Recurrent Affective Disorders Research Articles

The Course Patterns and Diagnostic Shifts of Patients With Schizoaffective Disorder: A Retrospective Cohort Study.

Since its introduction, schizoaffective disorder (SAD) has been one of the most controversial diagnoses in psychiatry, both clinically and nosologically. In the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), SAD diagnostic criteria were changed, and instead of a cross-sectional diagnosis, a longitudinal approach covering the life course of the illness was adopted. In this study, the meaning of this conceptual shift in the diagnosis of SAD in clinical practice is investigated throughout the course of the illness for patients with SAD. Sixty-two inpatients diagnosed with SAD according to DSM-5 diagnostic criteria are included in this study. The course of the illness from its onset to the present is investigated retrospectively. The disease duration is 18.3 ± 9.1 years. The most common diagnoses in the first hospitalization are bipolar disorder (manic episodes) and psychotic disorder, not otherwise specified. Furthermore, the time that elapsed between the first psychiatric application of the patients and the diagnosis of SAD is 9.5 ± 7.3 years. Further, when the course of the illness is grouped according to the predominance of affective and psychotic disorders, recurrent affective disorders are observed most frequently (29.3%), followed by mixed-episode disorders and a shift from affective disorders to psychotic disorders (22.4%). It is found that SAD has a heterogeneous course, and affective disorder diagnoses are more dominant during the course of the illness. The clinical relevance of the longitudinal emphasis on the total duration of the illness in the DSM-5 is also demonstrated. The affective and psychotic dichotomy, based on Kraepelin, has failed to elucidate the course of the disease in clinical practice. Therefore, clinicians should meticulously evaluate the entire course of the illness for SAD and avoid conclusive judgments over a single episode.

Life stress and Bipolar Disorder: regarding a clinical case

IntroductionResearch on life stress in bipolar disorder largely fails to account for the possibility of a dynamic relationship between psychosocial stress and episode initiation. The kindling hypothesis states that over the course of recurrent affective disorders, there is a weakening temporal relationship between major life stress and episode initiation that could reflect either a progressive sensitization or progressive autonomy to life stress.ObjectivesTo explore the concept of the Kindling model applied to bipolar disorder and to present a clinical case of a bipolar patient whose latter mood episodes were caused by adverse life events.MethodsWe performed a non-systematic literature review using the most relevant papers found on the database PubMed with the keywords “kindling effect”, “allostatic load”, “bipolar disorder” and “prevention”. Description of the clinical case report.ResultsThe phenomenon of kindling was first discovered by Goddard in 1967 who described it in epilepsy. Later, Post applied it to the bipolar disorder, arguing that the initial episodes of both unipolar and bipolar affective disorders are often precipitated by psychosocial stressors, but after multiple recurrences, not only do precipitated episodes continue to occur, but so do spontaneous ones as well. We present the case report of a 62 years old woman, divorced, diagnosed with type 1 bipolar disorder since she was 20 years old. She always have had poor adherence to her medication and follow-up with Psychiatry consultation, with a non-containing sociofamily environment that does not promote clinical stability. Over the time, her admissions on the Psychiatry ward were more frequent and precipitated by adverse life events, mainly caused by the deteriorated relationship with her children.ConclusionsThe kindling model clarifies aspects of the longitudinal course of episode development, recurrence, and progression to spontaneity, as well as further conceptual and theoretical rationales for intervention in order to prevent illness progression.Disclosure of InterestNone Declared

Chemical Element Profiling in the Sera and Brain of Bipolar Disorders Patients and Healthy Controls.

