History Of Affective Disorder Research Articles

The effect of selective serotonin reuptake inhibitors in healthy subjects. A systematic review

Background: Selective serotonin reuptake inhibitors (SSRIs) show antidepressant properties in many patients with a diagnosis of depression. An understanding of the underlying mechanisms of the effect of SSRIs in healthy patients may lead to an understanding of the yet unclear pathophysiology of depression. Recent reviews of studies investigating the effect of SSRIs in healthy persons conclude that the results are inconsistent and that—in relation to a wide range of outcomes—the effect of SSRIs is limited; however, reasons for the inconsistencies are poorly studied. Aims and Methods: To investigate whether methodological artefacts can explain the diverging findings, we conducted a systematic review of all randomized multiple-dose, placebo-controlled trials on the effect of treatment by SSRI for at least a week in healthy persons published before January 2009. Results: We identified 33 trials, investigating six SSRIs and 163 outcome tests. The effect of SSRI showed divergence presumably related to methodological issues. Specifically, it is likely that the majority of studies included a mix of healthy persons with and without a family history of affective disorders. Few presented information on factors that may influence outcomes such as age, gender, family history of psychiatric disorder, drug levels and ethnicity. No study fulfilled principles of conducting and reporting randomized controlled trials, according to the CONSORT Statement guidelines. Conclusions: It is unclear whether the effect of SSRIs in healthy persons may lead to an understanding of the pathophysiology of depression, since the present evidence is divergent and may be severely influenced by a number of methodological drawbacks.

The BDNF Val66Met polymorphism: Relation to familiar risk of affective disorder, BDNF levels and salivary cortisol

Brain-derived neurotrophic factor (BDNF) and the hypothalamic-pituitary-adrenal (HPA) axis are considered to play an important role in the pathophysiology of affective disorders. The aim of the present study was to investigate whether the BDNF Val66Met polymorphism is associated with a familiar risk of affective disorder and whether these genotypes affect whole blood BDNF level and salivary cortisol. In a high-risk study, healthy monozygotic and dizygotic twins with and without a co-twin (high- and low-risk twins, respectively) history of affective disorder were identified through nationwide registers. Familiar predisposition to unipolar and bipolar disorder was not associated with any specific genotype pattern of the BDNF Val66Met polymorphism, not in this sample of 124 val/val, 58 val/met and 8 met/met individuals. However, the combination of having a high familiar risk of affective disorder and the met allele was associated with a higher whole blood BDNF (p=0.02) and a higher evening cortisol level (p=0.01), but not with awakening cortisol. Individuals at high risk of affective disorders and who are carriers of the met allele of the Val66Met polymorphism may present with an enhanced stress response. The presence of a specific genotype alone may not enhance the risk of developing an affective episode. Rather, the altered stress response may be expressed only in combination with other risk variants through interactions with the environment.

Neural correlates of idiographic goal priming in depression: goal-specific dysfunctions in the orbitofrontal cortex

We used functional magnetic resonance imaging (fMRI) to determine whether depressed (vs non-depressed) adults showed differences in cortical activation in response to stimuli representing personal goals. Drawing upon regulatory focus theory as well as previous research, we predicted that depressed patients would manifest attenuated left orbitofrontal cortex (OFC) activation in response to their own promotion goals as well as exaggerated right OFC activation in response to their own prevention goals. Unmedicated adults with major depression (n = 22) and adults with no history of affective disorder (n = 14) completed questionnaires and a personal goal interview. Several weeks later, they were scanned during a judgment task which (unknown to them) included stimuli representing their promotion and prevention goals. Both groups showed similar patterns of task-related activation. Consistent with predictions, patients showed significantly decreased left OFC and increased right OFC activation compared to controls on trials in which they were exposed incidentally to their promotion and prevention goals, respectively. The results suggest that depression involves dysfunction in processing two important types of personal goals. The findings extend models of the etiology of depression to incorporate cognitive and motivational processes underlying higher order goal representation and ultimately may provide an empirical basis for treatment matching.

Dysregulation of the behavioral activation system in remitted bipolar I disorder.

The current study tests a prediction of the behavioral activation system (BAS) dysregulation theory of bipolar disorder, namely that following high levels of reward or frustration, individuals with bipolar disorder will take longer than will healthy controls to recover to baseline levels of BAS activity. Eighty individuals (40 with bipolar I disorder, currently euthymic; 40 with no history of affective disorder) completed a daily diary over a 28 day period. No differences were found between the 2 groups in terms of the relation among levels of reward or frustration experienced, magnitude of initial response, or time taken to recover. However, examination of the relation between number of previous episodes and time to recover revealed that history of mania was associated with prolonged activation following reward, whereas history of both mania and depression were associated with prolonged recovery following frustration. The findings do not support an association between lifetime diagnosis of bipolar disorder and slow recovery of BAS activity. Nevertheless, they offer tentative support for an association between number of previous episodes and slow recovery of BAS activity.

