The clinical-familial correlates and naturalistic outcome of panic-disorder-agoraphobia with and without lifetime bipolar II comorbidity

<p>Abstract</p> <p>Background</p> <p>Much of the literature on panic disorder (PD)-bipolar disorder (BP) cormorbidity concerns BP-I. This literature emphasizes the difficulties encountered in pharmacologic treatment and outcome when such comorbidity is present. The present report explores these issues with respect to BP-II.</p> <p>Methods</p> <p>The sample comprised 326 outpatients (aged 34.5 ± 11.5 years old; 222 females) with Diagnostic and Statistical Manual of Mental Disorders 3rd edn, revised (DSM-III-R) PD-agoraphobia; among them 52 subjects (16%) were affected by lifetime comorbidity with BP-II. Patients were evaluated by means of the Structured Clinical Interview for DSM-IV (SCID), the Panic-Agoraphobia Interview, and the Longitudinal Interview Follow-up Examination (Life-Up) and treated according to routine clinical practice at the University of Pisa, Italy, for a period of 3 years. Clinical and course features were compared between subjects with and without BP-II. All patients received the clinicians' choice of antidepressants and, in the case of the subsample with BP-II, mood stabilizers (for example, valproate, lithium) were among the mainstays of treatment.</p> <p>Results</p> <p>In comparison to patients without bipolar comorbidity, those with BP-II showed a significantly greater frequency of social phobia, obsessive-compulsive disorder, alcohol-related disorders, and separation anxiety during childhood and adolescence. Regarding family history, a significantly greater frequency of PD and mood disorders was present among the BP-II. No significant differences were observed in the long-term course of PD or agoraphobic symptoms under pharmacological treatment or the likelihood of spontaneous pharmacological treatment interruptions.</p> <p>Conclusion</p> <p>Although the severity and outcome of panic-agoraphobic symptomatology appear to be similar in patients with and without lifetime bipolar comorbidity, the higher number of concomitant disorders in our PD patients with BP-II does indicate a greater complexity of the clinical picture in this naturalistic study. That such complexity does not seem to translate into poorer response and outcome in those with comorbid soft bipolarity probably reflects the fact that we had brought BP-II under control with mood stabilizers. We discuss the implications of our findings as further evidence for the existence of a distinct anxious-bipolar diathesis.</p

Affective temperaments in tango dancers

Background: Links between affective temperaments and folk culture have been infrequently explored systematically. Creativity and personality and temperament studies, conversely, have reported several associations. Tango is one of the most typical Argentinean folk dance-musical repertoires. The main purpose of this study is to compare affective temperaments between Argentinean professional tango dancers and the general population. Methods: TEMPS-A was administered to a sample of 63 professional tango dancers and 63 comparison subjects from the general population who did not practice tango. Subscale median scores and total median scores with non-parametric statistics were analyzed. Results: Median scores on hyperthymic subscale (p≤0.001), irritable subscale (p=0.05) and total median score were significantly higher among tango dancers compared to controls (p≤0.001). Limitations: Self-report measures were used. A larger sample size would have provided greater statistical power for data analysis. Besides, the naturalistic study design did not allow controlling for other clinical variables and limited the generalization of results to broader populations. Conclusions: Our data adds new evidence for the hypothesis that artistic performance is related to one's temperament. Tango passionata, which has both melancholic and vigorous (including "upbeat") features, seems to impart tango dancers' hyperthymic and irritable temperament features. Our study supports the increasing literature on the validity of utilizing temperament as a sub-affective traits in relation to artistic creativity and performing arts.Fil: Lolich, Maria. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad de Palermo; ArgentinaFil: Vázquez, Gustavo H.. Universidad de Palermo; ArgentinaFil: Zapata, Stephanie. International Mood Center; Estados UnidosFil: Akiskal, Kareen K.. Universidad de Palermo; ArgentinaFil: Akiskal, Hagop S.. International Mood Center; Estados Unido

Estudo de associação entre COMT 158Met e criatividade em sujeitos com transtorno bipolar e controles saudáveis

