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Background: Cyclothymic temperament (CT) is an affective disposition often preceding bipolar disorder (BD), and is the most common affective temperament in patients with BD. In depressed patients, CT is a predictor for developing a bipolar course. In a clinical sample of adults with BD and attention deficit hyperactivity disorder (ADHD), CT was associated with higher loads of psychiatric symptoms, somatic comorbidity, impairment, and higher morbidity among first-degree relatives. We aimed to investigate the morbidity and occupational functioning of persons with CT in the general population.Methods: Randomly recruited Norwegian adults (n = 721) were assessed with a 21-item cyclothymic subscale from the TEMPS Autoquestionnaire. Self-reported data were collected on psychiatric symptoms, comorbidity, educational and occupational level, and known family morbidity.Results: Thirteen percent had CT associated with an increased prevalence of ADHD, BD, high scores on the Mood Disorder Questionnaire (MDQ), and childhood and adulthood ADHD symptoms. CT was found in 75% (p < .001) of the bipolar participants, and in 68% (p < .001) of those with a positive MDQ score. CT was associated with more anxiety/depression, substance and alcohol problems, lower educational and occupational levels, and having a first-degree relative with anxiety/depression, alcohol problems, ADHD, and BD.Limitations: The CT subscale alone might include overlapping features with cyclothymic, anxious, irritable, and depressed temperaments, thus increasing the prevalence estimate of CT.Conclusions: CT is a strong predictor of occupational failure and associated with more psychiatric impairment in the participants and their families. CT should be assessed in both mood disorder and ADHD patients. [ABSTRACT FROM AUTHOR]

Abstract: Background: Migraine, depression and anxiety disorders have been associated with one another in several epidemiological studies. However, it is not known if or how these associations are reflected in the concurrent use of medications for migraine and depressive/anxiety disorders in the general population. The purpose of the present study was to identify groups of patients particularly likely to receive clinical treatment for both conditions. Methods: Data from the Norwegian Prescription Database for 2006 were analysed for the purpose of ascertaining concurrence of prescriptions for migraine and depression/anxiety disorders. Data were subjected to analysis testing deviation from unity for the OR performed by a chi-square test. Results: In the total Norwegian population (N =4640219) migraine drugs were prescribed to 81225 persons (1.8% of the population), antidepressant drugs to 257700 persons (5.6% of the population), and 11269 persons were prescribed both types of drugs. The prescription of antidepressants was significantly increased in patients receiving a prescription for a medication used to treat migraine (OR=2.82 (95% CI=2.76–2.88); chi-square p <0.001), and this association was stronger for men than for women. Teenage women carried the highest risk for this co-morbid constellation (OR=3.89 CI=3.17–4.77); chi-square p <0.001). Conclusion: This study revealed a strong positive association between the prescription of migraine and antidepressant medications, and this association was generally most pronounced in men. However, teenage girls carried the highest risk of receiving both kinds of prescriptions, suggesting particular attentiveness is required in the clinical management of these patients. [Copyright &y& Elsevier]

Abstract: Background: A relation between the type A behaviour pattern (TABP) and coronary heart disease has been found in many studies and the existence of a psychiatric coronary-prone mood profile has been suggested. TABP consist of fairly stable character traits such as time urgency, impatience, irritability and competitiveness, which in patients with affective disorders could be bipolar traits. The aim of this study was to compare TABP in depressed unipolar and bipolar II patients, and explore the relation between TABP, affective temperaments and migraine headaches, another disorder associated with bipolar II disorder. Methods: The Jenkins Activity Survey (JAS) (Form C), a self-report multiple-choice questionnaire designed to measure TABP, was given to 99 patients diagnosed with a DSM-IV major affective disorder. Affective temperaments were diagnosed according to Akiskal''s criteria and migraine diagnosed according to the criteria of the International Headache Society. The JAS was scored in the traditional manner, yielding scores for TABP and three factorially independent components, speed and impatiens (factor S), job involvement (factor J) and hard-driving and competitive (factor H). Results: 65 patients diagnosed with a unipolar (n =42) or bipolar II (n =23) disorder had valid scores on the JAS. Patients with bipolar II diagnosis had significantly higher JAS scores than the unipolar patients (Wilks'' λ =0.851, F =2.62, df =4, 60, p <0.05). Type A behaviour differed (total JAS score: mean square 509.3, df =1, F =9.4, p <0.005), mainly due to a divergence in factor S (mean square 465.5, df =1, F =6.0, p <0.02). Higher JAS scores were significantly associated with having a cyclothymic temperament (Wilks'' λ =0.728, F =4.30, df =4, p =0.005) and lower JAS scores with having a depressive temperament (Wilks'' λ =0.747, F =3.13, df =4, p =0.026). TABP was not associated with migraine. Limitations: Non-blind, cross-sectional assessment of affective disorders and migraine headaches and questionnaire-based type A behaviour assessment. Conclusions: These results indicate that a well-established questionnaire designed to recognize the type A behaviour pattern, distinguishes depressed unipolar from depressed bipolar II patients as well. [Copyright &y& Elsevier]

