Number Of Depressive Episodes Research Articles

Bipolar Bozukluk Ve Özkıyım / Bipolar Disorder and Suicide

Objective: The risk factors associated with suicidal behaviour in bipolar patients still are not clear. We aimed to evaluate the frequency of suicide attempt, type of suicide attempt and significant clinical characteristics associated with suicide attempts. Methods: One hundred twenty two consecutive patients, from Bipolar Disorder Unit of Cukurova University, Faculty of Medicine, Department of Psychiatry, are included in this study. “Affective Disorders Patient Registry Form” was developed by Bipolar Disorder Unit and SCID-I were used in this study to collect the data. These forms are filled in through interviews with patients and their relatives, and evaluation of inpatient files. Results: The prevalence of suicide attempt was 19.7% in the outpatient group. Lifetime history of suicidal behavior was significantly associated with following characteristics: being a woman, depression as a first episode and indicators of severity of bipolar disorder including duration of illness, duration of untreated illness (latency), number of hospitalization, number of total mood episodes, number of depressive episodes, number of mixed episodes, positive familial psychiatric disorder history. Conclusion: Our study showed that patients with bipolar disorder have a high rate of suicide attempt. Reduction of the duration of untreated illness, prevention of mood episodes, assessment of suicide risk during depressive and mixed episodes should be the main targets of the treatment. Detection of warning signs about suicide among patients with bipolar disorder may help to distinguish the risky group and prevent suicide.

Does sex moderate the clinical correlates of pediatric bipolar-I disorder? Results from a large controlled family-genetic study

BackgroundSince little is known as to whether sex differences affect the clinical presentation of pediatric BP-I disorder, it is an area of high clinical, scientific and public health relevance. MethodsSubjects are 239 BP-I probands (65 female probands, 174 male probands) and their 726 first-degree relatives, and 136 non-bipolar, non-ADHD control probands (37 female probands, 99 male probands) and their 411 first-degree relatives matched for age and sex. We modeled the psychiatric and cognitive outcomes as a function of BP-I status, sex, and the BP-I status-gender interaction. ResultsBP-I disorder was equally familial in both sexes. With the exception of duration of mania (shorter in females) and number of depressive episodes (more in females), there were no other meaningful differences between the sexes in clinical correlates of BP-I disorder. With the exception of a significant sex effect for panic disorder and a trend for substance use disorders (p=0.05) with female probands being at a higher risk than male probands, patterns of comorbidity were similar between the sexes. Despite the similarities, boys with BP-I disorder received more intensive and costly academic services than girls with the same disorder. LimitationsSince we studied children referred to a family study of bipolar disorder, our findings may not generalize to clinic settings. ConclusionsWe found more similarities than differences between the sexes in the personal and familial correlates of BP-I disorder. Clinicians should consider bipolar disorder in the differential diagnosis of both boys and girls afflicted with symptoms suggestive of this disorder.

Cognitive function in first episode major depressive disorder: Poor inhibition and semantic fluency performance

Introduction.Executive Functions (EF) has been documented to be impaired in patients with recurrent Major Depressive Disorder (MDD) in several studies. Longitudinal studies have suggested that these impairments may be a result of several episodes of depression or they may represent stable traits in this patient group. However, few studies have addressed these issues and investigated cognitive functioning with a particular focus on EF in patients who experience MDD for the first time.Methods.In the present study, the executive functions of inhibition, verbal fluency, mental flexibility, and planning and problem solving were investigated in a group of patients diagnosed with first episode MDD. Thirty patients and 30 control subjects were included in the study.Results.The patient group performed significantly more poorly in the cognitive functions of inhibition and semantic fluency. In addition, the patient group showed a reduced speed of mental processing on some of the measures. However, the results showed that reduced processing speed alone could not account for the poor performance in inhibition and semantic fluency. There were no differences between the two groups in the other measures of EF, indicating that functioning of mental flexibility, phonemic fluency, planning, and problem solving was intact in the patient group.Conclusions.The results show that impaired inhibition and semantic fluency are present early in the course of MDD. The present findings indicate that poor inhibition and performance in semantic fluency may represent stable traits in MDD, independent of symptom severity and the number of depressive episodes.