Cognitive processing in bipolar disorder conceptualized using the Interactive Cognitive Subsystems (ICS) model

BackgroundThere are few theoretical proposals that attempt to account for the variation in affective processing across different affective states of bipolar disorder (BD). The Interacting Cognitive Subsystems (ICS) framework has been recently extended to account for manic states. Within the framework, positive mood state is hypothesized to tap into an implicational level of processing, which is proposed to be more extreme in states of mania.MethodThirty individuals with BD and 30 individuals with no history of affective disorder were tested in euthymic mood state and then in induced positive mood state using the Question–Answer task to examine the mode of processing of schemas. The task was designed to test whether individuals would detect discrepancies within the prevailing schemas of the sentences.ResultsAlthough the present study did not support the hypothesis that the groups differ in their ability to detect discrepancies within schemas, we did find that the BD group was significantly more likely than the control group to answer questions that were consistent with the prevailing schemas, both before and after mood induction.ConclusionsThese results may reflect a general cognitive bias, that individuals with BD have a tendency to operate at a more abstract level of representation. This may leave an individual prone to affective disturbance, although further research is required to replicate this finding.

Midlife Neuroticism and the age of onset of Alzheimer's disease

There may be important public health implications of increasing our knowledge of factors associated with age of dementia onset. The pre-morbid personality domain of Neuroticism constituted an interesting and theoretically plausible, yet uninvestigated, candidate for such an association. We aimed to examine whether midlife Neuroticism was associated with earlier age of onset of Alzheimer's disease (AD). This was a case-comparison study of 213 patients with probable AD. Detailed clinical information was collected for all patients including age of onset of dementia symptoms. One or two knowledgeable informants rated each patient's midlife personality retrospectively using the Neuroticism, Extraversion, Openness Five-Factor Inventory (NEO-FFI) questionnaire. The relationship between midlife Neuroticism and age of dementia onset was evaluated using both correlational analysis and backward linear regression analysis. Midlife Neuroticism predicted younger age of dementia onset in females but not in males. The association found in females was independent of pre-morbid history of affective disorder. This finding and its potential mechanism warrant further investigation.

Mindfulness-Based Cognitive Therapy and Self-Discrepancy in Recovered Depressed Patients with a History of Depression and Suicidality

Long-term vulnerability to depression is related to the presence of perceived discrepancies between the actual self and ideal self-guides. This study examined the immediate effects of an 8-week course of Mindfulness-Based Cognitive Therapy (MBCT) on self-discrepancies in individuals currently in recovery, with a history of affective disorder that included suicidal ideation and behaviour. Results indicated significant time × group interactions for both ideal self similarity and ideal self likelihood ratings, primarily accounted for by increases in self-discrepancy from pre-test to post-test in the waiting list group which were not seen in those receiving MBCT. Changes in self-discrepancy were not associated with changes in residual depressive symptoms, but in the MBCT group there was a significant association between increases in ideal self similarity and the adoption of more adaptive ideal self-guides post treatment. MBCT may protect against increases in self-discrepancy in people vulnerable to relapse to depression and may also facilitate a shift in the goals of self-regulation.

Antidepressant Treatment During Pregnancy: Between Scylla and Charybdis

Antidepressant Treatment During Pregnancy: Between Scylla and Charybdis

Decreased neuroactive steroids induced by combined oral contraceptive pills are not associated with mood changes

To evaluate the effects of a low-dose combined oral contraceptive pill (OCP) on peripheral neuroactive steroid concentrations, precursors for neuroactive steroid synthesis, and mood in healthy women desiring contraception. These neuroactive steroids are gamma-aminobutyric acid receptor agonists and are important in the modulation of affect and adaptation to stress. Prospective observational study. Human ambulatory patient study. Healthy OCP-naive women without current or history of affective disorder. A 0.020-mg ethinyl E2-0.1-mg levonorgestrel containing OCP for 3 months. Serum neuroactive steroids allopregnanolone, allotetrahydrodeoxycorticosterone, and DHEA; neuroactive steroid precursors P and pregnenolone; E2; and mood and anxiety as assessed by the Premenstrual Syndrome Daily Ratings Form, Beck Depression Inventory, Spielberger State-Trait Anxiety Inventory, and Profile of Mood States. The combined OCP resulted in a decrease in neuroactive steroids and neuroactive steroid precursors as well as in E2. However, this decline was not associated with adverse mood changes on any of the well-validated assessment tools. Healthy women without underlying mood or anxiety disorder who were given a low-dose OCP did not experience adverse psychological symptoms despite a significant reduction in neuroactive steroids.