Background: It is well known that affective disorders and migraine often coexist in the same patients, and some information is available indicating that migraine is particularly prevalent in bipolar II disorder. The aims of this study were to compare the clinical features in unipolar depressed patients with and without comorbid migraine to bipolar patients. Methods: Semi-structured interview of 201 patients with major affective disorders, using DSM-IV criteria for affective disorders combined with Akiskal''s criteria for affective temperaments, and IHS-criteria for migraine. Results: Compared to the group of patients having unipolar depressions without comorbid migraine (n=51) the group with unipolar depression and migraine (n=63) had a higher number of depressive episodes (4.5 vs. 2.5, P=0.017), significantly higher prevalences of affective temperaments (46% vs. 16%, P=0.001), irritability (70% vs. 45%, P=0.008), seasonal variation (22% vs. 5%, P=0.017), agoraphobia (44% vs. 26%, P=0.036), asthma (25% vs. 6%, P=0.006) and migraine in family (59% vs. 29%, P=0.002). The clinical features of unipolar depressed patients with comorbid migraine resemble the bipolar II patients (n=51) in this sample. Limitations: Non-blind, cross-sectional assessment. Conclusions: These results indicate that there may be important clinical differences between unipolar depressed patients with and without comorbid migraine, possibly indicating that migraine in depressed patients is a bipolar spectrum trait. [Copyright &y& Elsevier]

Objectives: The purpose of the present study has been to examine differences in the laterality of pain in patients with migraine and comorbid unipolar depressive (UP) and bipolar II (BP II) disorders. Methods: Semi-structured interviews of 102 patients with major affective disorders were conducted, using DSM-IV criteria for affective disorders combined with Akiskal's criteria for affective temperaments and International Headache Society criteria for migraine. The group of patients reported on in the present study encompass 47 subjects with UP (n=24) or BP II (n=23) disorders. Fifteen of the bipolar II patients fulfilled DSM-IV criteria while eight were diagnosed according to the broader criteria of Akiskal. Results: Sixteen of the 38 patients with migraine headaches had bilateral pain or pain equally often on the left or right side while 22 had pain predominantly located on one side. Among the UP patients the pain was most often on the right side (8/10) while among the BP II patients the pain was most often on the left (9/12, p = 0.01). Apart from the presence of hypomanic symptoms in the BP II group there were no clinical or demographic characteristics that distinguished these two sub-groups of affective disorders. Conclusions: These results indicate that there may be a differential affection of the cerebral hemispheres in patients with migraine and comorbid unipolar depressive disorder versus patients with migraine and comorbid bipolar II disorder. [ABSTRACT FROM AUTHOR]

Introduction: Alterations in motor activity are well‐established symptoms of bipolar disorder, and time series of motor activity can be considered complex dynamical systems. In such systems, early warning signals (EWS) occur in a critical transition period preceding a sudden shift (tipping point) in the system. EWS are statistical observations occurring due to a system's declining ability to maintain homeostasis when approaching a tipping point. The aim was to identify critical transition periods preceding bipolar mood state changes. Methods: Participants with a validated bipolar diagnosis were included to a one‐year follow‐up study, with repeated assessments of the participants' mood. Motor activity was recorded continuously by a wrist‐worn actigraph. Participants assessed to have relapsed during follow‐up were analyzed. Recognized EWS features were extracted from the motor activity data and analyzed by an unsupervised change point detection algorithm, capable of processing multi‐dimensional data and developed to identify when the statistical property of a time series changes. Results: Of 49 participants, four depressive and four hypomanic/manic relapses among six individuals occurred, recording actigraphy for 23.8 ± 0.2 h/day, for 39.8 ± 4.6 days. The algorithm detected change points in the time series and identified critical transition periods spanning 13.5 ± 7.2 days. For depressions 11.4 ± 1.8, and hypomania/mania 15.6 ± 10.2 days. Conclusion: The change point detection algorithm seems capable of recognizing impending mood episodes in continuous flowing data streams. Hence, we present an innovative method for forecasting approaching relapses to improve the clinical management of bipolar disorder. [ABSTRACT FROM AUTHOR]

