Search

Background Literature suggests bipolars may differ in several features according to predominant polarity, but the role of temperaments remains controversial. Methods The EPIDEP study was designed to identify bipolar patients among a large sample of major depressives. Only bipolars were included in the current study. Patients were subtyped as predominantly depressive (PD) and predominantly manic and hypomanic (PM) according to a broad (more episodes of a given polarity) and a narrow (2/3 of episodes of one polarity over the other) definition, and compared on their characteristics. Results Among 278 bipolars, 182 (79.8%) could be subtyped as PD and 46 (20.2%) as PM (broad definition); the respective proportions were of 111 (81.6%) and 25 (18.4%) using narrow definition. Expanding the definition added little in detecting differences between groups. Compared to PDs, PMs showed more psychosis, rapid cycling, stressors at onset, family history of affective illness, and manic first episode polarity; they also received more antipsychotics and lithium. The PDs showed more chronic depression, comorbid anxiety, and received more antidepressants, anticonvulsants and benzodiazepines. The following independent variables were associated with manic/hypomanic predominant polarity: cyclothymic temperament, first hospitalization≤25 years, hyperthymic temperament, and alcohol use (only for broad definition). Limitation Cross-sectional design, recall bias. Conclusions Study findings are in accord with literature except for suicidality and mixicity which were related to predominant mania, and explained by higher levels of cyclothymic and hyperthymic temperaments. Temperaments may play a key role in the subtyping of bipolar patients according to predominant polarity, which warrants confirmation in prospective studies. [ABSTRACT FROM AUTHOR]

Abstract: The hepatitis C virus is a major public health problem. The prevalence of serum antibodies to the hepatitis C virus in the world is estimated at 3% of the population. Although the incidence of new infection is declining, a large asymptomatic population with chronic hepatitis C exists. This infection often affects persons with psychiatric and substance use problems. Neuropsychiatric symptoms are commonly associated with chronic hepatitis C virus infection, and its treatment by interferon-alpha. During hepatitis C infection, discomfort, fatigue, and depressive symptoms are frequently reported, before IFN-a treatment. Many side effects are reported during the IFN-a treatment. Neuropsychiatric symptoms frequently occur in hepatitis C patients treated with IFN-a. These side effects are troublesome and frequently account for dose reduction or treatment discontinuation. These symptoms include cognitive, affective, and behavioural components. The cognitive changes include impaired concentration, decreased alertness, deficits in verbal memory and mental slowing. These cognitive changes can be related to the IFN-a treatment or to the action of the hepatitis C virus on the brain. Depression is the most common psychiatric side effect. The reported rates of depressive symptoms range from 10 to 40%. The rates are higher in studies that used specific tools to assess for depression and in prospective studies. Depressive symptoms associated to the IFN-a treatment are particular: irritability, emotional lability, insomnia, behavioural disorders, impulsivity, fatigue, loss of interest. Occasional cases of mania and psychosis have been reported. There have been reports of anxiety disorders, including phobias, obsessive thoughts and rituals, and post-traumatic stress disorder. Several studies have shown that patients with chronic hepatitis C have a reduced quality of life. The impact of IFN-a is not clear. The quality of life may be related to the cognitive change or to the stage of the liver disease according to the authors. A large study showed that successful therapy with IFN-a improves quality of life. Studies of mechanisms of IFN-a neuropsychiatric effects are preliminary, so theories remain speculative. IFN-a may directly affect the central nervous system and affects neuroendocrine, cytokine, and neurotransmitter pathways. Identification and treatment of chronic hepatitis C infections are likely to become more aggressive with the improved prognosis offered by combination therapy (IFN-a and ribavirin). Psychiatrists will increasingly be involved in the care of such patients. Psychiatrists are often involved in the care of intravenous drug users and alcoholics, both of whom have high rates of hepatitis C infection. Depression may also be the visible symptom of a chronic hepatitis C infection, early detection of hepatitis C might lead to secondary prevention and improved outcomes. Recognition of depression associated to IFN-a is important, for treatment and for the possibility of improving adherence to IFN-a. The nature and severity of the neuropsychiatric adverse effects are, in part, dose dependent, though there is significant variability. No risk factor of psychiatric effects is clearly identified. All patients who receive interferon should be considered at some risk of developing neuropsychiatric adverse effects. Baseline assessments of mood and cognitive functions will help the clinician determine if behavioural symptoms are interferon-related. In clinical practice, SSRIs appear to be used commonly and to be helpful. The choice of therapy is based on the visible mood symptoms and the adverse effect profile of the antidepressants. The antidepressants drugs recommended are citalopram, sertraline, tianeptine, milnacipram and viloxazine. The efficacy of prophylactic antidepressant treatment is a matter of clinical debate. Non-pharmacological interventions are also useful. Education regarding the possible neuropsychiatric changes secondary to interferon treatment may prepare patients and make earlier interventions possible. Improved understanding of the mechanisms of neuro-psychiatric symptoms and their treatment may help patients with chronic hepatitis C sustain treatment, which will ultimately prolong their life and improve their quality of life. Research should include patients with psychiatric problems so that they are not excluded from effective treatments for hepatitis C. [Copyright &y& Elsevier]