Bipolar Disorder (BD) is a severe recurrent affective mood disorder characterized by a wide range of lifelong mood swings, varying between depressive and manic states. BD affects more than 1% of the world's population irrespective of nationality, ethnic origin, or socioeconomic status and is one of the main causes of disability among young people, leading to cognitive and functional impairment and raised mortality, particularly death by suicide. Trace elements play a vital role in many biochemical and physiological processes. Compelling evidence shows that element toxicity might play a crucial role in the onset and progression of neurodegenerative disorders, but their involvement in mood disorders has been scarcely studied. In the present investigation, we determined the concentration of 26 elements in the serum of BD patients before and after treatment and in postmortem brain samples from BD patients and compared them with matched controls. The only element that was reduced significantly in the serum following treatment was vanadium (V). Furthermore, the concentration of Al, B, Cu, K, Mg and V were significantly lower in the pre-frontal cortex of BD patients compared with those of the controls. A comparison of Spearman's rank correlation coefficients between the elements in the serum and brain of BD patients and control groups pointed to boron and aluminum as being involved in the disease. These results suggest that there is a disturbance in the elements' homeostasis and the inter-elements' relationship in the brain of BD patients and advocate a thorough examination of the possible involvement of chemical elements in different stages of the disease.

Profiles of the Patients and Their Referral Patterns Visiting the Psychiatry Clinic of a General Hospital Setting Located in a Mental Health Resource Deficient Region of India: A Retrospective Observational Study.

Objectives Treatment for mental health problems is determined by cultural, health infrastructure, and illness-related factors. Literature is sparse from India, particularly from the mental health resources-deficient regions of the country such as central India. Therefore, the current study is aimed at assessing the profile of the patients visiting the psychiatry outpatient facility (OPF) of a tertiary-care general hospital setting (GHS), their referral patterns, and their determinants. Materials and Methods A retrospective chart review of the newly registered individuals (October 2019 to March 2020) in the psychiatry OPF of the GHS from Central India was used in the study. Data (sociodemographic profiles, illness characteristics, and referral patterns) were extracted as per the standard guidelines. Statistical Analysis Descriptive statistics were used to represent sociodemographic, illness-, and past treatment-related characteristics of the participants. Chi-squared test was used to compare the referral characteristics of the two groups (self-referred patients vs. those referred by others, dependent variable) with regard to characteristics of the patients (independent variables). Results A total of 418 individuals were registered in the clinic. Most individuals suffered from the neurotic, stress-related, and somatoform group of disorders ( n = 231, 39.5%). More than halves were self-referred; most were referred from the internal medicine and allied departments. Being male, having at least graduate degree (χ 2 df(1) = 4.25 to 6.79, p < 0.05), suffering from organic mental-, psychotic-, and recurrent affective-disorders, and positive family history (χ 2 df(1) = 4.91 to 21.76, p < 0.05 to <0.001) along with first treatment attempt or previous treatment from the traditional healers, and absence of co-occurring medical illness were associated with self-referral (vs. referred by others) (χ 2 df(1) = 4.64 to 17.6, p < 0.05 to <0.001). Conclusions GHS has a characteristic referral pattern. The referral patterns of the patients for various psychiatric problems are determined by their sociodemographic, illness, and cultural characteristics; particularly, poor mental health literacy (among the patients-caregivers), stigma related to mental disorders, and unavailability of the mental health services act as major determinants. Sensitizing the patients-caregivers and health-care professionals concerning this could facilitate an early engagement with the psychiatric treatment. Future research needs to explore this phenomenon in greater detail, maybe by qualitative methods.

Suicide Risk in a National VA Sample: Roles of Psychiatric Diagnosis, Behavior Regulation, Substance Use, and Smoking.