Induced Mood Change and Dysfunctional Attitudes in Remitted Bipolar I Affective Disorder.

This study investigated the possibility that, in remitted bipolar I affective disorder, dysfunctional attitudes are mood-state dependent. Participants were 120 individuals with remitted bipolar I disorder, remitted unipolar depression, or no history of affective disorder. The Dysfunctional Attitudes Scale (DAS; Weissman, 1979) was completed before and after positive or negative mood challenge. Following mood increase, the bipolar group changed significantly less in DAS total score than did the other 2 groups, and in goal-striving and achievement attitudes relative to the unipolar group. These findings did not provide clear support for the mood-state dependency theory in bipolar disorder, arguing instead for the presence in bipolar I disorder of dysfunctional cognitions that show characteristic resilience in the face of minor positive mood increase.

Prevalence of and Markers for Affective Disorders Among Cancer Patients' Caregivers

This study aimed to establish the prevalence of psychiatric morbidity among cancer patients' caregivers and to identify markers of risk. Using the Psychiatric Assessment Schedule (a standardized psychiatric interview), the authors assessed 222 caregivers retrospectively. Thirty-one caregivers (14%) had developed an affective disorder during the two years since the patients' initial cancer diagnoses. Caregivers who were the patient's partner were more likely to develop anxiety, depression, or both when their ill spouse had developed these symptoms. Notably, the prevalence of affective disorders among female caregivers was comparable to the prevalence among patients (23%). Female nonpartner caregivers developed disorders as frequently as partners did. Female caregivers with a prior history of affective disorder who reported more illness-related concerns appeared to be at particular risk, providing useful markers for clinical practice.

Pouch dilatation following laparoscopic adjustable gastric banding: psychobehavioral factors (can psychiatrists predict pouch dilatation?).

Laparoscopic adjustable gastric banding is increasingly being performed in morbidly obese individuals for weight loss. Some patients develop pouch dilatation as a postoperative complication that limits the utility of the procedure. Surgical variables are poor predictors of this complication. 5 patients from a series of 157 who underwent LAGB at a single center developed the condition. Psychiatric and surgical case-notes were analyzed retrospectively for the presence of operationally defined psychiatric disorders and compared to 10 controls from the same population. Cases were significantly more likely to have past or current binge eating, emotionally triggered eating with reduced awareness of the link, a history of affective disorder, reduced sexual functioning and successful preoperative weight loss. No difference between groups was observed for compliance with orlistat, childhood sexual abuse, relationships with parents, history of bulimia nervosa, rate of band inflation or preoperative BMI. Psychological factors may be better predictors of pouch dilatation than biomedical variables. Disordered eating can be an attempt to modulate negative emotions. Pouch dilatation may be a consequence of this eating behavior.

History of affective disorder and the temporal trajectory of fatigue in rheumatoid arthritis.

This study examines whether the general level and rate of change of fatigue over time is different for those rheumatoid arthritis (RA) patients with and those without a history of affective disorder (AD). Four hundred fifteen RA patients from a national panel had yearly telephone interviews to obtain fatigue and distress reports, and a one-time semistructured assessment of the history of depression and generalized anxiety disorder Growth-curve analysis was used to capture variations in initial fatigue levels and changes in fatigue over 7 years for those with and without a history. RA patients with a history of major AD reported levels of fatigue that were 10% higher than those without a history in the 1st year of the study. Their fatigue reports remained elevated over 7 years. Further analysis showed that the effects of a history of AD on fatigue are fully mediated through current distress, although those with a history had a significantly smaller distress-fatigue slope. Thus, a history of AD leaves RA patients at risk for a 7-year trajectory of fatigue that is consistently higher than that of patients without a history. The elevation in fatigue reports is, at least in part, a function of enduring levels of distress.

Natural history of affective disorders: Comorbidity as a predictor of suicide attempts

OBJECT: Comorbidity of psychiatric illnesses and substance misuse can lead to an increase in suicide attempts. METHOD: Retrospective data collection from case notes of 81 consecutive admissions to an acute psychiatric ward. Previous diagnoses, substance misuse and suicidal attempts were all examined. RESULTS: The rate of suicide attempts among all groups was 40.7%. Alcohol abuse or use of illegal drugs was reported in 69.7% of suicide attempters. More than half of the patients (66.7%) overconsumed alcohol. CONCLUSION: Clinical implication of the effect of comorbidity on suicidal behaviour and length of stay are discussed.