Prevalence of restless leg syndrome in subjects with depressive disorder

Background:Restless legs syndrome (RLS) is known to be associated with depression. We hypothesized that RLS in depression is linked to the severity, duration, and frequency of depressive episodes.Materials and Methods:Subjects fulfilling DSM-IV-TR criteria of depressive disorders were included in this study after seeking informed consent. Using structured interview of MINI-Plus their demographic data and history were recorded. Severity of depression was assessed with the help of HAM-D. Insomnia was diagnosed following ICSD-2 criteria. RLS was diagnosed according to IRLSSG criteria. Descriptive statistics, Chi-square test, independent sample t test and MANOVA were computed with the help of SPSS v 17.0.Results:RLS was reported by 31.48% of sample. There was no gender difference in prevalence of RLS (X2 =0.46; P=0.33). There was no difference in the age , total duration of depressive illness and number of depressive episodes between RLS and non-RLS groups (F=0.44; P=0.77; Wilk's Lambda=0.96). The HAM-D score was higher in the non-RLS group (P=0.03). Onset of RLS symptoms was not related to onset of depressive symptoms.Conclusion:RLS is prevalent in depressive disorder. However, onset of RLS is unrelated to age and number or duration of depressive disorders.

Probabilistic analysis of depressive episodes: Application of renewal theory under uniform probability law

The renewal process has been formulated on the basis of hazard rate of time between two consecutive occurrences of depressive episodes. The probabilistic analysis of depressive episodes can be performed under various forms of hazard rate viz. constant, linear etc. In this paper we are considering a particular form of hazard rate which is h(x)=(b-x)^- where b is a constant, x is the time between two consecutive episodes of depression. As a result time between two consecutive occurrences of depressive episodes follows uniform distribution in (a,b). The distribution of range i.e. the difference between the longest and the shortest occurrence time to a depressive episode, and the expected number of depressive episodes in a random interval of time are obtained for the distribution under consideration. If the closed form of expression for the waiting time distribution is not available, then the Laplace transformation is used for the study of probabilistic analysis. Hazard rate of occurrence and expected number of depressive episodes have been presented graphically.

Affective set-shifting deficits in patients with major depression in remission

While numerous studies have focused on neuropsychological deficits during acute depressive episodes, results have been inconsistent for patients in remission. This case–control study aimed to explore whether remitted patients show deficits in an affective shifting task that has proven sensitive to assess emotional–cognitive deficits in acute depression. 69 fully remitted depressed patients were compared with 76 matched healthy subjects in their performance of a picture-based affective shifting task. Compared to healthy subjects, remitted patients show impaired go/no-go performance during shift, but not during non-shift conditions, reflecting a specific deficit in affective set-shifting. Impaired performance concerns omissions rather than false alarms or response times and is correlated with the duration of illness, but not the number of depressive episodes, time since remission or age. Our findings suggest that affective set-shifting deficits are also present during remission of depressive symptoms. These deficits may particularly concern enhanced inhibitory control and seem to develop over the course of the illness independent of acute episodes.

Serum brain-derived neurotrophic factor, vascular endothelial growth factor and leptin levels in patients with a diagnosis of severe major depressive disorder with melancholic features

Brain-derived neurotrophic factor (BDNF), vascular endothelial growth factor (VEGF) and leptin have been hypothesized to be involved in the neurobiology of depression. The aim of this study was to investigate BDNF, VEGF and leptin levels in patients with severe melancholic depression. A total of 40 drug-free patients with major depressive disorder (MDD) with melancholic features and 40 healthy controls were included in the study. Demographic information, psychiatric evaluation and physical examination were documented for both groups. Serum BDNF, VEGF levels were determined by enzyme-linked immunosorbent assay and leptin with radioimmunoassay methods. The Hamilton Depression Rating Scale and Hamilton Anxiety Rating Scale were applied to the patients. There were no significant differences in serum BDNF, VEGF and leptin levels between the patient and control groups. There was a negative correlation between BDNF levels and the number of depressive episodes. It was noted that VEGF levels decreased with increasing severity of depression. These findings suggest that BDNF levels might be associated with the recurrence of depression and VEGF levels might be a determinant of the severity of depression.