Background: Most suicides are first attempts that are difficult to predict, possibly reflecting impaired and unstable behavior regulation. We sought to identify characteristics specifically associated with severe suicidal behavior by comparing risk ratios (RRs) for severe suicidal attempts (ATTP) to RRs for suicidal ideation (SI) only in a transdiagnostic sample of Veterans, focusing on impulsive-aggressive or externalizing behavior (EB), substance use disorders (SUDs), and recurrent affective or psychotic disorders (ie, severe mental illness [SMI]).Methods: The VA Information and Computing Infrastructure (VINCI) Data Navigators provided aggregate phenotype counts and relevant ICD and clinic codes from about 350,000 Veterans in the US Department of Veterans Affairs national Million Veterans Program (MVP). Data were collected by MVP between 2011 and 2017, without relationship to the current work. Work on this report and related analyses took place from April 11, 2020, to October 6, 2021.Results: We compared 3 suicide risk groups: 1,269 Veterans with previous ATTP, 109,836 with SI only, and 242,872 without previous suicidality. Nearly three-fourths of ATTP Veterans did not have SMI diagnoses. RR for ATTP behavior was highest in Veterans with EB (25.4), followed by those with SUD (13.9); both RRs were greater than RRs for Veterans with schizophrenia (7.4) or bipolar disorder (7.8). ATTP RR was greater for smoking than for major depressive disorder (5.0 vs 3.5, respectively). RR for smoking, across clinical groups, was strongly related to RR for ATTP risk, but not for SI only.Discussion: ATTP suicidal behavior was more strongly associated with EB and SUD than with SMI. Suicide risk is associated with SUD or EB beyond SMI, so routine clinical encounters in primary care and emergency settings must recognize EB, SUD, and smoking as risks for severe suicidal behavior.

Clinical features of atypical depression in bipolar and recurrent affective disorders, psychogenic depression

Objective: to perform a comparative study of the clinical features of atypical depression (AtD) in affective disorders of various origins: in bipolar affective disorder (BAD), recurrent depressive disorder (RDR) and psychogenic depression (PD).Patients and methods. A sample of 250 depressed patients aged 18 to 65 years were examined, of which 77 participants (50 women and 27 men) with symptoms of AtD were included to the study. Group 1 included 35 patients with BAD, group 2 – 18 patients with RDR, and group 3 – 24 patients with diagnoses including PD. The patients' condition was assessed using the diagnostic criteria for affective disorders according to ICD-10 and DSM-5 with a Montgomery-Asberg Depression Rating Scale (MADRS).Results and discussion. AtD detection rate was 30.8%, including 45.4% in BAD, 23.4% – in RDR, and 31.2% – in PD. AtD manifested at the age of about 20 years, and was more common in women. AtD in BAD occurred more often in individuals with cycloid, hyperthymic, and hysterical features. Affective fluctuations before the disease onset, a significantly greater number of depressive episodes in history were characteristic. The most frequent typical depressive symptoms included: daily and seasonal mood fluctuations, morning deterioration of well-being, decreased appetite. High comorbidity with metabolic endocrine diseases was observed. AtD in RDR often began spontaneously in individuals with emotionally labile, psychasthenic, and hysterical features. The most common typical depressive symptoms included melancholy, derealization, weakness, ideas of self-accusation, suicidal thoughts and attempts. A high comorbidity with cardiovascular diseases was found. AtD in PD occurred more often in psychasthenic individuals. The most characteristic symptoms included: increased appetite, anxiety, asthenia, superficial night sleep, hypochondriacal inclusions. Comorbidity with skin and gastrointestinal diseases was observed.Conclusion. The identified features of the clinical picture and course of AtD in BAD, RDR, and PD can be used for earlier and more accurate evaluation of affective disorders and the adequate treatment administration.

Comparative evaluation of psychopharmacotherapy of atypical depression in bipolar and recurrent affective disorder, psychogenic depression