Irritable Bowel Syndrome

Irritable Bowel Syndrome (IBS) is a common gastrointestinal disorder. Abdominal pain or discomfort relieved by bowel movements and worsened by stress suggest a brain/gut disorder. Associated factors include a history of affective disorders, sexual or physical abuse, low fiber intake, certain foods, and drugs. Diagnosis is one of exclusion and is based on the Rome Criteria. Symptom control is a reasonable treatment goal using fiber-containing foods, bulk laxatives, antidiarrheals, and antispasmodics. Tricyclic antidepressants may relieve unremitting pain and improve daily functioning. Other measures include patient education and reassurance, behavioral therapy, reduction of stress, and inclusion of the patient and family in the treatment plan.

Lupron-induced mania

Background: Gonadotropins and sex hormones are intimately related to the stability of affective states. Patients with affective disorders may demonstrate abnormal levels of sex hormones and gonadotropins. It is therefore possible that affective disorder patients may experience mood dysregulation by synthetic sex hormones and gonadotropins like lupron.Methods: A case report of a young woman with a history of endometriosis and a past history of irritability and depression is described. Treatment of the endometriosis with lupron induced a manic episode.Results: The lupron-induced mania was successfully treated with a mood-stabilizing agent, lithium carbonate.Conclusions: Patients with a history of affective disorder may develop manic episodes when treated with Lupron. Mood-stabilizing agents are helpful in ameliorating this unwanted effect.

The effect of maternal depression in the context of risk in a poor urban sample of mothers and their toddlers

The relationship between parental psychopathology and psychiatric disturbance in 153 offspring aged 6–19 was assessed in 81 families randomly selected from a prepaid health plan. Offspring of parents with a history of affective disorders and of parents with non-affective psychiatric disorders had higher rates of psychiatric diagnoses and poorer adaptive functioning than children of parents who had never experienced a psychiatric illness. Offspring whose parents had affective disorder had a rate of affective disorder of 30% compared to a rate of 2% in the rest of the sample. This relationship between parental affective disorder and poor child outcome was observed when the separated and divorced families were removed from the analyses.

Risk factors for DSM-III-R posttraumatic stress disorder: findings from the National Comorbidity Survey.

The present study examined the association of childhood risk factors with exposure to traumas and posttraumatic stress disorder (PTSD). PTSD is a unique symptom configuration after exposure to an unusual, extreme event. Data come from the US National Comorbidity Study of 5,877 respondents aged 15-54 years conducted between September 1990 and February 1992. The risk factors examined were preexposure affective, anxiety, and substance use disorders; parental mental and substance use disorders; parental aggression toward the respondent and toward the other parent; and a nonconfiding relationship with the mother during childhood. Analyses were stratified by gender and adjusted for demographic variables and traumatic experiences prior to the index trauma. The occurrence of trauma was associated with many risk factors in women but few in men. Similarly, more risk factors predicted PTSD in women than in men. Overall, when respondents were grouped into broad trauma categories, an increase in the number of risk factors was associated with higher rates of PTSD. However, in analyses of the trauma subsample that adjusted for individual type of trauma (e.g., rape, physical attack), only one risk factor (history of affective disorder) predicted PTSD in women, and two (history of anxiety disorder and parental mental disorder) predicted PTSD in men. The results thus indicate that although these risk factors have an important association with PTSD, they operate largely by predicting trauma exposure rather than by predicting the onset of disorder after exposure.

How does marriage protect women with histories of affective disorder from post-partum relapse?

Interviews were carried out at 36 weeks antenatal with 63 married couples, in 36 of which the woman had a history of affective disorder and in 27 the woman had no previous psychiatric history. The men's attitudes to their wives were assessed using expressed emotion methodology. Also assessed were psychiatric history, neuroticism, satisfaction with the marital relationship and attitudes to sex, pregnancy and parenthood in both the woman and her partner. Women with psychiatric histories who did not relapse in the six months following delivery had partners who were more positive about them than partners of high-risk women who remained well and control women. This effect is explored further by examining which characteristics of the man and which of the woman contributed to his critical and positive comment score. Criticism of his wife was associated with each partner reporting less marital satisfaction and also with the man's psychiatric history. No characteristic of the woman contributed to her partner's criticism. In contrast, the men's positive comments about their wives were associated with the woman's satisfaction with key aspects of her femaleness. Positive husbands had wives were pleased to be pregnant, happy with their pregnant bodies and enjoying the sexual aspect of the marital relationship. In women with psychiatric histories the time which had elapsed since her last psychiatric admission also influenced his positive comments.

Mania and Cortical Lewy Body Dementia

A case of mania occurring after the onset of cortical Lewy body dementia is described in a lady with no family history or previous history of affective disorder. It is proposed that cortical Lewy body dementia should be considered as a cause of secondary mania. The difficulties of treating mania in this context are discussed.