Unipolar Disease Research Articles

Coronary arterial disease after electroconvulsive therapy: a case report

Objectives Unipolar depression (UPD) is a leading cause of global burden of diseases, particularly among the elderly, whose treatment may be challenging. In such cases, ECT is often recommended due to its safety and efficacy. This report presents a case of a 67-year-old male inpatient that developed a rare cardiac complication during ECT. Methods Clinical case report with patient’s consent and bibliographic review. Results A 67-year-old male inpatient with recurrent severe psychotic depression was hospitalized and ECT was indicated after failure of the pharmacological treatment. A comprehensive clinical pre-evaluation revealed only nonspecific ST-segment changes in electrocardiogram. During the 7th ECT session, it was observed transitory ST-segment depression followed by a discrete increase of plasma troponin I. Severe tri-vessel coronary artery stenosis was found and a percutaneous coronary angioplasty was performed, with satisfactory psychiatric and cardiac outcomes. Conclusions Unipolar depression (UPD) and cardiovascular disease are often coexistent conditions, especially among the elderly. In the current case, myocardial ischemia was detected lately during ECT therapy and its treatment allowed the UPD treatment to be completed adequately.

Combined osteochondral allograft and meniscal allograft transplantation: a survivorship analysis.

The efficacy of meniscal allograft transplantation (MAT) and osteochondral allografting (OCA) as individual treatment modalities for select applications is well established. MAT and OCA are considered symbiotic procedures due to a complementary spectrum of indications and reciprocal contraindications. However, few outcomes of concomitant MAT and OCA have been reported. This study is a retrospective review of patients who received simultaneous MAT and OCA between 1983 and 2011. Forty-eight (twenty-nine male: nineteen female) patients with a median age of 35.8years (15-66) received combined MAT and OCA procedures between 1983 and 2011. Forty-three patients had received previous surgery with a median of 3 procedures (1-11 procedures). The underlying diagnosis was trauma (tibial plateau fracture) in 33% with osteoarthritis predominating in 54.2% of cases. Thirty-one patients received a lateral meniscus, 16 received a medial meniscus and one patient received bilateral MAT. The median number of OCAs was two per patient (1-5 grafts), with a median graft area of 15cm(2) (0.7-41cm(2)). There were 21 unipolar, 24 bipolar (tibiofemoral) and three multifocal lesions. Thirty-six MATs constituted a compound tibial plateau OCA with native meniscus attached. At follow-up, failure was defined as any procedure resulting in removal or revision of one or more of the grafts. Patients completed the modified Merle d'Aubigné and Postel (18-point) scale, Knee Society Function (KS-F) score, and subjective International Knee Documentation Committee (IKDC) scores. Patient satisfaction was also captured. Twenty-six of 48 patients (54.2%) required reoperation, but only 11 patients (22.9%) were noted to have failed (10 MAT and 11 OCA). The mean time to failure was 3.2years (95% CI 1.5-4.9years) and 2.7years (95% CI 1.3-4.2years) for MAT and OCA, respectively. The 5-year survivorship was 78 and 73% for MAT and OCA respectively, and 69 and 68% at 10years. Six of the failures were in the OA cases and one was an OCD lesion where bipolar grafts were utilized. The OCD case underwent a revision OCA and remains intact. The others were converted to knee arthroplasty. One case failed due to early deep infection, ultimately requiring arthrodesis. Of those with grafts still intact, the mean clinical follow-up was 6.8years (1.7-17.1years). Statistically significant improvements in all outcome scores were noted between baseline and the latest follow-up. In total, 90% of those responding would have the surgery again and 78% were either extremely satisfied or satisfied with the outcome. The overall success rate of concomitant MAT and OCA was comparable with reported results for either procedure in isolation. A trend towards aworse outcome was observed with bipolar tibiofemoral grafts in the setting of OA. Comparatively better results in less advanced, unipolar disease could suggest a benefit to early intervention that might merit a lower treatment threshold for combined MAT and OCA. IV.

Brain changes in early-onset bipolar and unipolar depressive disorders: a systematic review in children and adolescents.