Objective: to evaluate the treatment effectiveness for atypical depression (AtD) depending on its nosology: in bipolar affective disorder (BAD), recurrent depressive disorder (RDD) and psychogenic depression (PD).Patients and methods. A total of 250 patients with depression were screened, of which 77 patients with symptoms of AtD were enrolled in the study, 35 of them with BAD, 18 with RDD, and 24 with PD. Patients in all three groups received an antidepressant (AD) or a mood stabilizer (MS) monotherapy, or a combination of AD and antipsychotic (A), AD and A, MS and A, as well as a combination of AD, A and MS. The patients' condition was assessed clinically using a specially designed questionnaire and MADRS and CGI scales at the baseline and the 2nd, 3rd, 4th, 6th, 12th weeks of treatment. Quality of life satisfaction was assessed with the Q-LES-Q-SF (Scoring the Quality-of-Life Enjoyment and Satisfaction Questionnaire) scale at the treatment onset and after the 12th week of treatment.Results and discussion. Treatment regimens that included AD were the most eff in all groups of patients with AtD. The proportion of responders among those who received AD for bipolar disorder (75% or more) was significantly higher than among those who did not receive it (˂50%). In the RDD and PD groups, patients responded significantly better to AD monotherapy (RDD – 93.2%; PD – 91.5%) compared to other regimens. Agomelatine was the most frequently used (31.8%) and effective AD in all groups. Also, escitalopram, vortioxetine, and venlafaxine (p˂0.05) showed high efficacy, good tolerance, and absence of side effects that aggravate the main symptoms that characterize AtD. Among the antipsychotics in combination with AD, sulpiride was significantly more effective in patients with PD (p˂0.05). The highest rates of quality of life satisfaction were achieved in the BAD group, the lowest – in patients with PD (p˂0.05), which indirectly indicates the quality of remission, which is determined not only by the degree of reduction of depressive symptoms but also by the patients' subjective perception of their mental state.Conclusion. The inclusion of AD in the AtD treatment regimen significantly increases its effectiveness in patients of all groups, including BAD. AtD treatment should be administered not only taking into account its clinical signs and severity, but also depending on the nosology of the disease, the characteristics of its course. During drug administration, it is necessary to consider the spectrum of side effects, especially those that increase the symptoms of AtD itself.

Features of Cognitive Impairments in Patients with Comorbid Recurrent Affective and Panic Disorders

Objectives. To identify targets for medication and psychotherapy in the treatment of patients with comorbid recurrent affective and panic disorders based on results from studies of cognitive functions. Materials and methods. A set of pathopsychological methods (Schulte tables, correction test, 120-word test, cube drawing test, Binet and Berstein tests) was used. Cognitive status was studied in 60 patients with signs of recurrent affective (depressive) and panic disorders. ICD-10 diagnoses for the 27 patients making up the study group (SG) were recurrent affective disorder with mild and moderate depressive episodes (RAD, F33.0, F33.1) in combination with panic disorder (PD, F41.0). The control group (CG) included 33 patients with recurrent affective disorder (RAR, F33.0, F33.1) without panic disorder. Results and conclusions. All patients showed changes in the cognitive domain. Cognitive disorders in patients of the SG were more severe than those in patients of the CG. Cognitive functions in SG patients were characterized by being “left-hemisphere” impairments, in the form of paroxysmal emotional disorders with a predominance of fear and anxiety and dysfunction in the operation of a number of neuropsychological factors: successiveness, spatiality, inertia-mobility, for which the mediobasal and subcortical parts of the brain are responsible. Studies of cognitive impairments in remission provided evidence of some level of improvement in the cognitive domain in SG and CG patients, though there were no significant differences between the groups (p > 0.05). Targets for medication and psychotherapy in SG patients were attention, audioverbal memory, and components of thought (logical and spatial). The authors believe that use of neuropsychological correction of cognitive impairments is appropriate in patients of this group.

