clinical presentation and overall severity of bipolar disorder.

Association between OPCRIT dimensions and polymorphisms of HPA axis genes in bipolar disorder

The aim of the study was to investigate the possible association between polymorphisms of HPA axis genes-CRHR1 (corticotrophin-releasing hormone receptor), NR3C1 (glucocorticoid receptor) and AVPR1B (arginine vasopressin receptor) and dimensions of bipolar disorder assessed by OPCRIT.We examined 560 patients with diagnosis of bipolar disorder (n=457) and unipolar disorder (n=103). Diagnosis was established by SCID and OPCRIT.We found association between polymorphisms of AVPR1b gene and psychotic dimension and CRHR1 polymorphisms and excitement and psychotic dimension.Our results suggest possible involvement of the AVPR1b and CRHR1 genes in the ethiology of psychotic features in the course of affective disorders, and possible involvement of CRHR1 gene in the ethiology of bipolar disorder.

Affective temperaments and hopelessness as predictors of health and social functioning in mood disorder patients: A prospective follow-up study

BackgroundAffective disorders are highly disabling illnesses constituting a significant burden for the patients, their family and the society. Therefore, it would be very useful to find tools which carefully subtype these conditions and have a strong and reliable predictive power concerning the course of illness and health and social functioning. To date, the role of hopelessness and affective temperaments in the prediction of health and social functioning and the course of affective disorders has not been studied. Thus, the aim of the present study was to assess whether affective temperaments and hopelessness, measured during hospitalization, can be useful in the prediction of global functioning (the severity of the illness and the presence and severity of psychosocial problems) at follow-up in inpatients with major depressive disorder and bipolar disorder (BD). MethodsThe patients were 96 consecutive patients admitted to the inpatient psychiatric clinic of Sant'Andrea Hospital between January 2009 and December 2010. All patients completed the Temperament Evaluation of Memphis, Pisa, Paris and San Diego (TEMPS-A) and the Beck Hopelessness Scale on admission. They were contacted on average 14 months after discharge and were asked to complete a telephone interview based on the Health of the Nation Outcome Scales (HoNOS). ResultsTwo patients committed suicide before the follow-up assessment. Around 77% of the patients who completed the follow-up assessment were diagnosed as BD, and around 47% reported severe hopelessness. In the multivariate analyses, a factor derived from hopelessness and hyperthymia scores and unemployment, independently predicted severity of the illness and psychosocial functioning at the follow-up. ConclusionsScreening for the affective temperament profile and for hopelessness has importance for designing the treatment and rehabilitation plans of affective disorder patients, as these variables are involved in the course and outcome of affective disorder patients and influence their health and social functioning.

Comment on Lara Rzesnitzek (2013) “Early Psychosis” as a mirror of biologist controversies in post-war German, Anglo-Saxon, and Soviet Psychiatry

Comment on Lara Rzesnitzek (2013) “Early Psychosis” as a mirror of biologist controversies in post-war German, Anglo-Saxon, and Soviet Psychiatry

Impact of antiepileptic therapy on the course of affective disorders in women with epilepsy

The impact of antiepileptic drugs (AEDs) on affective disorders was analyzed in women with epilepsy. One hundred and one reproductive-aged epileptic patients with depressive and emotionally labile disorders were examined. Thirty-two (31.7%) and 64 (63.4%) took one and two AEDs, respectively; 5 (4.9%) patients did not take. New-generation AEDs were shown to have a more favorable profile of psychotropic effects than traditional ones. The positive psychotropic effects of lamotrigine in treating epilepsy in women with affective disorders are described.

Frontal lobe changes occur early in the course of affective disorders in young people

BackgroundMore severe and persistent forms of affective disorders are accompanied by grey matter loss in key frontal and temporal structures. It is unclear whether such changes precede the onset of illness, occur early in the course or develop gradually with persistence or recurrence of illness. A total of 47 young people presenting with admixtures of depressive and psychotic symptoms were recruited from specialist early intervention services along with 33 age matched healthy control subjects. All participants underwent magnetic resonance imaging and patients were rated clinically as to current stage of illness. Twenty-three patients were identified as being at an early 'attenuated syndrome' stage, while the remaining were rated as having already reached the 'discrete disorder' or 'persistent or recurrent illness' stage. Contrasts were carried out between controls subjects and patients cohorts with attenuated syndromes and discrete disorders, separately.ResultsThe patients that were identified as having a discrete or persisting disorder demonstrated decreased grey matter volumes within distributed frontal brain regions when contrasted to both the control subjects as well as those patients in the attenuated syndrome stage. Overall, patients who were diagnosed as more advanced in terms of the clinical stage of their illness, exhibited the greatest grey matter volume loss of all groups.ConclusionsThis study suggests that, in terms of frontal grey matter changes, a major transition point may occur in the course of affective illness between early attenuated syndromes and later discrete illness stages.