Pediatric bipolar disorder (BD) and unipolar disorder (UD) share common symptomatic and functional impairments. Various brain imaging techniques have been used to investigate the integrity of brain white matter (WM) and gray matter (GM) in these disorders. Despite promising preliminary findings, it is still unclear whether these alterations may be considered as common trait markers or may be used to distinguish BD from UD. A systematic literature search of studies between 1980 and September 2013 which reported WM/GM changes in pediatric and adolescent BD/UD, as detected by diffusion tensor imaging and voxel-based analysis was conducted. Of the 34 articles judged as eligible, 17 fulfilled our inclusion criteria and were finally retained in this review. More abnormalities have been documented in the brains of children and adolescents with BD than UD. Reductions in the volume of basal ganglia and the hippocampus appeared more specific for pediatric UD, whereas reduced corpus callosum volume and increased rates of deep WM hyperintensities were more specific for pediatric BD. Seminal papers failed to address the possibility that the differences between unipolar and bipolar samples might be related to illness severity, medication status, comorbidity or diagnosis. UD and BD present both shared and distinctive impairments in the WM and GM compartments. More WM abnormalities have been reported in children and adolescents with bipolar disease than in those with unipolar disease, maybe as a result of a low number of DTI studies in pediatric UD. Future longitudinal studies should investigate whether neurodevelopmental changes are diagnosis-specific.

Nonarthroplasty management of knee arthritis in the young individual

Managing knee arthritis in the young individual remains a challenging problem. Prearthritic chondral damage (unipolar disease) may be as disabling as the arthritic knee (bipolar disease). When unipolar disease exists, patient expectations, joint alignment, and stability as well as defect size must b

A Family Study of Manic-Depressive (Bipolar I) Disease

To determine whether bipolar I illness is autonomous or part of a multifactorial continuum with unipolar depression. In this study, we compare familial bipolar I illness and depression among three groups: probands with bipolar I disorder; probands with primary unipolar disorder; and controls. We also examine a continuum of severity between psychotic and nonpsychotic patients with bipolar I disorder. Considerable data suggest that bipolar I illness is distinct from unipolar illness as regards epidemiology, familial psychiatric illness, course, response to treatment, and biologic findings. Probands were separated into bipolar I and primary unipolar depressive groups. Personally interviewed family members of these patients were compared on variables of bipolar illness or schizoaffective mania and unipolar or schizoaffective depression. A personally examined control group was compared with the relatives of the two proband groups. Similar analyses were performed using data obtained by a systematic family history method. For the same familial variables, psychotic and nonpsychotic manic probands were compared. Familial mania is more frequent in families of patients with bipolar disease than in controls or in families of patients with primary unipolar disorder. The latter two groups did not differ in amount of mania. Unipolar depressive illness or schizoaffective depression was higher in families of probands with bipolar and unipolar disorder than in controls. Probands with bipolar disease separated into those who had psychotic symptoms (including schizoaffective mania) and no psychotic symptoms did not differ from each other in risk for familial mania or depression. Bipolar I illness is a separate illness from primary unipolar illness because of an increase in familial mania. Patients with primary unipolar disease and controls show the same amount of familial mania. Lack of an increase in familial illness according to the severity of bipolar disease is against an affective continuum.

Electroencephalography of patients on long-term treatment in a lithium clinic

Seventy-six patients attending the lithium units in a Swedish psychiatric clinic were investigated with electroencephalography. The patients, 50 women and 26 men, were between 27 and 84 years of age and had been on medication for periods ranging from 1 to 20 years. The serum lithium level varied between 0.2 and 1.1 mmol/l. Thirty-nine patients had bipolar and 19 had unipolar affective psychosis (ICD-9). Fifteen of the 19 patients with unipolar disease were diagnosed as melancholic. Twenty-eight patients (37%) had EEG changes consisting of an episodic abnormality of generalized slow waves. A tendency towards the higher serum lithium values, 0.7–0.9 mmol/l, was seen among these patients. Abnormal EEGs were over-represented among the patients with melancholy (60%). Only 1 of the 10 patients without the common lithium-induced side effects had an abnormal EEG. The EEG abnormality did not seem to influence the patients' behaviour or social status to any major extent.

The concept of distinct but voluminous groups of bipolar and unipolar diseases

Comparing unipolar diseases (n = 121) as one group with bipolar diseases (n = 86) as another group (both groups including affective and schizoaffective disorders) relevant differences were found in sex distribution, age at onset, premorbid personality, long-term course and some aspects of long-term outcome. Although building two voluminous groups of "unipolar diseases" and "bipolar diseases" runs some risk of inhomogeneity, this danger could perhaps be limited by referring to the "affective subtype" and the "schizoaffective subtype".