ПСИХОЛОГИЧЕСКИЕ ОСОБЕННОСТИ БОЛЬНЫХ КОМОРБИДНЫМИ РЕКУРРЕНТНЫМ АФФЕКТИВНЫМ И ПАНИЧЕСКИМ РАССТРОЙСТВОМ

The paper presents data from the examination of 54 patients with combined mental pa-thology. The main group (MG) included 27 patients with comorbid recurrent affective and panic disorders. Patients (27 people) in the control group (CG) were diagnosed with inde-pendent affective disorder. The clinical and psychological parameters of the patients’ personal sphere in the main and control groups were studied and analyzed. The trait profile of patients with MG is represented by disharmonious manifestations and significant peak rise in the scales: “hypochondria”, “depression” and “psychasthenia”. According to the analysis conducted, the following personality characteristics were marked in patients with a combined variant of recurrent affective and panic disorders: inert thinking style, insecurity, high sensitivity, impressionability, dependence on the surroundig people’s opinion, suspiciousness, caution, discretion, high moral exactingness towards oneself and others, conscientiousness, comfort and diligence, unsociability, secrecy and isolation. Besides, the relationship between personal characteristics and choice of protective and coping behavior in patients MG and CG was determined as part of the study. To reduce the discomfort caused by a stressful situation, the patients with MG used the following coping mechanisms: “escape-avoidance” and “acceptance of commitment”. In order to resolve inner experiences patients with a combined variant of recurrent affective and panic disorders use destructive mechanisms of personality psychological defense by the type “denial”, “suppression”, “regression” and “compensation”. As part of the study conducted, the main psychocorrective targets were identified, includ-ing the components of defensive-coping patients’ behavior that showed manifestations of recurrent affective and panic disorders. The results obtained can be taken into account when developing a psychotherapeutic program aimed at harmonizing the personal profile of pa-tients. In the course of psychotherapeutic correction, it is advisable to use methods of the cognitive-behavioral direction, relaxation techniques and breathing exercises. The obtained results can be taken into account when developing a psychotherapeutic pro-gram aimed at harmonization of the patients’ personal profile. In the course of psychothera-peutic correction, the use of cognitive-behavioral methods, relaxation techniques and breathing exercises is advisable.

Cognitive impairment in patients with comorbid recurrent affective and panic disorders

To designate the targets for medical and psychotherapeutic effects in patients with comorbid recurrent affective and panic disorders based on the study of cognitive functions. A battery of pathopsychological tests («Schulte Table», «Corrective Test», «Ten Words test», «Cube Drawing Technique», Binet and Berstein Tests) has been used to assess the neuro-cognitive status of 60 patients with symptoms of recurrent affective (depressive) and panic disorders. According to ICD-10, 27 patients have been diagnosed with recurrent affective disorder with a mild or moderate depressive episode (RAD, F33.0, F33.1) in combination with panic disorder (PD, F41.0). The control group included 33 patients with recurrent affective disorder with a mild to moderate depressive episode (RAD, F33.0, F33.1) without panic disorder. All the patients showed the changes in the cognitive sphere. In patients with recurrent affective disorder in combination with panic disorder, cognitive impairment was more pronounced than that in patients from the control group. Cognitive functions in patients with recurrent affective and comorbid panic disorder were distinguished by their peculiarity, which manifested itself in «left hemisphere» disorders in the form of paroxysmal emotional disorders with the predominance of fear and anxiety affect, work dysfunction in a number of neuropsychological factors: successiveness, spatial, inertness-mobility, for which mediobasal and subcortical parts of the brain are responsible. The targets for medical and psychotherapeutic effects in patients with comorbid panic and recurrent depressive disorder are: attention, auditory and verbal memory, thinking components (logical and spatial). It is reasonable to use neuropsychological correction of cognitive impairment in this group of patients.

The role of genetic research with family design in the study of affective disorders

Affective disorders (recurrent depressive disorder and bipolar affective disorder) are multifactorial and polygenic diseases, which suggests the involvement of multiple neurobiological mechanisms. The phenotype of affective disorders is a heterogeneous group of clinically similar psychopathological symptoms, which also makes it difficult to detect potential biomarkers and new therapeutic targets. To study families at high risk of developing affective disorders using both clinical and molecular genetic approaches can help to study the neurobiological basis of depressive conditions, as well as to identify endophenotypes of affective disorders. The most important criterion for an endophenotype is its heritability, which can be proved only within the framework of the family design of the study. Comprehensive clinical and molecular genetic studies based on family design have the best prospects.

Protein misassembly and aggregation as potential convergence points for non-genetic causes of chronic mental illness.