Background: Most research on patterns of motor activity has been conducted on adults with mood disorders, but few studies have investigated comorbid attention-deficit/hyperactivity disorder (ADHD) or temperamental factors that may influence the clinical course and symptoms. Cyclothymic temperament (CT) is particularly associated with functional impairment. Clinical features define both disorders, but objective, biological markers for these disorders could give important insights with regard to pathophysiology and classification. Methods: Seventy-six patients, requiring diagnostic evaluation of ADHD, mood or anxiety disorders were recruited. A comprehensive diagnostic evaluation, including the CT scale of the Temperament Evaluation of Memphis, Pisa, Paris and San Diego – Auto-questionnaire (TEMPS-A), neuropsychological tests and actigraphy, was performed. ADHD was diagnosed according to the DSM-IV criteria. There was a range of different conditions in this clinical sample, but here we report on the presence of CT and ADHD in relation to motor activity. Twenty-nine healthy controls were recruited. We analyzed motor activity time series using linear and nonlinear mathematical methods, with a special focus on active and inactive periods in the actigraphic recordings. Results: Forty patients fulfilled the criteria for ADHD, with the remainder receiving other psychiatric diagnoses (clinical controls). Forty-two patients fulfilled the criteria for CT. Twenty-two patients fulfilled the criteria for ADHD and CT, 18 patients met the criteria for ADHD without CT, and 15 patients had neither. The ratio duration of active/inactive periods was significantly lower in patients with CT than in patients without CT, in both the total sample, and in the ADHD subsample. Conclusions: CT is associated with objectively assessed changes in motor activity, implying that the systems regulating motor behavior in these patients are different from both healthy controls and clinical controls without CT. Findings suggest that actigraphy may supplement clinical assessments of CT and ADHD, and may provide an objective marker for CT. [ABSTRACT FROM AUTHOR]

Changes in motor activity are core symptoms of mood episodes in bipolar disorder. The manic state is characterized by increased variance, augmented complexity and irregular circadian rhythmicity when compared to healthy controls. No previous studies have compared mania to euthymia intra-individually in motor activity. The aim of this study was to characterize differences in motor activity when comparing manic patients to their euthymic selves. Motor activity was collected from 16 bipolar inpatients in mania and remission. 24-h recordings and 2-h time series in the morning and evening were analyzed for mean activity, variability and complexity. Lastly, the recordings were analyzed with the similarity graph algorithm and graph theory concepts such as edges, bridges, connected components and cliques. The similarity graph measures fluctuations in activity reasonably comparable to both variability and complexity measures. However, direct comparisons are difficult as most graph measures reveal variability in constricted time windows. Compared to sample entropy, the similarity graph is less sensitive to outliers. The little-understood estimate Bridges is possibly revealing underlying dynamics in the time series. When compared to euthymia, over the duration of approximately one circadian cycle, the manic state presented reduced variability, displayed by decreased standard deviation (p = 0.013) and augmented complexity shown by increased sample entropy (p = 0.025). During mania there were also fewer edges (p = 0.039) and more bridges (p = 0.026). Similar significant changes in variability and complexity were observed in the 2-h morning and evening sequences, mainly in the estimates of the similarity graph algorithm. Finally, augmented complexity was present in morning samples during mania, displayed by increased sample entropy (p = 0.015). In conclusion, the motor activity of mania is characterized by altered complexity and variability when compared within-subject to euthymia. [ABSTRACT FROM AUTHOR]

Current practice of assessing mood episodes in affective disorders largely depends on subjective observations combined with semi-structured clinical rating scales. Motor activity is an objective observation of the inner physiological state expressed in behavior patterns. Alterations of motor activity are essential features of bipolar and unipolar depression. The aim was to investigate if objective measures of motor activity can aid existing diagnostic practice, by applying machine-learning techniques to analyze activity patterns in depressed patients and healthy controls. Random Forrest, Deep Neural Network and Convolutional Neural Network algorithms were used to analyze 14 days of actigraph recorded motor activity from 23 depressed patients and 32 healthy controls. Statistical features analyzed in the dataset were mean activity, standard deviation of mean activity and proportion of zero activity. Various techniques to handle data imbalance were applied, and to ensure generalizability and avoid overfitting a Leave-One-User-Out validation strategy was utilized. All outcomes reports as measures of accuracy for binary tests. A Deep Neural Network combined with SMOTE class balancing technique performed a cut above the rest with a true positive rate of 0.82 (sensitivity) and a true negative rate of 0.84 (specificity). Accuracy was 0.84 and the Matthews Correlation Coefficient 0.65. Misclassifications appear related to data overlapping among the classes, so an appropriate future approach will be to compare mood states intra-individualistically. In summary, machine-learning techniques present promising abilities in discriminating between depressed patients and healthy controls in motor activity time series. [ABSTRACT FROM AUTHOR]