Introduction: Bipolar disorder (BD) is associated with impaired psychosocial behaviours. Little is known about deficits in neurocognitive functions like decision-making possibly related both to these behaviours and to the nature of the disorder. Objectives: To determine whether decision-making impairments exist in manic (M), depressed (D) and euthymic (E) bipolar patients (BP) and to determine whether illness and course-of-illness characteristics can predict participants’ performance Methods: A power analysis was conducted. A total of 315 subjects, including 45 M and 32 D inpatients and 90 E outpatients with BD I, medicated, and 150 Healthy Controls (HC), age, IQ and gender-matched, were included. Decision-making ability and sensitivity to punishment frequency were assessed with the Iowa Gambling Task (IGT). Results: On the IGT, MBP (p< 0.001), DBP (p< 0.01) and EBP (p< 0.05) selected significantly more cards from the risky decks than HC with no significant differences between BP groups. Unlike HC, MBP (p< 0.001), DBP (p< 0.05) and EBP (p< 0.05) showed little capacity to learn from incurred losses with no significant differences between BP groups, but, like HC, BP preferred decks that yielded infrequent penalties over those decks that yielded frequent penalties. In a multivariate analysis, decision-making impairment in the BP was significantly (p=0.001) predicted by low level of education, high total number of admissions and family history of BD. Conclusions: BP clearly show defects in decision-making predicted by course-of-illness illness characteristics. Impaired decision-making might be a trait-related neurocognitive deficit in BD and partly explain impaired psychosocial behaviours of BP. [Copyright &y& Elsevier]

Abstract: Objective: To analyze the interface between borderline personality disorder (BPD) and bipolarity in depressed patients comorbid with BPD. Methods: As part of National Multi-site Study of 493 consecutive DSM-IV major depressive patients evaluated in at least two semi-structured interviews 1month apart, 19 (3.9%) had comorbid BPD (BPD+), whereas 474 (96.1%) did not manifest this comorbidity (BPD−). Results: Compared to BPD (−), BPD (+) patients displayed higher rates of bipolar (BP) disorders and temperaments, an earlier age at onset with a family history of affective illness, more comorbidity, more stressors before the first episode which was more often depressive or mixed, as well as a greater number and severity of affective episodes. Conclusions: The hypothesis which fitted at best our findings was to consider BPD as a contributory factor in the development of BP disorder, which could have favoured the progression from unipolar major depression to BP disorder. We could not however exclude that some features of BP disorder may have contributed to the development of BPD. [Copyright &y& Elsevier]

Abstract: Objective: To identify some of the main features of bipolar disorder for both first-episode (FE) mania and the preceding prodromal phase, in order to increase earlier recognition. Methods: One thousand and ninety manic patients (FE=81, multiple-episodes [ME]=1009) were assessed for clinical and temperamental characteristics. Results: Compared to ME, FE patients reported more psychotic and less depressive symptoms but were comparable with respect to temperamental measures and comorbid anxiety. The following independent variables were associated with FE mania: a shorter delay before correct diagnosis, greater substance use, being not divorced, greater stressors before current mania, a prior diagnosis of an anxiety disorder, lower levels of depression during index manic episode, and more suicide attempts in the past year. Conclusion: In FE patients, the diagnosis of mania may be overlooked, as they present with more psychotic symptoms than ME patients. The prodromal phase is characterised by high levels of stress, suicide attempts, anxiety disorders and alcohol or substance abuse. Data suggest to consider these prodromes as harmful consequences of temperamental predispositions to bipolar disorder that may concur to precipitate mania onset. Their occurrence should therefore incite clinicians to screen for the presence of such predispositions, in order to identify patients at risk of FE mania. [Copyright &y& Elsevier]