Chronic mental illnesses (CMI), such as schizophrenia or recurrent affective disorders, are complex conditions with both genetic and non-genetic elements. In many other chronic brain conditions, including Alzheimer's disease, Parkinson's disease, amyotrophic lateral sclerosis and frontotemporal dementia, sporadic instances of the disease are more common than gene-driven familial cases. Yet, the pathology of these conditions can be characterized by the presence of aberrant protein homeostasis, proteostasis, resulting in misfolded or aggregated proteins in the brains of patients that predominantly do not derive from genetic mutations. While visible deposits of aggregated protein have not yet been detected in CMI patients, we propose the existence of more subtle protein misassembly in these conditions, which form a continuum with the psychiatric phenotypes found in the early stages of many neurodegenerative conditions. Such proteinopathies need not rely on genetic variation. In a similar manner to the established aberrant neurotransmitter homeostasis in CMI, aberrant homeostasis of proteins is a functional statement that can only partially be explained by, but is certainly complementary to, genetic approaches. Here, we review evidence for aberrant proteostasis signatures from post mortem human cases, in vivo animal work, and in vitro analysis of candidate proteins misassembled in CMI. The five best-characterized proteins in this respect are currently DISC1, dysbindin-1, CRMP1, TRIOBP-1, and NPAS3. Misassembly of these proteins with inherently unstructured domains is triggered by extracellular stressors and thus provides a converging point for non-genetic causes of CMI.

Risk and prophylaxis of venous thromboembolism in hospitalized psychiatric patients. A review.

Venous thromboembolism (VTE) is a frequent dangerous complication occurring during hospital treatment with total annual incidence of 70-200 per 100,000 citizens. Venous thromboembolism includes deep vein thrombosis (DVT) and pulmonary embolism (PE). Pulmonary embolism is responsible for about 10% of hospitalization-related deaths and is the most common avoidable reason for deaths in hospitals. Psychiatric inpatients are particularly vulnerable to an increased risk of VTE due to their limited mobility, the use of restraints, catatonia, communication difficulties, and the use of antipsychotics. Patients with chronic psychiatric conditions like schizophrenia and recurrent affective disorders have significantly higher somatic comorbidity. This population of patients requires specific approach to VTE prophylaxis during hospitalization. This article offers an insight into issues related to thromboembolism, and presents validated diagnostic tools and VTE prophylaxis strategies. The paper includes the review of available research on VTE in patients hospitalized for psychiatric reasons. Considering the scarcity of specific studies in this population we highlight the necessity to follow the available general medical guidelines for psychiatric inpatients.

P.1.016 - Molecular linking of influenza infection to cellular pathology of protein misassembly: the case of Disrupted-in-Schizophrenia 1 (DISC1)

Chronic mental illnesses such as schizophrenia or recurrent affective disorders are heterogeneous in their biological causes behind the clinical, syndromatic diagnosis. Viral infection has been linked to chronic mental illnesses both by direct mechanisms and indirect mechanisms through immune stimulation. For example, studies showed that intrauterine influenza infection could be a risk factor for chronic mental illness [1]. It is also established that viral infection can lead to a change in proteostasis impairing regulatory protein networks and leading to disease. The most dramatic consequences of disrupted proteostasis are the so-called protein misfolding diseases that show as a phenotypical hallmark, microscopically visible deposits of one or several proteins, and cell degeneration. More subtle forms of proteostatic imbalance exist where protein deposits are not microscopically visible and the neurons do not die but remain functionally impaired, for example in some forms of chronic mental illness such as schizophrenia [2]. We previously reported insoluble Disrupted-in-schizophrenia 1 (DISC1) protein in a subpopulation of patients with chronic mental illness [3]. This gene/protein is involved in vulnerability to chronic mental disorders, and was discovered mutant and segregating in a large Scottish pedigree with a chromosomal translocation leading to a 3′ truncation of the gene [4]. Subsequent genetic association studies in multiple populations of different ethnicities also support the involvement of this protein in mental illness. For the present study, our hypothesis was that influenza infection could cause significant long-term impairments of specific proteostatic pathways leading to aggregated DISC1 protein in chronic mental illness patients [5]. Neuroblastoma cell lines expressing inducible full-length, non-mutant DISC1 protein were infected with WSN33 influenza (H1N1 strain). The effect of viral infection was investigated by immunocytochemistry, biochemical and functional assays. Furthermore, infected mice with WSN33 influenza where investigated for insoluble DISC1 deposits by immunohistochemistry. Antiviral drugs were tested in order to reverse the influenza-induced DISC1 aggregates. Influenza infection of cell lines induced DISC1 misassembly but not misassembly of the protein TDP43 known to be mislocalized in ALS, but not in mental illness or influenza, and therefore serving as a control for specificity of DISC1 mis-assembly upon influenza infection in cellular models. Appearance of DISC1 deposits was dependent on infectious influenza virus titer, and the infection time. Functional consequences of influenza-induced DISC1 misassembly will be reported, as well as our investigations of influenza-infected mice that are still ongoing. We conclude that influenza infection leads to a very specific proteostatic change, including the misassembly of DISC1, which has functional consequences for dopamine homeostasis. Thus a selective reprogramming of cellular homeostasis, as measured by proteostasis, may be a novel molecular mechanism by which influenza infection can lead to brain disease.

