Seizure (Ictal)—EEG Characteristics in Subgroups of Depressive Disorder in Patients Receiving Electroconvulsive Therapy (ECT)—A Preliminary Study and Multivariate Approach

Objectives. Examine frequency distributions of ictal EEG after ECT stimulation in diagnostic subgroups of depression. Methods. EEG registration was consecutively monitored in 33 patients after ECT stimulation. Patients were diagnosed according to DSM IV and subdivided into: (1) major depressive disorder with psychotic features (n = 7), (2) unipolar depression (n = 20), and (3) bipolar depression (n = 6). Results. Results indicate that the diagnostically subgroups differ in their ictal EEG frequency spectrumml: (1) psychotic depression has a high occurrence of delta and theta waves, (2) unipolar depression has high occurrence of delta, theta and gamma waves, and (3) bipolar depression has a high occurrence of gamma waves. A linear discriminant function separated the three clinical groups with an accuracy of 94%. Conclusion. Psychotic depressed patients differ from bipolar depression in their frequency based on probability distribution of ictal EEG. Psychotic depressed patients show more prominent slowing of EEG than nonpsychotic depressed patients. Thus the EEG results may be supportive in classifying subgroups of depression already at the start of the ECT treatment

Biomarkers and electroconvulsive therapy in late-life depression

Overall conclusions The main objective of this thesis was to expand current knowledge on biomarkers in ECT-treatment to contribute to future personalized treatment of late-life depression. The first part aimed to explore biomarkers and treatment outcome. The second part aimed to explore biomarkers and cognitive functioning. We can conclude that older depressed patients with a profile of low-grade inflammation or intermediate levels of S100B who receive ECT have higher chances of remission of depression. However, we also conclude that both CRP and S100B are not eligible biomarkers for ECT outcome as their sensitivity and specificity were low. In general, a useful biomarker should have a sensitivity (for detecting therapy outcome) and a specificity (for discriminating between outcomes) of at least 80%.49 Vascular brain changes, that is, white matter hyperintensities, are not associated with persistent apathy after ECT. Higher levels of inflammation before start of ECT are associated with lower cognitive functioning. This association remains during and after ECT, however, it seems that patients with inflammation and white matter hyperintensities are in particular vulnerable to developing lower cognitive functioning after ECT

Aripiprazole for the treatment of psychotic symptoms in patients with dementia with Lewy bodies: a case series

Yuka Sugawara Kikuchi, Tetsuo ShimizuDepartment of Neuropsychiatry, Akita University Graduate School of Medicine, Akita 010-8543, JapanPurpose: The core features of dementia with Lewy bodies (DLB) are cognitive fluctuations, visual hallucinations, and parkinsonian symptoms. Although there have been several reports on the efficacy of treatments for psychotic symptoms in patients with DLB, little is known regarding the treatment effects of aripiprazole. The aim of this study was to evaluate the efficacy and safety of aripiprazole for the treatment of psychotic symptoms in patients with DLB.Patients and methods: We employed a 10-week, open-label study design with 11 patients who met the criteria for DLB. The patients had previously experienced persistent or intermittent delusions, hallucinations, or both for at least 1 month. Aripiprazole was initiated at a low dose (3 or 6 mg/day) and titrated to higher doses at 2-week intervals or more rapidly, as needed. The Neuropsychiatric Inventory (NPI), Brief Psychiatric Rating Scale (BPRS), and Clinical Global Impression-Severity (CGI-S) were administered at baseline and 1, 2, 4, 8, and 10 weeks later. The Simpson–Angus Scale (SAS), Clinical Dementia Rating (CDR), and Mini-Mental State Examination (MMSE) Scale were evaluated at baseline and at week 10. The NPI, CGI-S, and BPRS scores were compared between the baseline and each assessment point and between each assessment point and the one before assessment point. The SAS, CDR, and MMSE scores were compared between the baseline and the end point.Results: The mean NPI and BPRS scores improved until the fourth week; they significantly decreased at each assessment point compared to the previous one. Afterward, improvements slowed and continued without significant decrease. The median SAS scores significantly decreased at the end point compared to the baseline (P<0.05). The median MMSE score was higher at the end point than at the baseline (P<0.05).Conclusion: This study showed that aripiprazole may be effective and well tolerated for the treatment of psychotic symptoms in patients with DLB. Keywords: aripiprazole, Lewy bodies, dementia, psychotic symptom

Improving somatic health for outpatients with severe mental illness: the development of an intervention