Background: Literature is scarce about the characteristics of mood disorder patients with a family history (FH) of affective illness. The aim of the current study was to compare the prominent features of depressive patients with a FH of mania (FHM), those of depressive patients with a FH of depression (FHD), and those of depressive patients with no FH of affective illness (FHO).Methods: As part of the EPIDEP National Multisite French Study of 493 consecutive DSM-IV major depressive patients evaluated in at least two semi-structured interviews 1 month apart, 45 (9.1%) were classified as FHM, 210 (42.6%) as FHD, and 238 (48.3%) as FHO.Results: The main characteristics of FHM patients were a cyclothymic temperament, the presence of mixed features and diurnal variations of mood during depression, early sexual behaviour, a high number of mood episodes and hypomanic switches, high rates of suicide attempts and rapid cycling; diagnosis of bipolar disorder was more frequent in this group as well as comorbid obsessive compulsive disorder, posttraumatic stress disorder, bulimia, attention deficit/hyperactivity disorder and impulse control disorders. The FHD patients had more depressive temperament, generalized anxiety disorder, and anorexia nervosa. Compared to FHO, FHM and FHD showed an earlier age at onset, more comorbid anxiety disorders, as well as more psychotic features.Limitations: The following are the limitations of this study: retrospective design, recall bias, and preferential enrolment of bipolar patients with a depressive predominant polarity.Conclusions: In light of genetic studies conducted in affective disorder patients, our findings may support the hypothesis of genetic risks factors common to affective disorders and dimensions of temperament, that may extend to comorbid conditions specifically associated with bipolar or unipolar illness. [ABSTRACT FROM AUTHOR]

Abstract: Background: Religiosity has been reported to be inversely related to depression and to suicide as well, but there is a lack of studies on its impact on bipolar disorder and especially, on depressed patients belonging to the bipolar spectrum. Methods: As part of the EPIDEP National Multisite French Study of 493 consecutive DSM-IV major depressive patients evaluated in at least two semi-structured interviews 1 month apart, 234 (55.2%) could be classified as with high religious involvement (HRI), and 190 (44.8%) as with low religious involvement (LRI), on the basis of their ratings on the Duke Religious Index (DRI). Results: Compared to LRI, HRI patients did not differ with respect to their religious affiliation but had a later age at onset of their affective illness with more hospitalizations, suicide attempts, associated hypomanic features, switches under antidepressant treatment, prescription of tricyclics, comorbid obsessive compulsive disorder, and family history of affective disorder in first-degree relatives. The following independent variables were associated with religious involvement: age, depressive temperament, mixed polarity of first episode, and chronic depression. The clinical picture of depressive patients with HRI was evocative of chronic mixed depressive episodes described in bipolar III patients within the spectrum of bipolar disorders. Limitations: Retrospective design, recall bias, lack of sample homogeneity, no assessment of potential protective and risk factors, and not representative for all religious affiliations. Conclusions: In depressive patients belonging to the bipolar spectrum, high religious involvement associated with mixed features may increase the risk of suicidal behavior, despite the existence of religious affiliation. [Copyright &y& Elsevier]

Abstract: Objective: To check whether the presence or not of free intervals between episodes could help differentiate subtypes of bipolar disorder, as suggested by the seminal controversy between Falret and Baillarger. Methods: From 1090 bipolar I patients included in a French national study, 981 could be classified as with or without free intervals and assessed for demographic and illness characteristics. Results: Compared with patients with free intervals (n =722), those without (n =259) had an earlier age at onset, more episodes, suicide attempts, cyclothymic and irritable temperaments. The following independent variables were associated with no free intervals: being single or divorced, delay to mood stabilizer treatment, multiple hospitalizations, incongruent psychotic features, panic and generalized anxiety disorder. Conclusion: “Folie à double forme” (without free intervals) and “folie circulaire” (with free intervals) may actually refer to early and later onset bipolar subtypes, insofar as most differences we found between them were previously evidenced between the latter two. We cannot, however, exclude that they might simply be two separate subtypes, whose main characteristics could be accounted for by different explanatory factors. [Copyright &y& Elsevier]