P-204 - Clinical features of bipolar depression versus unipolar depression: a preliminary study

Depressive episodes in bipolar type I, II and unipolar disorder have many common traits, but also differences. Failing to diagnose bipolar disorder in patients who are in a severe depressive episode can lead to unfortunate treatment options and a poor outcome. Identifying differences in clinical features of bipolar and unipolar depression. Identifying clinical features that distinguish bipolar from unipolar depression will allow better treatment options, improve the outcome and the quality of life of the patients. The preliminary study is being conducted in Timisoara, Romania and consists of 76 in- and outpatients from the Timisoara Psychiatric Clinic and the Timisoara Mental Health Center, diagnosed with either bipolar type I, II or recurrent depressive disorder, according to ICD-10 criteria. 5 separate assessments will be made over a period of 20 months, comprising of a battery of assessment scales and tests, including neurocognitive assessments. The preliminary results show an association between the age of onset (earlier in bipolar depression), atypical depressive symptoms (more frequent in the bipolar group), number of depressive episodes (a higher number in the bipolar group), somatic symptoms (more frequent in the unipolar group) and cognitive functioning (less impared in the unipolar group). Initial results show that there are subtle differences in presentation between bipolar and unipolar depression and that these differences may help guide the initial diagnosis.

P-474 - Duration of untreated illness and long-term outcome in major depressive disorder

Introduction A number of studies of a possible relationship between duration of untreated illness (DUI) and various psychiatric disorders shown the possible role of DUI as negative prognostic factor in schizophrenia and psychotic disorders. On the other hand few data evaluate the role of DUI in the clinical outcome of major depressive disorder. Objectives Analyze the duration of untreated illness and evaluate long-term outcomes in major depressive disorder. Method Sample of 73 subjects (53F and 20M) with major depressive disorder according to DSM-IV-TR. We collected demographic, clinical and outcome data: age, sex, family history, age at onset of illness, age of first antidepressant treatment and dosage, possible comorbidity with other diagnoses and substance abuse, number of depressive episodes before and after treatment, number of hospitalizations and suicide attempts. Results Results show that the DUI is longer in the male than in the female sample (p = 0.049) and long DUI is related to an onset disorder at a younger age (p = 0.040) and with a longer duration of illness (p = 0.006). It was also demonstrated that the number of depressive episodes prior to the first antidepressant treatment is higher in the sample of patients with a longer DUI (p = 0.006). Discussion These results show that the duration of untreated illness is longer in the male sample; other results are consistent with previous studies and show a better outcome of depression in patients with a short duration of untreated illness.

P-471 - Evaluation of potential predictors of response to treatment with adjunct extended release quetiapine fumarate (quetiapine XR) in patients with MDD

Introduction Two 6-week, double-blind, placebo-controlled studies evaluated quetiapine XR (QTP-XR) adjunct to ongoing antidepressant therapy in patients with MDD and an inadequate response to prior antidepressant treatment (D14486/D14487). Objective and aim A post hoc pooled analysis examined clinical and demographic characteristics as potential predictors of response to adjunct QTP-XR Methods Pooled MITT population (n = 616 QTP-XR [both doses]; n = 303 placebo) data were analysed from the two adjunct QTP-XR (150 or 300 mg/day) studies. Effects of psychiatric history and baseline demographic and disease characteristics on efficacy were evaluated in subgroups based on Week 6 MADRS total score reduction: ≥50% reduction (responders: n = 345 QTP-XR, n = 140 placebo) versus Impact of baseline CGI-S score and number of episodes (0, 1, 2–3, 4–10, ≥10) over previous year and lifetime on Week 6 MADRS total score change was evaluated. Effect of baseline MADRS individual item (1–10) scores on Week 6 change in CGI-I score was evaluated. Results No major differences between responders and non-responders to QTP-XR were observed for patient characteristics. There was no predictive association between baseline CGI-S score, number of depressive episodes, and baseline MADRS item scores and efficacy outcomes for adjunct QTP-XR. Conclusions This pooled analysis showed no major differences between responders and non-responders, and no suggestion of a predictive association between the parameters assessed and efficacy outcomes for adjunct QTP-XR. Further investigation including logistic regression may be required. AstraZeneca funded.