Objective: Patients with severe mental illness (SMI) suffer from more somatic illness than the general population. Possible causes are side effects of neuropsychiatric medication, genetic vulnerability, insufficient health care and lifestyle. This co-morbidity is potentially reversible and augments the costs for health care and diminishes quality of life. Screening on symptoms and risks of somatic diseases and coordination of care are proposed to improve SMI-patients' somatic health status. Methods: A clinical facility was started to improve the somatic health status of patients in an outpatient centre in southern Netherlands. This outpatient centre was added to the specialized care for severe and enduring SMI. The intervention consisted of the inventarisation of side-effects and the detection of gaps in health care provision for 72 patients. This was based on interviewing the patients, laboratory screening, collecting information from their general practitioner and pharmacy. A list was compiled of possible diagnosis and health risks, and a plan of action was made for the treatment. Healthcare consumption, quality of life and general functioning were assessed to analyze cost-effectiveness. Evaluations were performed with the psychiatric care team on the process. Results: Mean annual cost of GP's and medical specialist's consultations were E492. There existed a negative relation between EQ5D VAS and the number of self reported chronic diseases. Conclusion: The authors conclude that the procedure is well feasible, but should be set up in close collaboration with all health care professionals of these patients to make tailor made solutions possible

Investigating susceptibility to bipolar disorder, migraine and epilepsy

Epidemiological and clinical studies demonstrate a high degree of comorbidity between bipolar disorder (BD) and migraine. A relationship between BD and epilepsy is also suggested, with both disorders displaying phenotypically similar symptom profiles. The overall aim of this thesis was to further explore the relationship between BD and the neurological conditions of migraine, and epilepsy, within a large, well-characterised sample of individuals with BD. Data were utilised from the Bipolar Disorder Research Network (BDRN); a large (n>6000) UK sample of individuals with a diagnosis of BD. Lifetime history of migraine and epilepsy were assessed within BDRN using questionnaire and telephone interview methods. Migraine was highly prevalent within the bipolar sample and was found to disproportionately affect those with bipolar II disorder. Bipolar subjects with comorbid migraine experienced a relatively distinct illness profile, with a multivariate model revealing migraine comorbidity to be characterised by an increased risk of suicide attempt and anxiety disorder. Further analysis of the migraine phenotype revealed that observed differences in the clinical presentation of BD associated with migraine were largely associated with the migraine with aura subtype. A high rate of self-reported epilepsy was identified within the bipolar sample and group differences were revealed in the clinical course of the bipolar illness according to the presence of self-reported epilepsy. Multivariate analysis revealed an independent association of a history of suicide attempt with self-reported epilepsy within BD. Findings from this thesis highlight the importance of identifying migraine and epilepsy within BD, and that their recognition and treatment may have a beneficial impact on the course of illness and outcome in BD. This thesis also suggests that these comorbidities may represent a clinically useful subgroup characterised by specific clinical features, and may provide an opportunity for subcategorising for future aetiological studies, potentially facilitating the identification of shared pathophysiological mechanisms

燒炭自殺在東亞國家的流行散佈: 趨勢分析

The Abstract Book can be viewed at: http://www.sop.org.tw/book/download/Summary2013.pdfConference Theme: Focusing on Mental Health, Life Care and Social Network in the ElderlyObjective: Suicides by carbon monoxide poisoning resulting from burning barbecue charcoal reached epidemic levels in Hong Kong and Taiwan within 5 years in the early 2000s. Methods: We used data for suicides by gases other than domestic gas in Hong Kong, Japan, South Korea (1995-2010), Taiwan (1995-2011), and Singapore (1996-2011) to systematically investigate the spread of this method in East Asia. Graphical and joinpoint regression analyses were used to examine suicide trends and Poisson regression analysis to study sex- and age-specific patterns. Results: In 1995/1996, charcoal-burning suicides accounted for < 1% of all suicides in all study countries, except around 5% in Japan, but they increased to account for 14%, 28%, 13%, 4.3%, and 3.4% of all suicides in Hong Kong, Taiwan, Japan, South Korea, and Singapore respectively in 2010. Rises were first seen in Hong Kong in 1999, followed by Singapore in 2000, Taiwan in 2001, Japan in 2003, and South Korea in 2008. There was some evidence for an impact on overall suicide trends in Hong Kong, Taiwan, and Japan (females), but not in Japan (males), South Korea, and Singapore. Rates of change did not differ by sex/age group in Taiwan and Hong Kong but were greatest in young people in Japan and middleaged men and young women in South Korea. Conclusion: Variations in the timing, scale and sex/age pattern of the epidemic appear to be influenced by the media reporting of charcoal-burning suicide, whilst other factors such as the characteristics of the first or first few cases, language and ulture, familiarity and accessibility with the method, and socio-economic conditions may also play a role. Strategies to limit the epidemic spread of new suicide methods include surveillance to enable the early identification of the emergence of such methods, responsible media reporting and restrictions on Internet sites giving technical information about the method