Abstract: Background: Epidemiological and clinical studies indicate that major depressive disorder is the leading cause of suicidal behaviour and that bipolar II subjects carry the highest risk. Identification of risk factors is therefore essential to prevent suicide in this population. Methods: As part of the EPIDEP National Multisite French Study of 493 consecutive DSM-IV major depressive patients evaluated in at least two semi-structured interviews 1month apart, 155 (33.7%) were classified as suicide attempters, and 295 (66.3%) as nonattempters, after exclusion of bipolar I patients. Results: Compared to nonattempters, attempters had a longer duration of illness, longer delays before seeking help and correct diagnosis and a higher number of previous episodes; they were more frequently rapid cyclers, with fewer free intervals between episodes. Lifetime suicide attempts were associated with more comorbid bulimia and substance abuse. Bipolar II spectrum disorders, depressive, cyclothymic and irritable temperaments were overrepresented in attempters, as well as family history of both affective disorder and suicide attempts. The following independent variables were associated with lifetime suicide attempts: higher number of previous depressive episodes, multiple hospitalizations, cyclothymic temperament, rapid cycling and earlier age at onset. Limitations: Retrospective design, recall bias, lack of sample homogeneity, and insufficient assessment of hypomanic features during index depression. Conclusions: In major depressive disorders, family history, age at onset, illness course, comorbidity and cyclothymic temperament alongside other indices of bipolarity may help predict suicidal behaviour. Longer delays to seeking help and diagnosis in attempters emphasize the importance of early recognition of bipolar spectrum disorders. [Copyright &y& Elsevier]

Behavioral sensitization is a preclinical model which can be defined as an augmentation in the behavioral effect of a psychostimulant upon re-administration. It has two phases, induction and expression. Induction refers to the transient sequence of events precipitated by psychostimulant administration that leads to the enduring changes in neural functions responsible for behavioral augmentation. Expression corresponds to the enduring neural alterations arising from the induction process that directly mediate the augmented behavorial response. These two processes are not only temporally but also anatomically and biochemically distinct. Induction seems to require the stimulation of dopamine D1 receptors in the ventral tegmental area (VTA) either directly by dopamine (DA) agonists, or indirectly via GABAergic inhibition; the stimulation of excitatory amino acid (EEA) receptor in the VTA, the amygdala and the hippocampus may also have a central role in the induction process. Contrary to its induction the expression of sensitization depends on the stimulation of the DA terminal fields and appears to be D2 mediated, whereas GABA and EEA do not seem to play a role. These processes result in an enhanced DA efflux induced by repeated exposure to stimulants. At least three different subcellular cascades have been involved in the molecular mechanisms of sensitization. Activation of these cascades induce changes in expression of neuritogenesis and synaptogenesis genes and remodelling of neural networks. First used to conceptualize various aspects of the course of affective disorders, behavioral sensitization models have been recently applied to the pathophysiology of schizophrenia, as a consequence of a better understanding of their neurobiologic underpinnings. Other psychiatric syndroms such as anxious disorders and drug addiction have been concerned too. Behavioral sensitization helps understand syndrome progression manifested by either increasing frequency, severity or spontaneity of psychiatric episodes, as well as the deteriorative course of some psychotic illnesses since sensitization, if sustained can lead to potential neurotoxic effects producing structural alterations. This model has found many applications in the psychopharmacological domain. Repeated application of stimulants either parenterally or directly into the brain may also produce a progressive increase in neural excitability, eventually producing major motor seizures in response to a previously subthreshold dose of drug. This could explain why anticonvulsants may be effective in psychiatric disorders in which behavioral sensitization is deemed to be involved. Recent data show that drugs like valproate are not only useful for treating affective illness but are also efficient in schizophrenia and anxious disorders. Contrary to lithium, valproate appears to prevent not only the induction but also the expression of behavioral sensitization in rodents. Drugs like olanzapine have, in addition to their D2 blockade effect, the capacity to block D1 receptors which may be linked to their antimanic and mood stabilising properties, considering the role of D1 receptors in the induction of sensitization phenomena. It is also possible that 5HT2 blockade play a role in this respect, as these receptors have been involved too in the development of behavioral sensitization. Finally the model allows specific predictions about the course of some psychiatric illnesses and particularly regarding the fact that treatment intervention that limit duration and number of psychiatric episodes may prevent progression of brain pathology. However such hypotheses have still to be tested through futures studies. [Copyright &y& Elsevier]