Eating habits and nutritional status of patients with affective disorders and schizophrenia.

The aim of the study was to assess the nutritional value of the food intake in the group of men and women suffering from recurrent affective disorders and schizophrenia, and also to determine the relation between selected nutritional parameters with anthropometric indices defining the nutritional status of the subjects. 219 persons participated in the study (61 patients with recurrent depressive disorders, 60 patients with schizophrenia and 98 healthy volunteers). A24-hour dietary recall was used in the quantitative assessment of the diet. Anthropometric and biochemical measurements as well as body composition analysis were used to assess the nutritional status. It was shown that women with depression and schizophrenia had a significantly higher content of both visceral adipose tissue and subcutaneous adipose tissue as compared with the control group. A diet with a higher content of energy from protein, a higher supply of calcium promoted a lower fat content in the bodies of women suffering from depression (no such relationship was observed in the group of men). In the group of patients with schizophrenia, a diet with a lower supply of energy promoted a lower BMI value, waist circumference, lower waist-hip ratio and a lower fat content in the body. An improper energy structure and an improper content of nutrients can, in the future, contribute to the development of many somatic diseases, thus leading to deterioration of life quality of subjects and preventing the maintenance of mental health.

The association of recurrent affective disorders with functional capabilities in the subjects over 60 yeras of age. a preliminary findings

IntroductionMajor depressive disorder (MDD) in the older adults is correlated with a significant decline in daily physical activity, consequently resulting in chronically impaired quality of life and an increased exposure to falls-risk.ObjectivesEstablishing whether geriatric depression Scale (GDS) scores, found correlated with dual motor tasks (TUGTMAN), are also correlated under the cognitive test constraints (TUGCOG).AimsThe study aimed to analyse the relationship of MDD symptoms, the number of depressive episodes and hospitalisations, with the efficiency of gait in single and dual task conditions, motor and cognitive, functional capabilities.MethodsThe study was conducted in the outpatient clinic, university hospital, department of psychiatry, Krakow, on 30 patients over 60 years of age presenting recurrent MDD. The assessment consisted of GDS, MMSE, TUGT, TUGMAN, TUGCOG, 30sChS, SLS. Spearman rho rank correlation was applied to determine the relationship between the variables.ResultsStatistical analysis showed a significant association between the intensity of depressive symptoms expressed in the GDS and the number of completed episodes and depression and TUGT. The number of hospitalisations was associated with gait under motor (TUGMAN) and cognitive (TUGCOG) constraints.ConclusionDuration of the disorder and the number of hospital admissions are related to the functional efficiency of the single and dual-task performance in the persons suffering from this disorder for at least 10 years. Aged persons should effectively be encouraged to undertake physical activities.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Mixed features: evolution of the concept, past and current definitions, and future prospects.