Insomnia Associated with Depressive Disorder: Primary, Secondary, or Mixed?

Background:Insomnia is a common problem that is known to occur during depression. However, literature still debates whether insomnia is part of depression or a separate entity.Materials and Methods:Subjects presenting with depressive disorder according to DSM-IV-Text Revision criteria were recruited after seeking informed consent. Clinical interview was performed with the help of Mini International Neuropsychiatric Interview Plus. Their demographic data and depression related history were recorded. Depression severity was assessed by using Hamilton Rating Scale for Depression. Diagnosis of insomnia was made with the help of International Classification of Sleep Disorders-2 criteria. Type of insomnia, its duration, and its relationship with depressive illness were specifically asked. If any subject fulfilled criteria for more than one type of insomnia, both were recorded. Statistical analysis was done with the help of statistical package for social sciences (SPSS) version 17.0. χ2 test, independent sample t test, and Pearson's correlation were performed.Results:A total of 54 subjects were enrolled in this study. Primary insomnia was seen in 40.7% cases and secondary insomnia in 58.8% cases; 27.3% subjects did not experience insomnia along with depressive disorder. In the primary insomnia category, adjustment insomnia was most prevalent (63.6%), and in secondary insomnia group, insomnia due to depressive disorder was most frequent (59.3%). Interestingly, primary insomnia often followed an onset of depressive illness (P=0.04), while secondary insomnia preceded it (c2 =11.1; P=0.004). The presence of either type of insomnias was not influenced by duration of depressive illness, number of depressive episodes, and duration of current depressive episode. On the other hand, duration of insomnia was positively correlated with total duration of depressive illness (P=0.003), number of episodes (P=0.04), and duration of current depressive episode (P<0.001).Conclusion:Primary insomnia is common in subjects with depression, and it usually follows depressive illness. On the other hand, secondary insomnia often precedes the onset of depressive illness. Duration of insomnia positively correlates with duration and frequency of depressive episodes.

Progressive neurostructural changes in adolescent and adult patients with bipolar disorder

Several lines of evidence suggest that bipolar disorder is associated with progressive changes in gray matter volume (GMV), particularly in brain structures involved in emotional regulation and expression. The majority of these studies however, have been cross-sectional in nature. In this study we compared baseline and follow-up scans in groups of bipolar disorder and healthy subjects. We hypothesized bipolar disorder subjects would demonstrate significant GMV changes over time. A total of 58 bipolar disorder and 48 healthy subjects participated in structural magnetic resonance imaging (MRI). Subjects were rescanned 3-34 months after their baseline MRI. MRI images were segmented, normalized to standard stereotactic space, and compared voxel-by-voxel using statistical parametrical mapping software (SPM2). A model was developed to investigate differences in GMV at baseline, and associated with time and episodes, as well as in comparison to healthy subjects. We observed increases in GMV in bipolar disorder subjects across several brain regions at baseline and over time, including portions of the prefrontal cortex as well as limbic and subcortical structures. Time-related changes differed to some degree between adolescent and adult bipolar disorder subjects. The interval between scans positively correlated with GMV increases in bipolar disorder subjects in portions of the prefrontal cortex, and both illness duration and number of depressive episodes were associated with increased GMV in subcortical and limbic structures. Our findings support suggestions that widely observed progressive neurofunctional changes in bipolar disorder patients may be related to structural brain abnormalities in anterior limbic structures. Abnormalities largely involve regions previously noted to be integral to emotional expression and regulation, and appear to vary by age.

Sex-specific cortisol levels in bipolar disorder and schizophrenia during mental challenge — Relationship to clinical characteristics and medication

Our objective was to examine the cortisol release during a mental challenge in severe mental disorders versus healthy controls (HC), analyzing effects of sex, clinical characteristics and medication, and comparing Bipolar Disorder (BD) to Schizophrenia (SCZ). Patients with BD and SCZ (n=151) were recruited from a catchment area. HC (n=98) were randomly selected from the same area. Salivary samples were collected before and after a mental challenge and cortisol levels determined. During the challenge there was an interaction between group and sex (P = 0.015) with male patients having a blunted cortisol release compared to male HC (P = 0.037). Cortisol change did not differ significantly between BD and SCZ. In all patients, the cortisol change correlated with number of psychotic episodes (r = -0.23, P = 0.025), and in females patients, with number of depressive episodes (r = -0.33, P = 0.015). Patients using antidepressants had a greater cortisol release during challenge than those not using antidepressants (P = 0.043). Male patients with severe mental disorders seem to have a uniform abnormal cortisol release during mental challenges which associates with clinical course, and with beneficial effects of antidepressants.

