Episodes Of Affective Illness Research Articles

Comparison of Sexual Experience and Behavior between Bipolar Outpatients and Outpatients without Mood Disorders.

Sexual behavior over the past year of 32 outpatients with Bipolar disorder is compared to that of 44 Comparison patients that had never had an episode of affective illness. Subjects were outpatients treated with drugs and psychotherapy in routine office practice. Differences in sexual behavior between the two groups as a whole were minimal, but meaningful differences emerged when subgroups were compared. Compared to control men, Bipolar men had had more partners in the last year and were more likely to have had sex without condoms. Compared to Bipolar females, Bipolar males had more sex partners, had more sex with strangers, and were more likely to have engaged in homosexual behavior. Even so, some patients in the Comparison group also had engaged in risky sexual behavior. They had failed to use condoms and had had sex with strangers and prostitutes during the previous year.

Acute manic episodes in pregnancy [clinical conference

A 33-year-old pregnant woman at 26 weeks gestation, who had a history of bipolar mood disorder, type I, was admitted to the hospital for hypomania and poorly controlled diabetes mellitus. The patient had had her first episode of affective illness at age 28, after the birth of her second child. After an initial postpartum depression, she had cycled into a manic state. She had subsequently been hospitalized seven times for acute mania. A combination of valproate and chlorpromazine had proven effective in managing most of her manic episodes, while her two most severe episodes had been successfully managed with bilateral ECT.

Developmental psychobiology of cyclic affective illness: Implications for early therapeutic intervention

AbstractThe recurrent affective disorders are discussed from the perspective of accumulating inherited and experiential effects on gene expression. Stress and episodes of affective illness are viewed as leaving biochemical and microstructural residues in the central nervous system (CNS) in relation to their patterning, severity, and recurrence. Comorbid factors such as substance abuse and developmental disturbances may also interact with these illness-related variables. In addition to the primary pathological processes, secondary adaptive changes can also be induced, which, in concert with pharmacological interventions, may be sufficient to counter episode occurrences and illness progression. We postulate that the balance of primary pathological and secondary adaptive changes at multiple levels of CNS regulation accounts for recurrence and cyclicity in the affective disorders. The importance of early, effective, long-term interventions in the recurrent affective disorders and the therapeutic potential of several new treatment modalities including repeated transcranial magnetic stimulation (rTMS) are discussed.

Relapse and Recurrence of Depression

Most major affective disorders are, from a longitudinal perspective, recurrent conditions. This article reviews the rationale for longer term models of antidepressant treatment, including strategies for the prevention of relapse (defined as an increase of symptoms back to a syndromallevel after an initial treatment response) and recurrence (defined as the onset of a distinctly new episode of affective illness). To prevent relapse, it is recommended that all patients whose symptoms remit during pharmacotherapy receive 4 to 6 months of continuation therapy. Those patients at increased risk for subsequent recurrent depressive episodes should be considered for an extended course of maintenance pharmacotherapy. The efficacy of tricyclic antidepressants, lithium and the selective serotonin (5-hydroxytryptamine; 5-HT) reuptake inhibitors for the prevention of recurrent depression has been established, with the latter class having a clinical advantage in terms of common adverse effects and safety in overdose. With each new episode of depressive illness, the risk of illness becoming more autonomous, severe and potentially refractory may increase. Thus, prophylactic treatment of patients at risk of recurrent depression remains the best way to optimise their long term outcome.

The Effects of Treatment on Mortality in Affective Illness

All studies of mortality in patients with a diagnosis of affective illness agree that the death rate is increased. The excess mortality appears primarily to result from suicide; any excess mortality from physical illness, most notably cardiovascular disease, now appears unlikely to be a simple consequence of affective illness. Historical comparisons suggest that acute treatment of affective disorder reduces the immediate risk of death. It is much more difficult to assess the impact of treatment upon the subsequent rates of suicide. This is true of all aspects of the acute and short-term continuation of treatment for an episode of illness, from the need for hospital admission to the choice of drug treatment. Adequate treatment of refractory depression and the possibility that some actions of drugs may increase the risks of suicide are emergent therapeutic issues that are still providing more questions than answers. Prophylaxis should also reduce the risk of suicide. However, although standardized mortality rates, reflecting relative risk, are very high, only ∼2% of patients with affective disorder will commit suicide in a follow-up interval of 2 years. Comparison of mortality data for patients on lithium registers with that from lithium clinics shows important reductions in specialized clinics. Indeed, mortality from suicide may actually be lower than expected. It raises the question of whether long- term hospital follow-up by personnel with a specialist interest in drug treatment of major mental illness is safer than a potentially more erratic provision of care in the community. The future issues in the prevention of suicide include whether to treat patients by admission to a hospital in-patient unit or not, whether to treat for at least a year with adequate doses of tricyclic drugs or a selective 5-hydroxytryptamine (5-HT, serotonin) re-uptake inhibitor, and whether to maintain patients with a second episode of affective illness or a prolonged first illness indefinitely with lithium or antidepressants.