Mixed states address the relationships between episodes and the course of an illness, presenting significant clinical challenges. Recurrent affective disorders were described thousands of years ago as dimensional disturbances of the basic elements of behavior, combining the characteristics of what we would now consider manic and depressive episodes. It was recognized from the beginning that combinations of depressive and manic features are associated with a severe illness course, including increased suicide risk. Early descriptions of affective disorders formulated them as systemic illnesses, a concept supported by more recent data. Descriptions of affective disorders and their course, including mixed states, became more systematic during the 19th century. Structured criteria achieved importance with evidence that, in addition to early onset, frequent recurrence, and comorbid problems, mixed states had worse treatment outcomes than other episodes. In contrast to 2000 years of literature on recurrent affective episodes and mixed states, the unipolar-bipolar disorder distinction was formalized in the mid-20th century. Mixed-state criteria, initially developed for bipolar disorder, ranged from fully combined depression and mania to the DSM-5 criteria, no longer limited to bipolar disorder, of a primary depressive or manic episode with at least three symptoms of the other episode type. The challenges involved in understanding and identifying mixed states center largely on what drives them, including (1) their formulation as either categorical or dimensional constructs, (2) the specificity of their relationships to depressive or manic episodes, and (3) specificity for bipolar versus major depressive disorder. Their existence challenges the distinction between bipolar and major depressive disorders. The challenges involved in identifying the underlying physiological mechanisms go to the heart of these questions.

Dynamics of Electroencephalogram Spectral Characteristics during Use of Transcranial Magnetic Stimulation in Patients with Refractory Depression

Objective. To study the dynamics of EEG spectral characteristics during transcranial magnetic stimulation (TMS) in therapeutically refractory depression. Materials and methods. The study included 32 patients with depression in the framework of recurrent depressive and bipolar affective disorders. TMS was performed and EEG recordings made on the background of ineffective thymoanaleptic treatment at reduced doses. TMS was applied at the projection of the left prefrontal cortex. Treatment courses consisted of 15 sessions with 100% threshold intensity. In each session, patients received 20 cycles of stimuli at a frequency of 15 Hz, duration 6 sec, separated by intervals of 60 sec. EEG recordings were made using a Neiro-KM instrument (Russian-made) with a bandpass of 0.5–45 Hz and a time constant of 0.3 sec before and after courses of TMS. EEG spectral analysis was by fast Fourier transformation with averaging of at least 30 2-sec epochs followed by mapping using the Brainsys system (made in Russia). Results and conclusions. Post-TMS EEG changes were generalized in nature and involved rearrangement of all frequency ranges in brain electrical activity. However, the greatest changes were seen at the α rhythm frequencies: the index increased in all cortical zones, though the greatest increase in α activity was seen in the occipital areas of the cortex, forming an α rhythm focus in these zones.

Kindling of Life Stress in Bipolar Disorder: Effects of Early Adversity

Most theoretical frameworks regarding the role of life stress in bipolar disorders (BD) do not incorporate the possibility of a changing relationship between psychosocial context and episode initiation across the course of the disorder. The kindling hypothesis theorizes that over the longitudinal course of recurrent affective disorders, the relationship between major life stressors and episode initiation declines (Post, 1992). The present study aimed to test an extension of the kindling hypothesis in BD by examining the effect of early life adversity on the relationship between proximal life events and prospectively assessed mood episodes. Data from 145 bipolar participants (59.3% female, 75.2% Caucasian, and mean age of 20.19 years; SD = 1.75 years) were collected as part of the Temple-Wisconsin Longitudinal Investigation of Bipolar Spectrum Project (112 Bipolar II; 33 Cyclothymic disorder). Participants completed a self-report measure of early adversity at baseline and interview-assessed mood episodes and life events at regular 4-month follow-ups. Results indicate that early childhood adversity sensitized bipolar participants to the effects of recent stressors only for depressive episodes and not hypomanic episodes within BD. This was particularly the case with minor negative events. The current study extends prior research examining the kindling model in BD using a methodologically rigorous assessment of life stressors and mood episode occurrence. Clinicians should assess experiences of early adversity in individuals with BD as it may impact reactivity to developing depressive episodes in response to future stressors.

Relative hypocortisolism is associated with obesity and the metabolic syndrome in recurrent affective disorders

Relative hypocortisolism is associated with obesity and the metabolic syndrome in recurrent affective disorders