The concept of distinct but voluminous groups of bipolar and unipolar diseases

One hundred and six affective (76 unipolar and 30 bipolar) and 101 schizoaffective patients (45 unipolar and 56 bipolar) were investigated after a long-term course of illness, evaluating sociodemographic and general data, the long-term course of illness, disability and psychosocial alterations according to WHO/DAS, WHO/PIRS and GAS, as well as several social consequences of the illness (living situation at the end of the observation time, downward occupational drift, downward social drift, premature retirement, achievement of the expected social development). Comparing the 30 bipolar affective and 56 bipolar schizoaffective disorders, no differences were found regarding (a) sociodemographic and general data (i.e. sex distribution, age at onset, education and occupation at onset, stable heterosexual relationship, premorbid personality and social interactions, mental illness in the family, broken home, life events, season of birth and social classes) and (b) relevant patterns of the long-term course. Regarding long-term outcome, the only difference found concerned the more favourable outcome of the bipolar affective disorders according to WHO/DAS, while using GAS the difference was not statistically significant. No difference was found either between the two bipolar groups in the social consequences of the illness. The combining of both bipolar groups as "bipolar diseases" is discussed, as well as the use of the terms "bipolar disease, affective subtype" and "bipolar disease, schizoaffective subtype".

The concept of distinct but voluminous groups of bipolar and unipolar diseases

The concept of distinct but voluminous groups of bipolar and unipolar diseases

A family study of schizoaffective, bipolar I, bipolar II, unipolar, and normal control probands.

In a family study of 1,254 adult relatives of patients and controls, lifetime prevalences of major affective disorder (including schizoaffective) were 37%, 24%, 25%, 20% and 7% in relatives of probands with schizoaffective, bipolar I, bipolar II, and unipolar disease, and normal controls. These data were compatible with the different affective disorders representing thresholds on a continuum of underlying multifactorial vulnerability. In this model, schizoaffective illness represents greatest vulnerability, followed by bipolar I and bipolar II, then unipolar illnesses. Alcoholism, drug abuse, and sociopathy were not more frequent in relatives of patients v relatives of controls. Sex-related transmission of morbid risk was not present. Morbid risk was 74% to offspring of two III parents, and 27% to offspring of one III parent. Nationality and age at time of interview seem to be nongenetic factors that affect frequency of diagnosis.

Electroencephalographic sleep in unipolar depressive subtypes: support for a biological and familial classification.

A tripartite classification of unipolar disease based on family history has been proposed by Winokur. In this study, we sought to investigate whether the familial pure depressive disorder (FPDD) and the sporadic depressive disorder (SDD) populations could be differentiated on the basis of baseline EEG sleep as effected by a tricyclic pharmacological probe. A subject group consisting of 26 females and 10 males yielding 18 FPDD/SDD pairs matched for age was selected. Both groups of patients demonstrated a considerable amount of sleep continuity disturbance with an overall sleep efficiency of 80.5 per cent in the pure depressive (FPDD) group and 83 per cent in the sporadic (SDD) group. Examination of the rapid eye movement (REM) sleep variables revealed the usual shortened REM latency as well as increased REM activity and REM density changes. However, the only significant difference between the two groups on baseline was the presence of more stage 3 and 4 sleep in the sporadic group, but stage 3 and 4 sleep was found in less than 40 per cent of the total sample. In contrast, analysis of the first two nights of EEG sleep on 50 mg of amitriptyline demonstrated several significant findings between the two groups. While considerable REM sleep suppression occurred in both groups, REM activity, REM intensity, and the number of REM periods were significantly more suppressed in the pure group than the sporadic group. Application of these variables led to a successful discrimination of 75 per cent of all the cases. These findings suggest a hyper-reactivity of sleep in patients with FPDD to a pharmacological probe.

The epidemiology of bipolar affective disorder

There are three reasons why a review of the existing data on the epidemiology of bipolar affective disorder may be indicated: (1) to summarize the general differences between unipolar and bipolar affective disorder; (2) to illustrate the similarities and differences in biopolar disease (especially mania) and chronic schizophrenia, and (3) to look more closely at the depression of bipolar and unipolar disease.

Environmental Factors in Affective Disorders

What are the factors that may precipitate overt depressive illness in the predisposed patient? The available data indicate that for unipolar disease, at least, the clearest correlations are not with economic or social status or with race, but rather with sex. Women display a lifetime risk about twice that of men in the same population, and the differences in social roles of the two sexes are probably largely responsible.

Depression and marital turmoil.

In this report (one in a series on divorce and psychiatric illness) we consider the 33 female and 12 male divorced probands with the diagnosis of definite unipolar affective disease. Of this group, 43 had an episode of depression of more than one month duration at the time of their marital separation or divorce and 20 of the 22 who had prior episodes of depression were again depressed at the time of marital disruption. The divorced depressives who had an episode of depression at the time of their separation or divorce were classified as "event associated" or "event nonassociated" on the basis of the temporal relationship of specific events to the onset of depression. There were 19 female and five male probands placed in the event-associated subgroup. The depressive symptoms, in the opinion of the interviewing psychiatrist, contributed to the marital disruption of six of the event-associated and 11 of the event-nonassociated divorced depressives.