P02-313 - Neurotransmitters related to depression and psychosis in patients with temporal lobe epilepsy

IntroductionEpilepsy affects between 1 and 2% of the world population. Drug refractoriness is common and about 40% of patients suffer from psychiatric disorders.ObjectiveKnowing noradrenaline, dopamine, serotonin and substance P receptors’ role in hippocampi removed from people with temporal lobe epilepsy (TLE) with or without psychiatric comorbidity.AimsTo assess whether there are differences in different neurotransmitters’ roles in TLE with or without psychiatric comorbidity.MethodTacMan real-time PCR assay to quantify the receptors’ mRNA in 48 TLE patients without (Epilepsy-24) or with psychosis (Psychosis-10) or depression (Depression-14) and 8 necropsies (Controls).ResultsAD2A and AD2C showed differences and more expression in the Epilepsy group when compared with Control and Psychosis. AD2A showed significance in the Antiepileptic variable, a substance that activates AD2A in the hippocampus. AD2A and AD2C without difference for Epilepsy and Depression indicate a two-way relation or common pathogenesis between these illnesses; and their minor expression in the Psychosis group suggests different adrenergic mechanisms connected with psychosis and epilepsy. D2 showed a significant difference in the Psychiatric Diagnosis Subtype and Epileptic Seizures frequency, probably due to chronicity and number of depressive episodes. The role of 5-HT2A in TLE is indicated by its greater expression in the Epilepsy group when compared with the Control, with significance for the Epileptic Seizures frequency. No significant results were found for D4, 5-HT1A, 5-HT2C and NK1.ConclusionProspective research with complementary methods (immunohistochemistry, in situ hybridization, electronic microscopy and neuroimaging) is suggested to identify, locate and visualize the receptors’ distribution.

Impulse control disorder comorbidity among patients with bipolar I disorder

Objective Impulsivity is associated with mood instability, behavioral problems, and action without planning in patients with bipolar disorder. Increased impulsivity levels are reported at all types of mood episodes. This association suggests a high comorbidity between impulse control disorders (ICDs) and bipolar disorder. The aim of this study is to compare the prevalence of ICDs and associated clinical and sociodemographic variables in euthymic bipolar I patients. Method A total of 124 consecutive bipolar I patients who were recruited from regular attendees from the outpatient clinic of our Bipolar Disorder Unit were included in the study. All patients were symptomatically in remission. Diagnosis of bipolar disorder was confirmed using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Impulse control disorders were investigated using the modified version of the Minnesota Impulsive Disorders Interview. Impulsivity was measured with the Barratt Impulsiveness Scale Version 11. Furthermore, all patients completed the Zuckerman Sensation-Seeking Scale Form V. Results The prevalence rate of all comorbid ICDs in our sample was 27.4% (n = 34). The most common ICD subtype was pathologic skin picking, followed by compulsive buying, intermittent explosive disorder, and trichotillomania. There were no instances of pyromania or compulsive sexual behavior. There was no statistically significant difference between the sociodemographic characteristics of bipolar patients with and without ICDs with regard to age, sex, education level, or marital status. Comorbidity of alcohol/substance abuse and number of suicide attempts were higher in the ICD(+) group than the ICD(−) group. Length of time between mood episodes was higher in the ICD(−) group than the ICD(+) group. There was a statistically significant difference between the total number of mood episodes between the 2 groups, but the number of depressive episodes was higher in the ICD(+) patients as compared with the ICD(−) patients. There was no statistically significant difference between the age of first episode, seasonality, presence of psychotic features, and chronicity of illness. A statistically significant difference was observed between the ICD(+) and ICD(−) groups in terms of total impulsivity, attention, nonplanning, and motor impulsivity scores as determined by the Barratt Impulsiveness Scale Version 11. Conclusion The present study revealed that there is a high comorbidity rate between bipolar disorder and ICDs based on Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, criteria. Alcohol/substance use disorders, a high number of previous suicide attempts, and depressive episodes should alert the physician to the presence of comorbid ICDs among bipolar patients that could affect the course and treatment of the disorder.