Background Bipolar disorder (BD) patients have been reported to be associated higher creativity abilities, and recent data tend to support the hypothesis that dopaminergic system that could be associated with creativity. Catechol-O-methyltransferase (COMT) is one of the major enzymes involved in the metabolic degradation of dopamine. The COMT gene polymorphism (rs4680 or Val158Met) Met allele is reported to cause decreased activity of this enzyme in prefrontal cortex and improve performance in several cognitive domains. Objective The objective of this study was to evaluate the influence of Val158Met on creativity in BD type I and healthy controls. Methods Ninety-seven healthy volunteers and 120 BD type I were genotyped for COMT rs4680 and tested for creativity (Barrow Welsh Art Scale – BWAS) and intelligence Wechsler Abbreviated Scale of Intelligence (WASI). Results COMT Met allele positively influenced creativity scores in healthy controls but not in BD subjects during mood episodes and euthymia. The presence of allele Met did not influence IQ scores. No influence of IQ total score on creativity was observed. Limitations control group presented higher IQ scores and euthymic group was under medication use. Discussion Our research suggests positive effect of COMT rs4680 (allele Met) on creativity scores in healthy controls. One possible interpretation is that creativity is more likely to be associated with lesser degrees of bipolarity. The fact that the same results were not observed in BD may be associated to dysfunctions in the dopaminergic system that characterizes this disorder. Further studies with larger samples and other types of BD should explore the role of the dopaminergic system in creativity.Contexto O transtorno bipolar (TB) geralmente é associado a pessoas com maiores habilidades criativas, e dados recentes apontam que o sistema dopaminérgico pode estar relacionado à criatividade. A enzima catecol-O-metiltransferase (COMT) é um dos principais agentes envolvidos na degradação metabólica da dopamina. O gene da COMT apresenta um polimorfismo (rs4680 ou Val158Met) no qual o alelo Met se associa a uma diminuição da atividade enzimática da COMT, levando a um melhor desempenho em testes cognitivos. Objetivo O objetivo deste estudo foi avaliar a influência do polimorfismo funcional Val158Met na criatividade de pacientes com TB e em controles. Métodos Noventa e sete voluntários saudáveis e 120 pacientes com TB tipo I foram genotipados para COMT rs4680 e testados para criatividade (Barrow Welsh Art Scale – BWAS) e inteligência (Wechsler Abbreviated Scale of Intelligence – WASI). Resultados O alelo Met da COMT associou-se a maiores pontuações na escala de criatividade na amostra de controles saudáveis, mas o mesmo não foi observado em pacientes com TB. A presença do alelo Met não influenciou a pontuação de QI em nenhum dos grupos. O grupo controle apresentava QI médio maior que o grupo TB; o grupo TB estava em uso de múltiplas medicações no momento das avaliações. Conclusão Nossos resultados sugerem influência positiva do alelo Met do COMT rs4680 na criatividade de controles saudáveis. Isso sugere que a criatividade seja uma função possivelmente associada a menores graus de bipolaridade do que nos pacientes com TB tipo I. O fato de não termos observado influência do alelo Met nos resultados dos pacientes com TB pode ser justificado pelo fato de que justamente alterações nesse sistema sejam uma das características básicas do TB. É necessário maior número de estudos com maiores tamanhos amostrais para explorar mais detalhadamente o papel do sistema dopaminérgico na criatividade

Gender differences in the relationship between maladaptive behaviours and post-traumatic stress disorder. A study on 900 L’Aquila 2009 earthquake survivors.

Background: Post-traumatic stress disorder (PTSD) represents one of the most frequently psychiatric sequelae to earthquake exposure. Increasing evidence suggests the onset of maladaptive behaviors among veterans and adolescents with PTSD, with specific gender differences emerging in the latter. Aims of the present study were to investigate the relationships between maladaptive behaviours and PTSD in earthquake survivors, besides the gender differences in the type and prevalence of maladaptive behaviours and their association with PTSD. Methods: 900 residents of the town of L’Aquila who experienced the earthquake of April 6th 2009 (Richter Magnitude 6.3) were assessed by means of the Trauma and Loss Spectrum Self Report (TALS-SR).Results: Significantly higher maladaptive behaviour prevalence rates were found among subjects with PTSD. A statistically significant association was found between male gender and the presence of at least one maladaptive behaviour among PTSD survivors. In the latter, significant correlations emerged between maladaptive coping and symptoms of re-experiencing, avoidance and numbing and arousal in women, while only between maladaptive coping and avoidance and numbing in men. Conclusions: Our results show high rates of maladaptive behaviours among earthquake survivors with PTSD suggesting a greater severity among men. Interestingly, post-traumatic stress symptomatology appears to be a better correlate of these behaviours among women than among men, suggesting the need for further studies based on a gender approach

TEMPS-A (Rome): psychometric validation of affective temperaments in clinically well subjects in mid- and south Italy

Our aim was to study the psychometrics and factor structure replicability of the Temperament Evaluation of Memphis, Pisa, Paris and San Diego Autoquestionnaire (TEMPS-A) in its Italian (Rome) Version. The questionnaire is a self-report 110-item measure that postulates five affective temperaments-the depressive, cyclothymic, irritable, hyperthymic, and anxious-which embody both strengths and liabilities along affective reactivity. In Italian, the TEMPS has previously been validated in its original 32-item version, the TEMPS-I (Pisa), one which did not yet include an anxious subscale