Background: As a result of deinstitutionalization of psychiatric treatment and care, many people with severe mental illness have been offered supported accommodation. However, research on this costly intervention in Norway has been scarce. Aims: The aim of this study was to prospectively investigate the clinical and demographic factors associated with allocation to supported accommodation for people with schizophrenia. Methods: The study was a prospective cohort study of 334 people with schizophrenia acutely admitted to Haukeland University Hospital between 2005 and 2010. Information concerning allocation to supported accommodation in their residential municipalities was collected retrospectively. Univariate and multivariate statistical methods were used to assess the association of clinical and demographical variables with allocation to supported accommodation. Results: Supported accommodation was allocated to 29.6% of the participants during the study period. Age, gender, implementation of compulsory mental health care, substance abuse, symptom burden and suicidality were not associated with allocation to supported accommodation. Functional impairment, especially difficulties with activities of daily living, experiencing exacerbation in the course of chronic disease, being medicated and of Norwegian origin, favoured supported accommodation. Conclusions: Our results supported the hypothesis that people with severe mental illness presenting the greatest need for supported accommodation, based on functional difficulties and exacerbation of chronic disease were allocated supported accommodation. Symptom burden was not associated with allocation. Clinical implications: Further research is needed to examine the impact of supported accommodation on the outcomes for people with schizophrenia. [ABSTRACT FROM AUTHOR]

Hammar, Å., Sørensen, L., Årdal, G., Oedegaard, K.J., Kroken, R., Roness, A. & Lund, A. (2009). Enduring cognitive dysfunction in unipolar major depression: A test–retest study using the Stroop-paradigm. Scandinavian Journal of Psychology. The aim of the study was to investigate automatic and effortful information processing with the Stroop paradigm in a long term perspective in patients with major depressive disorder (MDD). Patients were tested at two test occasions: at inclusion with a Hamilton Depression Rating Scale (HDRS) score >18, and after 6 months, when most patients had experienced symptom reduction. The Stroop paradigm is considered to measure aspects of attention and executive functioning and consists of three conditions/cards: naming the color of the patches (Color), reading of the color-words (Word) and naming the ink color of color-words (Color-Word). The Color-Word condition is proved to be the most cognitive demanding task and requires the proband to actively suppress interference and is therefore considered to require more effortful information processing, whereas naming the color of the patches and reading the color-words are expected to be more automatic and less cognitive demanding. A homogenous group of 19 patients with unipolar recurrent MDD according to DSM-IV and a HDRS score of >18 were included in the study. A control group was individually matched for age, gender and level of education. Depressed patients performed equal to the control group on the Color and Word cards at both test occasions. However, the patients were impaired compared with the control group on the Color-Word card task at both test occasions. Thus, the depressed patients showed no improvement of effortful attention/executive performance as a function of symptom reduction. The results indicate that the depressed patients showed impaired cognitive performance on cognitive demanding tasks when symptomatic and that this impairment prevailed after 6 months, despite significant improvement in their depressive symptoms. [ABSTRACT FROM AUTHOR]

Abstract: Background: There is a substantial body of data showing differences in the functioning of the two hemispheres in unipolar depressive and bipolar disorders. Migraine is a frequent co-morbid disorder in these patients, and it has been proposed that migraine may be associated with left-handedness. It would therefore be interesting to study migraine and handedness in a population of patients with mood disorders. Methods: A total of 201 patients with an index episode of either major depression or mania were interviewed with a semi-structured interview based partly on DSM-IV criteria and partly on TEMPS-I for affective temperaments. The criteria of the Headache Classification Committee of the International Headache Society were used to establish the diagnosis of migraine. Hand preference was assessed using the Edinburgh inventory, and the patients were classified as having right-, left-, or mixed-handedness. Results: In the whole group 117 patients had migraine (58%) and 59 (29%) were classified as having non-right hand preference. There was a significant increased prevalence of non-right-handedness in the migraine group (37% vs. 19%, p =0.021, Chi-square test; OR 2.5; 95% CI 1.3 –4.8, p =0.007). In patients with cyclothymic, hyperthymic or irritable temperaments the prevalence of non-right-handedness (42%) was significantly higher (p =0.013, Chi-square test; OR 2.2, 95% CI 1.2–4.3) compared to patients with a depressive or no affective temperament (24%). The prevalence of non-right-handedness was also significantly higher both in patients with co-morbid eating disorders (48% vs. 26%, p =0.008 Chi-square test; OR 2.7, 95% CI 1.3–5.9, p =0.01) and asthma (45% vs. 26%, p =0.026 Chi-square test; OR 2.3, 95% CI 1.1–5.1, p =0.029). Limitations: Non-blind evaluation of affective diagnosis, migraine and handedness. Conclusions: Our main finding supports the hypothesis that non-right-handedness is associated with migraine and bipolar affective temperaments (“soft bipolarity”) in a sample of patients with major affective disorders. [Copyright &y& Elsevier]