P.2.a.028 The effect of the number of depressive episodes on fatigue in female patients with major depression

P.2.a.028 The effect of the number of depressive episodes on fatigue in female patients with major depression

Gender differences in the developmental course of depression

Background There is ample evidence for female preponderance of major depressive disorder (MDD) in adolescence and adulthood. This study examined gender differences in the developmental course (i.e., incidence, duration, number of depressive episodes, and recovery rates) of MDD in non-referred adolescents and young adults. Methods Data from the Oregon Adolescent Depression Project were used to examine gender differences in the developmental course of MDD. Gender differences in the onset, duration, number of depressive episode and rate of recovery from MDD were examined in a population-based sample of the same individuals (participants: N = 773) during adolescence (age 14 to 17) and at age 30. Results Compared to males, females have higher incidence rates of MDD and had a more chronic course. Difference in duration of depressive episodes is marginally significant between male and female, with females having longer episodes. Lower onset age correlates significantly with more number of episodes in both genders; however, lower onset age predicts a worse course of depression only in females. Limitations The sample was from a single region of the country and consisted mostly of White adolescents. Conclusions Childhood depression may be a more serious risk factor for girls than for boys.

Insular cortex volume in established bipolar affective disorder: A preliminary MRI study

This structural magnetic resonance imaging study investigated insular cortex volume in 26 patients with bipolar I disorder and 24 matched controls. While insular volume did not differ between these groups, exploratory analyses demonstrated that the number of depressive episodes correlated negatively with the anterior insular volume in the patients, suggesting it may have a role in the pathophysiology of bipolar disorder.

Cortical thickness and voxel-based morphometry in depressed elderly

This is the first study to examine concurrently cortical thickness and voxel-based morphometric (VBM) abnormalities in patients with major depressive disorder (MDD). In the current study we set out to investigate depressed elderly patients to determine whether a previous depression is related to neurobiological abnormalities in older age. Cortical thickness measures and VBM were applied to the same magnetic resonance imaging data set of 28 female elderly subjects with MDD and 38 age-matched control subjects. Two principal findings emerge from this study. First, no effect of illness on cortical thickness or gray matter density measurements was found. Moreover, life time depression, severity of illness and the number of depressive episodes were not associated with neurobiological abnormalities in older age in our patient group. Second, a diffuse pattern of highly significant age effects was found in cortical thickness as well as in the VBM measurements in the same areas, irrespective of diagnosis. In contrast to most findings of the literature to date, the results from this study indicate that lifetime depression as well as current state does not seem to influence brain structure in depressed female elderly.

The role and impact of contextual factors on functioning in patients with bipolar disorder

Purposes. The International Classification of Functioning, Disability and Health, provides the framework to describe individual's functioning and allows the study of the interaction between patient's health status and the environmental factors involved. The main aim of this study was to analyse systematically those factors involved in the functioning of bipolar patients including the role of contextual factors.Methods. Eighty-eight euthymic patients with a diagnosis of bipolar disorder were included. To examine the importance of contextual factors above and over clinical variables after controlling of potential socio-demographic variables, a hierarchical multiple regression was used.Results. Clinical variables that significantly predicted patient functioning were the total number of episodes, number of depressive episodes, family history of psychiatric disorders and mild subdepressive symptoms, accounting for 34.1% of the variance of functioning (F = 2.14, p = 0.011). Contextual factors, including dysfunctional attitudes and perceived social support, accounted for 17.5% of the variance (F = 3.04, p < 0.001).Conclusions. Contextual factors appear to play a significant role in explaining bipolar patients' functioning after controlling for socio-demographic and clinical factors. These findings suggest that psychosocial interventions might be helpful to reduce or prevent disability associated to bipolar disorder. From an ICF model, understanding those factors may be useful to produce policy recommendations and guidelines.