Treatment, Prediction of Relapse and Prognosis of Chronic Primary Major Depression

Our study of chronic and non-chronic depressive patients suggests that the following individual factors may predispose a patient to develop chronicity: unipolar depression, neurotic premorbid personality, high familial loading for affective disorder and multiple life events before and after the onset of the illness episode. It is interesting to note that bipolar disorders appear to be under-represented. This may be due to symptomatic chronicity in bipolar illness being more often represented by rapid cycling disorder. Evidence from a group of prospectively ascertained depressives with a median duration of illness of one year showed that apparently 75% of the variance in length of illness episode can be explained. Thus time taken to introduce active treatments, premorbid neuroticism, the occurrence of life events before and after the onset of illness, age at onset of first illness episode and family history of affective disorders were confirmed as important predictor variables. The fact that 85% of patients who develop chronic primary major depressive disorders have previously had an episode of affective illness tends to militate against the stereotype of these patients having a personality disorder. In future, it is important that biological research (for example, neuroendocrine studies) is directed towards chronically depressed patients. In the past, these patients have tended to be excluded from such studies as they represent an atypical population. It is therefore quite clear that future research should be directed towards not only pharmacological but also psychological and social mechanisms which lead to the perpetuation of depressive illness.

Rapid cycling affective disorders in the mentally retarded

This article describes a group of 10 hospitalized, mentally retarded patients with rapid cycling affective disorders, including details of demography, pattern of illness, and response to an open trial of treatment with lithium and/or carbamazepine. Family histories of these patients revealed high rates of mental illness, including affective disorder and mental retardation. Men had an earlier onset of affective illness and rapid cycling than did women. Half of the patients showed partial or complete improvement on lithium alone or in combination with carbamazepine; those who responded to the combined treatment had more episodes of affective illness per year than those who did not. Rates of response to treatment and some clinical characteristics of these patients were similar to those of non-mentally retarded rapid cycling patients.

Genetic approach to heterogeneity in psychoses: relationship of a family history of mania or depression to course in bipolar illness.

A specific family history or genetic background may be used to distinguish valid subgroups in patients who show similar symptoms. Also, a familial background may predict differences in other characteristics, i.e. course of illness, response to treatment or biological characteristics. Two hundred and fifty-one bipolar patients were separated according to their family history, 20 with a family history of mania with or without depression, 86 with a family history of depression only, and 145 with a family history of neither mania nor depression. The group that had a family history of mania was notable in that it showed more episodes of affective illness and was more likely to be readmitted to hospital. This difference in course suggests a familial association with multiple episodes and mania. In other respects than in course of illness, the groups separated by family history were similar.

Transient sensory, cognitive and affective phenomena in affective illness. A comparison with complex partial epilepsy.

Behavioural changes have often been noted in patients with epilepsy. This study investigated the converse phenomenon--the occurrence of transient sensory, cognitive and affective changes resembling those described by epileptics, in affectively ill patients. Forty-four patients with affective illness, 37 with complex partial seizures, and 30 hypertensive controls were interviewed to determine the lifetime occurrence of these phenomena. Such symptoms occurred frequently in association with episodes of affective illness and epilepsy, but were rare in controls. Visual, auditory, olfactory and epigastric symptoms, illusions, jumbled thoughts and amnesia were common to both epilepsy and affective illness. Greater numbers of symptoms were associated with better response to lithium and tricyclic antidepressants. Transient sensory, cognitive, and affective phenomena may be more common in affective illness and other psychiatric conditions than is generally recognised, and may be clues to the underlying pathophysiology of these conditions.

Life events and early and late onset of bipolar disorder.

Forty-six subjects with bipolar disorder and their relatives and friends were interviewed in depth about life events preceding the first and the latest episode of the subject's affective illness. Twenty years of age was the cutting point for dividing the sample into early- and late-onset groups. The late-onset group reported the occurrence of significantly more stressful life events before the first and before the latest episode of affective illness than the early-onset group did.

Life Events at the Onset of Bipolar Affective Illness

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.